顔写真

トミナガ テイジ
冨永 悌二
Teiji Tominaga
所属
役員
職名
理事
学位
  • 医学博士(東北大学)

e-Rad 研究者番号
00217548

経歴 2

  • 1993年4月 ~ 1993年5月
    バロー神経学研究所脳神経外科

  • 1987年2月 ~ 1988年6月
    フィラデルフィア生体膜研究所

学歴 1

  • 東北大学 医学部

    ~ 1982年3月31日

委員歴 41

  • 一般社団法人 日本小児神経外科学会 理事

    2017年5月 ~ 継続中

  • 一般社団法人 日本神経内視鏡学会 理事

    2017年1月 ~ 継続中

  • 一般社団法人 日本脳卒中の外科学会 理事長

    2015年5月 ~ 継続中

  • 一般社団法人 脳神経外科手術と機器学会 理事

    2015年 ~ 継続中

  • 一般社団法人 日本脳ドック学会 理事

    2010年1月 ~ 継続中

  • 一般社団法人 日本神経外傷学会 理事

    2010年 ~ 継続中

  • 一般社団法人 日本脳卒中学会 理事

    2009年3月 ~ 継続中

  • 社団法人日本脳神経外科学会 理事

    2007年4月 ~ 継続中

  • 一般社団法人日本脳神経外科学会 理事

    2007年4月 ~ 継続中

  • 日本脳循環代謝学会 理事

    2006年11月 ~ 継続中

  • 日本脳循環代謝学会 理事

    2006年11月 ~ 継続中

  • 日本頭蓋底外科学会 理事

    2006年1月 ~ 継続中

  • 日本頭蓋底外科学会 理事

    2006年1月 ~ 継続中

  • 日本脊髄障害医学学会 評議員

    2005年11月 ~ 継続中

  • 日本脊髄障害医学学会 評議員

    2005年11月 ~ 継続中

  • 日本脳腫瘍病理学会 理事

    2005年8月 ~ 継続中

  • 日本脳腫瘍病理学会 理事

    2005年8月 ~ 継続中

  • 日本意識障害学会 評議員

    2005年7月 ~ 継続中

  • 日本意識障害学会 評議員

    2005年7月 ~ 継続中

  • 社団法人 日本脳卒中学会 理事

    2005年4月 ~ 継続中

  • 社団法人 日本脳ドック学会 理事

    2005年4月 ~ 継続中

  • 社団法人 日本神経外傷学会 理事

    2005年4月 ~ 継続中

  • 日本小児神経外科学会 理事

    2004年8月 ~ 継続中

  • 日本・定位機能神経外科学会 理事

    2004年4月 ~ 継続中

  • 日本血管内治療学会 評議員

    2004年4月 ~ 継続中

  • 日本神経内視鏡学会 理事

    2004年4月 ~ 継続中

  • 社団法人 日本脳腫瘍の外科学会 理事

    2004年4月 ~ 継続中

  • 日本血管内治療学会 評議員

    2004年4月 ~ 継続中

  • 株式会社 医学書院 編集委員

    2003年12月 ~ 継続中

  • 株式会社 医学書院 編集委員

    2003年12月 ~ 継続中

  • 一般社団法人 日本脳腫瘍の外科学会 理事

    2003年11月 ~ 継続中

  • 社団法人 日本脳卒中の外科学会 理事

    2003年5月 ~ 継続中

  • 日本脊髄外科学会 理事

    2003年4月 ~ 継続中

  • 日本脊髄外科学会 理事

    2003年4月 ~ 継続中

  • 日本てんかん外科学会 世話人

    2001年4月 ~ 継続中

  • アクテリオンファーマシューティカルズジャパン 医学専門家

    2008年7月 ~ 2012年3月

  • アクテリオンファーマシューティカルズジャパン 医学専門家

    2008年7月 ~ 2012年3月

  • 日本間脳下垂体腫瘍学会 理事

    2006年2月 ~ 2008年3月

  • 日本間脳下垂体腫瘍学会 理事

    2006年2月 ~ 2008年3月

  • 日本NO学会 評議員

    2004年4月 ~ 2008年3月

  • 日本NO学会 評議員

    2004年4月 ~ 2008年3月

︎全件表示 ︎最初の5件までを表示

所属学協会 33

  • 東北脳血管障害研究会(2003/12- 世話人)

  • 東北脊髄外科研究会(2006/02- 世話人代表)

  • 社団法人日本脳神経外科学会東北支部(2003/09-2009/01 支部長)

  • 日本脳腫瘍病理学会(2005/08- 理事)

  • 日本脊髄障害医学学会(2005/11- 評議員)

  • 日本小児神経外科学会(2004/08- 理事)

  • 日本脳神経CI学会(2004/04- 世話人)

  • 日本脳神経外科光線力学研究会(2007/03- 運営委員)

  • 日本間脳下垂体腫瘍学会(2006/02-2008/03 理事)

  • 社団法人日本脳神経外科学会(2007/04- 理事)

  • 日本意識障害学会(2005/07- 評議員)

  • 日本ヒト脳機能マッピング学会(2005/04- 運営委員)

  • 社団法人 日本神経外傷学会(2005/04- 理事)

  • 脳神経外科手術と機器学会(2005/04- 運営委員)

  • 日本老年脳神経外科学会(2004/04- 世話人)

  • 日本分子脳神経外科学会(2004/04- シニア世話人)

  • 社団法人 日本脳ドック学会(2005/04- 理事)

  • 社団法人 日本脳卒中の外科学会(2003/05- 理事)

  • 社団法人 日本脳卒中学会(2005/04- 理事)

  • 日本脳神経外科コンピュータ研究会(2003/05-2009/01 世話人)

  • 日本脳神経外科コングレス(2003/05- 運営委員)

  • 日本脳循環代謝学会(2006/11- 理事)

  • 社団法人 日本脳腫瘍の外科学会(2004/04- 理事)

  • 東北脳腫瘍研究会(2003/03- 世話人代表)

  • 日本てんかん外科学会(2001/04- 世話人)

  • 日本定位・機能神経外科学会(2004/04- 運営委員)

  • 日本脊髄外科学会(2003/04- 理事)

  • 日本生体磁気学会(2004/04- 評議員)

  • 日本頭蓋底外科学会(2006/01- 理事)

  • 日本神経内視鏡学会(2004/04- 理事)

  • 日本血管内治療学会(2004/04- 評議員)

  • 日本NO学会(2004/04-2008/03 評議員)

  • スパズムシンポジウム(2004/04- 世話人)

︎全件表示 ︎最初の5件までを表示

研究キーワード 1

  • 脳神経外科

研究分野 1

  • ライフサイエンス / 脳神経外科学 /

論文 552

  1. Incidence of initial spinal metastasis in glioblastoma patients and the importance of spinal screening using MRI. 国際誌 査読有り

    Ichiyo Shibahara, Ryuta Saito, Yoshinari Osada, Masayuki Kanamori, Yukihiko Sonoda, Toshihiro Kumabe, Shunji Mugikura, Mika Watanabe, Teiji Tominaga

    Journal of neuro-oncology 141 (2) 337-345 2019年1月

    DOI: 10.1007/s11060-018-03036-4  

    ISSN:0167-594X

    詳細を見る 詳細を閉じる

    PURPOSE: Intracranial glioblastomas with simultaneous spinal lesions prior to chemoradiation therapy or craniotomy, defined as initial spinal metastasis, are not well understood. Herein, we investigated intracranial glioblastoma and demonstrated the importance of spinal screening using gadolinium enhanced spinal magnetic resonance imaging (Gd-MRI). METHODS: Consecutive adult patients with intracranial glioblastoma were treated between 2010 and 2014 and received spinal screening using Gd-MRI. Spinal screening was performed regardless of spine-related symptoms, and patients presenting with and without initial spinal metastasis (spinal and non-spinal groups, respectively) were compared based on patient demographics, tumor characteristics, radiological and molecular features, and overall survival (OS). RESULTS: During the study period, 116 glioblastoma cases were treated and 87 of these (76%) underwent spinal screening. Among these patients, 11 (13%) were included in the spinal group, and 76 (87%) were included in the non-spinal group. All patients of the spinal group were free of symptoms related to spinal lesions. Compared with the non-spinal group, intracranial lesions of the spinal group presented higher incidences of intracranial dissemination and were located at subventricular zones (P = 0.0012 and 0.020, respectively). MIB-1 labeling index, molecular alterations such as IDH1 mutation, TERT promoter mutation, and immunoreactivity of ATRX and MGMT did not differ between two groups. OS was significantly shorter in the spinal group than in the non-spinal group (P = 0.0054). CONCLUSIONS: This study revealed a relatively high incidence of spinal metastasis. A subset of glioblastoma patients benefited from spinal screening, through which early detection of asymptomatic spinal metastasis was achieved.

  2. Early BBB breakdown and subacute inflammasome activation and pyroptosis as a result of cerebral venous thrombosis. 査読有り

    Rashad S, Niizuma K, Sato-Maeda M, Fujimura M, Mansour A, Endo H, Ikawa S, Tominaga T

    Brain research 1699 54-68 2018年11月

    DOI: 10.1016/j.brainres.2018.06.029  

    ISSN:0006-8993

  3. Biphasic Development of Focal Cerebral Hyperperfusion After Revascularization Surgery for Adult Moyamoya Disease Associated With Autosomal Dominant Polycystic Kidney Disease. 国際誌 査読有り

    Tashiro R, Fujimura M, Endo H, Endo T, Niizuma K, Tominaga T

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 27 (11) 3256-3260 2018年11月

    DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.024  

    ISSN:1052-3057

  4. Growth of Thrombosed Cerebral Venous Varix Following Resection of Cerebral Arteriovenous Malformation: Case Report with Pathologic Consideration. 査読有り

    Haryu S, Endo H, Endo T, Sato K, Fujimura M, Tominaga T

    World neurosurgery 119 274-277 2018年11月

    DOI: 10.1016/j.wneu.2018.08.072  

    ISSN:1878-8750

  5. Hemorrhagic Moyamoya Disease : A Recent Update. 査読有り

    Fujimura M, Tominaga T

    Journal of Korean Neurosurgical Society 2018年11月

    DOI: 10.3340/jkns.2018.0101  

    ISSN:2005-3711

  6. Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 Levels as a Biomarker of Acute Intracerebral Hemorrhage. 査読有り

    Inoue T, Ishida T, Inoue T, Saito A, Ezura M, Uenohara H, Fujimura M, Sato K, Endo T, Omodaka S, Endo H, Niizuma K, Tominaga T

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 28 (2) 490-494 2018年11月

    出版者・発行元:None

    DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.027  

    ISSN:1052-3057

  7. Spontaneous Development of Encapsulated Subdural Hematoma in the Posterior Cranial Fossa after Cardiac Surgery: A Case Report. 査読有り

    Kochi R, Mino M, Sonobe S, Yoshida M, Tominaga T

    NMC case report journal 5 (4) 87-90 2018年10月

    DOI: 10.2176/nmccrj.cr.2017-0230  

  8. Effects of a Novel Piezo Actuator-Driven Pulsed Water Jet System on Residual Kidney after Partial Nephrectomy in a Rat Model. 査読有り

    Kamiyama Y, Yamashita S, Nakagawa A, Fujii S, Goto T, Mitsuzuka K, Ito A, Abe T, Tominaga T, Arai Y

    Urology 2018年10月

    DOI: 10.1016/j.urology.2018.10.014  

    ISSN:0090-4295

  9. Stress-induced tRNA cleavage and tiRNA generation in rat neuronal PC12 cells. 国際誌 査読有り

    Alaa Elkordy, Eikan Mishima, Kuniyasu Niizuma, Yasutoshi Akiyama, Miki Fujimura, Teiji Tominaga, Takaaki Abe

    Journal of neurochemistry 146 (5) 560-569 2018年9月

    DOI: 10.1111/jnc.14321  

    ISSN:0022-3042

    詳細を見る 詳細を閉じる

    Transfer RNA (tRNA) plays a role in stress response programs involved in various pathological conditions including neurological diseases. Under cell stress conditions, intracellular tRNA is cleaved by a specific ribonuclease, angiogenin, generating tRNA-derived fragments or tRNA-derived stress-induced RNA (tiRNA). Generated tiRNA contributes to the cell stress response and has potential cell protective effects. However, tiRNA generation under stress conditions in neuronal cells has not been fully elucidated. To examine angiogenin-mediated tiRNA generation in neuronal cells, we used the rat neuronal cell line, PC12, in combination with analysis of SYBR staining and immuno-northern blotting using anti-1-methyladenosine antibody, which specifically and sensitively detects tiRNA. Oxidative stress induced by arsenite and hydrogen peroxide caused tRNA cleavage and tiRNA generation in PC12 cells. We also demonstrated that oxygen-glucose deprivation, which is an in vitro model of ischemic-reperfusion injury, induced tRNA cleavage and tiRNA generation. In these stress conditions, the amount of generated tiRNA was associated with the degree of morphological cell damage. Time course analysis indicated that generation of tiRNA was prior to severe cell damage and cell death. Angiogenin over-expression did not influence the amount of tiRNA in normal culture conditions; however, it significantly increased tiRNA generation induced by cell stress conditions. Our findings show that angiogenin-mediated tiRNA generation can be induced in neuronal cells by different cell stressors, including ischemia-reperfusion. Additionally, detection of tiRNA could be used as a potential cell damage marker in neuronal cells. Cover Image for this issue: doi: 10.1111/jnc.14191.

  10. Continuous Minor Bleeding from Tumor Surface in Patients with Craniopharyngiomas: Case Series of Nonobstructive Hydrocephalus. 査読有り

    Shoji T, Kawaguchi T, Ogawa Y, Watanabe M, Fujimura M, Tominaga T

    Journal of neurological surgery. Part A, Central European neurosurgery 79 (5) 436-441 2018年9月

    DOI: 10.1055/s-0038-1646957  

    ISSN:2193-6315

  11. SMART (stroke-like migraine attacks after radiation therapy) syndrome responded to steroid pulse therapy: Report of a case and review of the literature. 国際誌 査読有り

    Wenting Jia, Ryuta Saito, Masayuki Kanamori, Naoya Iwabuchi, Masaki Iwasaki, Teiji Tominaga

    eNeurologicalSci 12 1-4 2018年9月

    DOI: 10.1016/j.ensci.2018.05.003  

    詳細を見る 詳細を閉じる

    This report presents a case of stroke-like migraine attacks after radiation therapy (SMART) syndrome in a 31-year-old man in whom symptoms and radiological findings resolved with steroid pulsed therapy and reviews the literatures with special emphasis on the use of steroids against SMART syndrome. The patient had a past history of left temporal anaplastic astrocytoma and was treated with surgery followed by local 72 Gy radiation therapy and chemotherapy using Nimustine Hydrochloride. Four years after the surgery, he was suffering from subacute progressing symptoms of headache, right hemianopia, right hemiparesis and aphasia from 2 to 4 days before admission to our hospital. At first he was diagnosed as symptomatic epilepsy but after extensive examination, the final diagnosis was SMART syndrome. His symptoms soon improved with steroid pulse therapy. In the literature, steroid pulse therapy is not necessarily a standard of care for SMART syndrome, but it seemed to decrease the need of biopsy. As the lesions of SMART syndrome require differential diagnosis from recurrences, biopsy was performed in some cases. However, lack of benefit and possible detriment is reported with biopsy of SMART lesions. Through this experience we suggest that steroid pulse therapy may provide speedy recovery from symptoms, and it should be considered before other invasive investigations or treatments.

  12. Metabolomic Analysis of Mouse Brain after a Transient Middle Cerebral Artery Occlusion by Mass Spectrometry Imaging. 査読有り

    Abe T, Niizuma K, Kanoke A, Saigusa D, Saito R, Uruno A, Fujimura M, Yamamoto M, Tominaga T

    Neurologia medico-chirurgica 58 (9) 384-392 2018年9月

    DOI: 10.2176/nmc.oa.2018-0054  

    ISSN:0470-8105

  13. A refined model of chronic cerebral hypoperfusion resulting in cognitive impairment and a low mortality rate in rats. 査読有り

    Mansour A, Niizuma K, Rashad S, Sumiyoshi A, Ryoke R, Endo H, Endo T, Sato K, Kawashima R, Tominaga T

    Journal of neurosurgery 1-11 2018年9月

    DOI: 10.3171/2018.3.JNS172274  

    ISSN:0022-3085

  14. Surgical strategy for an adult patient with a catecholamine-producing ganglioneuroblastoma and a cerebral aneurysm: a case report. 国際誌 査読有り

    Kumata H, Nishimura R, Nakanishi C, Inoue C, Tezuka Y, Endo H, Miyagi S, Tominaga T, Unno M, Kamei T

    Surgical case reports 4 (1) 119-119 2018年9月

    DOI: 10.1186/s40792-018-0529-x  

  15. [Safety and Efficacy of Keishi-Bukuryo-Gan in Patients with Spontaneous Intracerebral Hemorrhage during the Acute Period:CT Image-Based Analysis of the Clearance of Hematoma]. 査読有り

    Osawa SI, Endo H, Kawamura T, Tominaga T

    No shinkei geka. Neurological surgery 46 (9) 763-770 2018年9月

    DOI: 10.11477/mf.1436203810  

    ISSN:0301-2603

  16. Paradoxical Association of Symptomatic Local Vasogenic Edema with Global Cerebral Hypoperfusion after Direct Revascularization Surgery for Adult Moyamoya Disease. 国際誌 査読有り

    Tashiro R, Fujimura M, Mugikura S, Niizuma K, Endo H, Endo T, Tominaga T

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 27 (8) e172-e176 2018年8月

    DOI: 10.1016/j.jstrokecerebrovasdis.2018.03.002  

    ISSN:1052-3057

  17. Intracellular S1P Levels Dictate Fate of Different Regions of the Hippocampus following Transient Global Cerebral Ischemia 査読有り

    Sherif Rashad, Kuniyasu Niizuma, Daisuke Saigusa, Xiaobo Han, Mika Sato-Maeda, Ritsumi Saito, Akira Uruno, Miki Fujimura, Shuntaro Ikawa, Masayuki Yamamoto, Teiji Tominaga

    Neuroscience 384 188-202 2018年8月1日

    出版者・発行元:Elsevier Ltd

    DOI: 10.1016/j.neuroscience.2018.05.015  

    ISSN:1873-7544 0306-4522

    詳細を見る 詳細を閉じる

    Sphingosine-1-phosphate (S1P) is a sphingolipid molecule produced by the action of sphingosine kinases (SphK) on sphingosine. It possesses various intracellular functions through its interactions with intracellular proteins or via its action on five G-protein-coupled cell membrane receptors. Following transient global cerebral ischemia (tGCI), only the CA1 subregion of the hippocampus undergoes apoptosis. In this study, we evaluated S1P levels and S1P-processing enzyme expression in different hippocampal areas following tGCI in rats. We found that S1P was upregulated earlier in CA3 than in CA1. This was associated with upregulation of SphK1 in both regions however, SphK2 was downregulated quickly in CA3. S1P lyase was also downregulated in CA3, but not in CA1. Spinster 2, the S1P exporter, was upregulated early in both regions, but was quickly downregulated in CA3. Together, these effects explain the variable levels of S1P in the CA1 and CA3 areas and indicate that S1P levels play a role in the preferential resistance of the CA3 subregion to tGCI-induced ischemia. FTY720 did not improve neuronal survival in the CA1 subregion, indicating that these effects were due to intracellular S1P accumulation. In conclusion, the findings suggest that intracellular S1P levels affect neuronal cell fate following tGCI.

  18. Lumbar tap-induced subarachnoid hemorrhage in a case of spinal epidural arteriovenous fistula. 査読有り

    Kajitani T, Endo T, Inoue T, Sato K, Matsumoto Y, Tominaga T

    Journal of neurosurgery. Spine 1-6 2018年8月

    DOI: 10.3171/2018.3.SPINE171343  

    ISSN:1547-5654

  19. [Surgical Planning for a Giant Pituitary Adenoma Based on Evaluation of the Fine Feeding System and Angioarchitecture:A Case Report]. 査読有り

    Aburakawa D, Ogawa Y, Sato K, Niizuma K, Tominaga T

    No shinkei geka. Neurological surgery 46 (8) 691-697 2018年8月

    DOI: 10.11477/mf.1436203795  

    ISSN:0301-2603

  20. Water Veil Effect to Control Splashing from the Pulsed Water Jet Device: Minimizing the Potential Risk of Dissemination Using Surgical Aspirators. 国際誌 査読有り

    Atsushi Nakayashiki, Tomohiro Kawaguchi, Atsuhiro Nakagawa, Motohiko Sato, Fusako Mochizuki, Toshiki Endo, Teiji Tominaga

    Journal of neurological surgery. Part A, Central European neurosurgery 79 (4) 309-315 2018年7月

    DOI: 10.1055/s-0037-1608836  

    ISSN:2193-6315

    詳細を見る 詳細を閉じる

    OBJECTIVE:  Maximum resection with minimum damage to normal structures is required for a better clinical outcome. Several efficient surgical devices such as the Cavitron ultrasonic surgical aspirator are available. Our group developed the actuator-driven pulsed water jet (ADPJ) to dissect soft tissue with vessel preservation. Although these devices are very effective for resection, tumor seeding is a potential risk. The present study investigated the control of splashing during ADPJ use. We demonstrate the effect of additional water flow around the instrument tip to veil the splashing. METHODS:  Pulsed water jet was ejected from the tip of the ADPJ nozzle. Effects of ADPJ parameters such as input voltage, suction pressure, and distance between the nozzle and the target (standoff distance) on the amount of splashing were analyzed. Methylene blue solution was ejected on photo paper, gelatin brain phantom, and porcine brain harvested and subsequently immersed into physiologic saline to quantify the amount of splashing. RESULTS:  High-input voltage and a long standoff distance had significant correlations with large amounts of splashing (r > 0.5; p < 0.01). However, suction pressure had no correlation (r = 0.23). Additional water flow combined with the ADPJ decreased the amount of splashing. A high-speed camera recording revealed that the additional water flow formed a water veil that prevented droplet dispersion, as confirmed with experiments using the brain phantom and porcine brain, in which the irregularity and elasticity are specific. CONCLUSIONS:  The veil effect of additional water flow is important to reduce splashing during ADPJ use and can minimize the potential risk of dissemination and enhance the safety of the ADPJ.

  21. Indications for salvage surgery during treatment for intracranial germ cell tumors. 国際誌 査読有り

    Masayuki Kanamori, Toshihiro Kumabe, Mika Watanabe, Masashi Chonan, Ryuta Saito, Yoji Yamashita, Yoshikazu Ogawa, Yukihiko Sonoda, Teiji Tominaga

    Journal of neuro-oncology 138 (3) 601-607 2018年7月

    DOI: 10.1007/s11060-018-2827-3  

    ISSN:0167-594X

    詳細を見る 詳細を閉じる

    This study retrospectively reviewed our single institute experience to clarify the optimal indication and timing of salvage surgery. Retrospective analysis of 159 consecutive cases with germ cell tumors identified 20 cases with salvage surgery. These cases were classified based on the radiological response to neoadjuvant treatment before salvage surgery into increase (growing group, five cases), no change (stable group, seven cases), and decrease (shrinkage group, eight cases) in tumor size. Changes in tumor markers, histological findings, and the pattern of failure after salvage surgery were reviewed. Growing teratoma syndrome (GTS) is defined as enlargement of tumor consisting of mature teratoma after chemotherapy with normalization of tumor markers. In growing group, two cases presented GTS, whereas other three cases did not fulfill the criteria for GTS. All cases in stable and shrinkage group had elevated levels of tumor markers at presentation and decreased levels after neoadjuvant treatment. Histologically, sparse components of mature teratoma with extensive fibrosis were found in cases with GTS and seven of eight cases in shrinkage group, whereas mature teratoma without fibrosis was found in six of seven cases in stable group. Six cases recurred after salvage surgery. We identified three factors as risks for recurrence after salvage surgery, as follows: (1) growing lesion which did not fulfill the criteria for GTS, (2) non-normalized level of tumor marker before salvage surgery, and (3) residual germinoma component. In conclusion, salvage surgery is recommended for patients with GTS, or with normalized tumor markers in stable or shrinkage group.

  22. Bilateral Upper Cerebellar Hemorrhage Due to Pial Arteriovenous Fistula and Its Pathophysiological Insight 査読有り

    Yosuke Akamatsu, Toshiaki Hayashi, Kenichi Sato, Hiroshi Karibe, Motonobu Kameyama, Teiji Tominaga

    World Neurosurgery 115 388-392 2018年7月1日

    出版者・発行元:Elsevier Inc.

    DOI: 10.1016/j.wneu.2018.05.010  

    ISSN:1878-8769 1878-8750

    詳細を見る 詳細を閉じる

    Objectives: Bilateral upper cerebellar hemorrhage is extremely rare clinical entity but relatively known as postoperative neurosurgical complication with as-yet unknown etiology. Here, we report a case of bilateral upper cerebellar hemorrhage due to pial arteriovenous fistula (pAVF) and discuss the possible pathophysiology of this bleeding pattern. Case Description: A 4-year-old boy who was previously healthy presented with a sudden onset of headache, vomiting, and gait instability. Computed tomography revealed atypical bleeding in the sulci of bilateral cerebellar hemispheres facing the tentorium. Despite the symmetric distribution of bleeding, T2-weighted magnetic resonance imaging showed flow void adjacent to the lateral margin of bleeding. Diffusion-weighted magnetic resonance imaging showed increased apparent diffusion coefficient value in the hemorrhagic lesion, suggesting vasogenic edema. Vertebral angiogram revealed a pAVF, which was fed by the hemispheric branch of superior cerebellar artery. It drained via the venous varix, inferiorly into the tortuous and engorged inferior hemispheric vein, indicating venous congestion. On the venous phase of vertebral angiogram, the superior vermian vein, which is one of the main drainers of the superior part of the cerebellum, was not opacified. Transarterial n-butyl-2-cyanoacrylate embolization was performed to prevent rebleeding, and the pAVF was treated successfully. The patient's follow-up has been uneventful for 3 years. Conclusions: We reported an extremely rare case of cerebellar pAVF presenting as bilateral upper cerebellar hemorrhage. Severe congestion of upper cerebellar veins seemed to be a possible pathophysiology of this specific bleeding pattern.

  23. Application of actuator-driven pulsed water jet for coronary artery bypass grafting: assessment in a swine model 査読有り

    Tomoyuki Suzuki, Shunsuke Kawamoto, Atsuhiro Nakagawa, Toshiki Endo, Teiji Tominaga, Masatoshi Akiyama, Osamu Adachi, Kiichiro Kumagai, Yoshikatsu Saiki

    Journal of Artificial Organs 21 (2) 247-253 2018年6月1日

    出版者・発行元:Springer Tokyo

    DOI: 10.1007/s10047-017-1008-z  

    ISSN:1619-0904 1434-7229

    詳細を見る 詳細を閉じる

    Actuator-driven pulsed water-jet (ADPJ) dissection is an emerging surgical method for dissecting tissue without heat and mechanical injury to vessels. We elucidated the mechanical properties of the piezo ADPJ and evaluated its usefulness and safety in coronary artery bypass grafting procedures. The relationship between the input voltage (10–100 V) and peak pressure of the pulsed water jet was evaluated. The tissue strengths of swine internal thoracic and coronary arteries and the surrounding tissues were measured to assure tissue-selective dissection. Internal thoracic arteries were harvested by conventional electric cautery and the water jet in four swine, and eight coronary arteries surrounded by myocardium were attempted to be exposed with the water jet. The dissected specimens were histologically evaluated. The peak pressure of the pulsed water jet was positively correlated with the input voltage (R2 = 0.9984, P &lt 0.001). The breaking strengths of the target vessels (internal thoracic and coronary arteries) and the surrounding tissues were significantly different (P = 0.002 and P &lt 0.001, respectively). Histologic examination revealed that internal thoracic arteries were isolated with less heat damage using the pulsed water jet (P = 0.002) compared with electric cautery, and coronary arteries also were dissected without apparent histologic damage. ADPJ has the possibility of assuring tissue selectivity among the internal thoracic and coronary arteries. The results also indicated that the use of ADPJ may enhance safe procedures to harvest grafts during coronary artery bypass grafting.

  24. Cervical Periosteal Chondroma Causing Spinal Cord or Nerve Compression: 2 Case Reports and Literature Review 査読有り

    Tomoo Inoue, Yukoh Ohara, Tadaaki Niiro, Toshiki Endo, Teiji Tominaga, Jyun-ichi Mizuno

    World Neurosurgery 114 99-105 2018年6月1日

    出版者・発行元:Elsevier Inc.

    DOI: 10.1016/j.wneu.2018.03.052  

    ISSN:1878-8769 1878-8750

    eISSN:1878-8769

    詳細を見る 詳細を閉じる

    Background: Chondroma is a rare benign cartilaginous tumor that originates in chondrocytes and is commonly seen in the long bones however, it infrequently occurs in the cervical spine. Case Descriptions: We report 2 patients with cervical periosteal chondroma that originated in the C2 vertebral body and C1 lamina as extramedullary tumors. The first patient was a 28-year-old man who presented with right upper extremity weakness and numbness. Cervical radiography revealed a bony tumor with evidence of severe spinal cord compression. The second patient was a 26-year-old woman with left occipital neuralgia. Cervical radiography demonstrated a bony tumor arising from the left C1 lateral mass that compressed the C2 nerve root. Both patients underwent surgical removal of the bony tumors, which were diagnosed as periosteal chondroma. Conclusions: The authors herein summarized 16 previous reports of cervical chondroma and compared the clinical courses and treatments. Recommended treatment included maximal surgical resection, especially when significant compression of the cervical cord and signal abnormality within the cord was observed. Annual postoperative follow-up is mandatory to ensure proper neurologic improvement.

  25. Posterior cerebral artery stenosis and posterior circulation revascularization surgery in pediatric patients with moyamoya disease 査読有り

    Tomomi Kimiwada, Toshiaki Hayashi, Reizo Shirane, Teiji Tominaga

    Journal of Neurosurgery: Pediatrics 21 (6) 632-638 2018年6月1日

    出版者・発行元:American Association of Neurological Surgeons

    DOI: 10.3171/2018.1.PEDS17367  

    ISSN:1933-0715 1933-0707

    詳細を見る 詳細を閉じる

    OBJECTIVE Some pediatric patients with moyamoya disease (MMD) present with posterior cerebral artery (PCA) stenosis before and after anterior circulation revascularization surgery and require posterior circulation revascularization surgery. This study evaluated the factors associated with PCA stenosis and assessed the efficacy of posterior circulation revascularization surgery, including occipital artery (OA)-PCA bypass, in pediatric patients with MMD. METHODS The presence of PCA stenosis before and after anterior circulation revascularization surgery and its clinical characteristics were investigated in 62 pediatric patients (&lt 16 years of age) with MMD. RESULTS Twenty-three pediatric patients (37%) with MMD presented with PCA stenosis at the time of the initial diagnosis. A strong correlation between the presence of infarction and PCA stenosis before anterior revascularization was observed (p &lt 0.001). In addition, progressive PCA stenosis was observed in 12 patients (19.4%) after anterior revascularization. The presence of infarction and a younger age at the time of initial diagnosis were risk factors for progressive PCA stenosis after anterior revascularization (p &lt 0.001 and p = 0.002, respectively). Posterior circulation revascularization surgery, including OA-PCA bypass, was performed in 9 of the 12 patients with progressive PCA stenosis, all of whom showed symptomatic and/or radiological improvement. CONCLUSIONS PCA stenosis is an important clinical factor related to poor prognosis in pediatric MMD. One should be aware of the possibility of progressive PCA stenosis during the postoperative follow-up period and consider performing posterior circulation revascularization surgery.

  26. [Two Craniotomies with Retained Cotton Patties:Is Their Retrieval Necessary?] 査読有り

    Shimizu S, Mano Y, Kumabe T, Tominaga T, Nakayama K, Yamamoto I

    No shinkei geka. Neurological surgery 46 (6) 529-533 2018年6月

    DOI: 10.11477/mf.1436203763  

    ISSN:0301-2603

  27. Circumferential Wall Enhancement on Magnetic Resonance Imaging is Useful to Identify Rupture Site in Patients with Multiple Cerebral Aneurysms. 査読有り

    Omodaka S, Endo H, Niizuma K, Fujimura M, Endo T, Sato K, Sugiyama SI, Inoue T, Tominaga T

    Neurosurgery 82 (5) 638-644 2018年5月

    DOI: 10.1093/neuros/nyx267  

    ISSN:0148-396X

  28. Clinical Features of Precocious, Synchronous, and Metachronous Brain Metastases and the Role of Tumor Resection. 国際誌 査読有り

    Ichiyo Shibahara, Masayuki Kanamori, Takashi Watanabe, Akihiro Utsunomiya, Hiroyoshi Suzuki, Ryuta Saito, Yukihiko Sonoda, Hidefumi Jokura, Hiroshi Uenohara, Teiji Tominaga

    World neurosurgery 113 e1-e9-e9 2018年5月

    DOI: 10.1016/j.wneu.2017.10.145  

    ISSN:1878-8750

    詳細を見る 詳細を閉じる

    OBJECTIVE: The purpose of this study was to clarify clinical features, outcomes, and the role of tumor resection in precocious, synchronous, and metachronous brain metastases. METHODS: Brain metastases were found before primary cancer detection in the precocious group, within 2 months after primary cancer detection in the synchronous group, and 2 months or later after primary cancer detection in the metachronous group. RESULTS: Of 471 patients with brain metastases, 93 (20%) were included in the precocious group, 76 (16%) in the synchronous group, and 302 (64%) in the metachronous group. The precocious group tended to be symptomatic, show a low Karnofsky Performance Status, and have a large single tumor, infrequent extracranial metastases, and frequent tumor resection compared with the other 2 groups. There were no differences in overall survival from the detection of brain metastases among the 3 groups in univariate and multivariate analyses. Of 471 cases, 97 (21%) underwent surgeries. Among this surgical cohort, overall survival from surgery was significantly shorter in the precocious group than in the metachronous group (P = 0.039). After adjustment for age, sex, tumor size, primary cancer, and the Graded Prognostic Assessment score, the hazard ratio for metachronous metastases was 0.52 (confidence interval, 0.29-0.95; P = 0.035). CONCLUSIONS: The timing of brain metastasis diagnosis is not a modifiable factor but affects patient demographics and treatment strategies. In particular, the precocious group is a unique subset of brain metastases that require special consideration during clinical decision making.

  29. Mid-term prognosis of non-functioning pituitary adenomas with high proliferative potential: really an aggressive variant? 査読有り

    Yoshikazu Ogawa, Hidefumi Jokura, Kuniyasu Niizuma, Teiji Tominaga

    Journal of Neuro-Oncology 137 (3) 543-549 2018年5月1日

    出版者・発行元:Springer New York LLC

    DOI: 10.1007/s11060-017-2740-1  

    ISSN:1573-7373 0167-594X

    詳細を見る 詳細を閉じる

    Pituitary adenomas with high proliferation rate and rapid growth are well known, but the clinical characteristics, prognosis, and treatment algorithm remain unclear. The clinical characteristics and mid-term prognosis of patients with non-functioning pituitary adenomas with high proliferative potential were retrospectively investigated. This study identified 53 patients with Ki-67 labeling index of &gt  3% among 845 patients with non-functioning pituitary adenoma (6.3%) initially treated by surgery. Prophylactic treatment was not applied for patients with residual tumor, but salvage treatment was performed if tumor progression was identified within the follow-up period. Twenty-two patients remained progression-free, whereas 31 patients suffered tumor progression. Comparison of gross total removal (n = 22) and non-total removal (n = 31) groups showed significantly longer progression-free period in the former group (P &lt 0.001). As salvage treatment gamma knife radiosurgery was applied for 11 patients resulting in 10 patients remaining progression-free and regrowth in 1 patient. Fractionated irradiation was applied for 10 patients, resulting in 2 patients remaining progression-free, deaths in 5 patients including 3 of transformation to pituitary carcinoma, dementia in 1 patient caused by frontal lobe dysfunction, and progression in 2 patients requiring additional surgery and gamma knife radiosurgery. Temozolomide was administered in 2 patients, resulting in deaths in both patients including 1 transformation to pituitary carcinoma. Total removal and gamma knife radiosurgery can result in good outcome. However, the prognosis is extremely poor for patients inadequate for gamma knife radiosurgery. Development of new salvage treatments is essential.

  30. Marked effectiveness of low-dose oral methotrexate for steroid-resistant idiopathic hypertrophic pachymeningitis: Case report 査読有り

    Hiroki Uchida, Yoshikazu Ogawa, Teiji Tominaga

    Clinical Neurology and Neurosurgery 168 30-33 2018年5月1日

    出版者・発行元:Elsevier B.V.

    DOI: 10.1016/j.clineuro.2018.02.035  

    ISSN:1872-6968 0303-8467

    詳細を見る 詳細を閉じる

    Idiopathic hypertrophic pachymeningitis (HP) is a rare clinical entity characterized by thickening of the dura mater without obvious underlying disease. High-dose steroid therapy is considered to be the first line for idiopathic HP, but half of patients show resistance for steroid therapy and suffer progressive clinical course. We describe low-dose methotrexate (MTX) administration for recurrent and steroid-resistant idiopathic HP resulting in noticeable improvement without severe adverse effects. A 51-year-old Japanese woman with dermatomyositis first presented with right retro-orbital pain caused by dural thickening in the sella and upper clivus involving the right trigeminal nerve, which was diagnosed as idiopathic HP by transsphenoidal biopsy. High-dose methylprednisolone therapy led to remission, and she remained healthy with low-dose dexamethasone. Three years after the initial therapy she presented with right facial nerve and lower cranial nerve palsies caused by diffuse and significant dural thickening in the posterior cranial fossa. Second highdose methylprednisolone therapy was introduced, but the effect was transient and she suffered aspiration pneumonia. Low-dose oral MTX therapy was begun, and her symptoms were almost resolved and dural thickening was remarkably improved without severe adverse effects. Lowdose MTX may be a more appropriate choice for idiopathic HP than steroid administration. Randomized controlled clinical trials are now needed.

  31. Endovascular Treatments in Combination with Extracranial-Intracranial Bypass for Complex Intracranial Aneurysms 査読有り

    Kenichi Sato, Hidenori Endo, Miki Fujimura, Toshiki Endo, Yasushi Matsumoto, Hiroaki Shimizu, Teiji Tominaga

    World Neurosurgery 113 e747-e760 2018年5月1日

    出版者・発行元:Elsevier Inc.

    DOI: 10.1016/j.wneu.2018.02.143  

    ISSN:1878-8769 1878-8750

    詳細を見る 詳細を閉じる

    Background: Although most intracranial aneurysms can be treated with microsurgery or endovascular procedure alone, a subset of aneurysms may require a combined approach. The purpose of this study was to assess the efficacy of endovascular interventions combined with bypass surgery for the treatment of complex intracranial aneurysms. Methods: We retrospectively reviewed medical records from a prospectively maintained patient database to identify patients who underwent endovascular treatment of an intracranial aneurysm at our institutes between 2007 and 2017. We recruited patients who received a preplanned combination of endovascular treatment and extracranial-intracranial bypass surgery. Results: Forty-four patients (44 aneurysms) were treated with a combined approach. Twenty-four patients presented with subarachnoid hemorrhage. Treatment strategies included endovascular parent artery occlusion with the bypass surgery to restore cerebral blood flow (n = 12), endovascular trapping with bypass surgery to isolate incorporated branches (n = 12), and intra-aneurysmal coil embolization with bypass surgery to isolate incorporated branches (n = 20). During a mean period of 35.6 months, follow-up catheter angiography was performed in 35 of 44 patients (79.5%) and demonstrated complete aneurysm obliteration in 29 patients (82.9%) and bypass patency in 33 (94.3%). The postoperative aneurysm-related mortality and morbidity rates were 6.8% and 13.6%, respectively. Conclusions: Combined endovascular and surgical bypass procedures are useful for the treatment of complex intracranial aneurysms when conventional surgical or endovascular techniques are not feasible and show acceptable rates of morbidity and mortality.

  32. Intrinsic development of choroidal and thalamic collaterals in hemorrhagic-onset moyamoya disease: case-control study of the Japan Adult Moyamoya Trial. 査読有り

    Fujimura M, Funaki T, Houkin K, Takahashi JC, Kuroda S, Tomata Y, Tominaga T, Miyamoto S, Japan Adult, Moyamoya Trial Investigators

    Journal of neurosurgery 1-7 2018年5月

    DOI: 10.3171/2017.11.JNS171990  

    ISSN:0022-3085

  33. [A Case of Ventriculoperitoneal Shunt Dysfunction in an Adult Secondary to Constipation]. 査読有り

    Nakamura L, Saito R, Kanamori M, Morita T, Tashiro R, Tominaga T

    No shinkei geka. Neurological surgery 46 (5) 385-389 2018年5月

    DOI: 10.11477/mf.1436203739  

    ISSN:0301-2603

  34. Parapharyngeal neuroglial heterotopia appearing as high uptake on 18F–FDG PET: case report and literature review of radiographical findings 査読有り

    Masayuki Kameyama, Tomohiro Kawaguchi, Hidetaka Niizuma, Takenori Ogawa, Kenichi Watanabe, Toshiaki Hayashi, Kanako Sato, Masayuki Kanamori, Mika Watanabe, Yukio Katori, Shigeo Kure, Teiji Tominaga

    Acta Neurochirurgica 160 (4) 801-809 2018年4月1日

    出版者・発行元:Springer-Verlag Wien

    DOI: 10.1007/s00701-017-3403-x  

    ISSN:0942-0940 0001-6268

    eISSN:0942-0940

    詳細を見る 詳細を閉じる

    Parapharyngeal neuroglial heterotopia is a rare entity, and the specific radiographical findings are unclear. We present a case of parapharyngeal neuroglial heterotopia examined with proton magnetic resonance spectroscopy (1H–MRS) and 18F–fluorodesoxyglucose positron emission tomography (18F–FDG PET). Our neonate patient presented with neck mass and polyhydramnios during gestation. Computed tomography and magnetic resonance imaging demonstrated the morphological characteristics, but failed to establish the diagnosis. 1H–MRS showed a non-malignant pattern, but 18F–FDG PET demonstrated high glucose metabolism. Complete resection was achieved and the histopathological diagnosis was neuroglial heterotopia. Assessment of biological activity may be useful for both preoperative diagnosis and postoperative evaluation of residual lesions.

  35. Accelerating Cell Therapy for Stroke in Japan: Regulatory Framework and Guidelines on Development of Cell-Based Products. 国際誌 査読有り

    Kiyohiro Houkin, Hideo Shichinohe, Koji Abe, Teruyo Arato, Mari Dezawa, Osamu Honmou, Nobutaka Horie, Yasuo Katayama, Kohsuke Kudo, Satoshi Kuroda, Tomohiro Matsuyama, Ichiro Miyai, Izumi Nagata, Kuniyasu Niizuma, Ken Sakushima, Masanori Sasaki, Norihiro Sato, Kenji Sawanobori, Satoshi Suda, Akihiko Taguchi, Teiji Tominaga, Haruko Yamamoto, Toru Yamashita, Toshiki Yoshimine

    Stroke 49 (4) e145-e152-e152 2018年4月

    DOI: 10.1161/STROKEAHA.117.019216  

    ISSN:0039-2499

  36. Three case reports of radiation-induced glioblastoma after complete remission of acute lymphoblastic leukemia. 査読有り

    Kajitani T, Kanamori M, Saito R, Watanabe Y, Suzuki H, Watanabe M, Kure S, Tominaga T

    Brain tumor pathology 35 (2) 114-122 2018年4月

    DOI: 10.1007/s10014-018-0316-1  

    ISSN:1433-7398

  37. Rapid detection of mutation in isocitrate dehydrogenase 1 and 2 genes using mass spectrometry. 査読有り

    Masayuki Kanamori, Masamitsu Maekawa, Ichiyo Shibahara, Ryuta Saito, Masashi Chonan, Miki Shimada, Yukihiko Sonoda, Toshihiro Kumabe, Mika Watanabe, Nariyasu Mano, Teiji Tominaga

    Brain tumor pathology 35 (2) 90-96 2018年4月

    DOI: 10.1007/s10014-018-0317-0  

    ISSN:1433-7398

    詳細を見る 詳細を閉じる

    The 2016 World Health Organization classification of tumors of the central nervous system was recently revised. Mutations in the isocitrate dehydrogenase 1 (IDH1) and IDH2 genes and chromosome 1p/19q codeletion are especially important for both the integrated diagnosis and the determination of surgical strategy. To establish a method for intraoperative molecular diagnosis, a simple, rapid method was developed for the measurement of 2-hydroxyglutarate (2-HG), a specific oncometabolite formed in the presence of IDH gene mutation, using liquid chromatography/electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS). This method requires only 10 min to measure the level of 2-HG from tissue preparation to completion of examination. Using this method, the level of 2-HG was analyzed in 105 patients with diffuse infiltrating glioma, and showed that IDH mutated glioma had significantly higher level of 2-HG compared to IDH wild-type glioma. Receiver operating characteristic curve analysis showed the area under the curve, sensitivity, and specificity were 0.9815, 97.5, and 100%, respectively. In contrast, tumor grade and presence of chromosome 1p/19q codeletion in the IDH mutated glioma could not be predicted from the level of 2-HG. Measurement of 2-HG level using LC/ESI-MS/MS can provide rapid and accurate information of mutation status in the IDH gene.

  38. Impact of bifurcation angle and inflow coefficient on the rupture risk of bifurcation type basilar artery tip aneurysms 査読有り

    Sherif Rashad, Shin-Ichiro Sugiyama, Kuniyasu Niizuma, Kenichi Sato, Hidenori Endo, Shunsuke Omodaka, Yasushi Matsumoto, Miki Fujimura, Teiji Tominaga

    Journal of Neurosurgery 128 (3) 723-730 2018年3月1日

    出版者・発行元:American Association of Neurological Surgeons

    DOI: 10.3171/2016.10.JNS161695  

    ISSN:1933-0693 0022-3085

    詳細を見る 詳細を閉じる

    OBJECTIVE: Risk factors for aneurysm rupture have been extensively studied, with several factors showing significant correlations with rupture status. Several studies have shown that aneurysm shape and hemodynamics change after rupture. In the present study the authors investigated a static factor, the bifurcation angle, which does not change after rupture, to understand its effect on aneurysm rupture risk and hemodynamics. METHODS: A hospital database was retrospectively reviewed to identify patients with cerebral aneurysms treated surgically or endovascularly in the period between 2008 and 2015. After acquiring 3D rotational angiographic data, 3D stereolithography models were created and computational fluid dynamic analysis was performed using commercially available software. Patient data (age and sex), morphometric factors (aneurysm volume and maximum height, aspect ratio, bifurcation angle, bottleneck ratio, and neck/parent artery ratio), and hemodynamic factors (inflow coefficient and wall shear stress) were statistically compared between ruptured and unruptured groups. RESULTS: Seventy-one basilar tip aneurysms were included in this study, 22 ruptured and 49 unruptured. Univariate analysis showed aspect ratio, bifurcation angle, bottleneck ratio, and inflow coefficient were significantly correlated with a ruptured status. Logistic regression analysis showed that aspect ratio and bifurcation angle were significant predictors of a ruptured status. Bifurcation angle was inversely correlated with inflow coefficient (p &lt 0.0005), which in turn correlated directly with mean (p = 0.028) and maximum (p = 0.014) wall shear stress (WSS) using Pearson's correlation coefficient, whereas aspect ratio was inversely correlated with mean (0.012) and minimum (p = 0.018) WSS. CONCLUSIONS: Bifurcation angle and aspect ratio are independent predictors for aneurysm rupture. Bifurcation angle, which does not change after rupture, is correlated with hemodynamic factors including inflow coefficient and WSS, as well as rupture status. Aneurysms with the hands-up bifurcation configuration are more prone to rupture than aneurysms with other bifurcation configurations.

  39. Newly Diagnosed Acquired Hemophilia A Manifesting as Massive Intracranial Hemorrhage Following a Neurosurgical Procedure 査読有り

    Yosuke Akamatsu, Toshiaki Hayashi, Joji Yamamoto, Hiroshi Karibe, Motonobu Kameyama, Teiji Tominaga

    World Neurosurgery 111 175-180 2018年3月1日

    出版者・発行元:Elsevier Inc.

    DOI: 10.1016/j.wneu.2017.12.016  

    ISSN:1878-8769 1878-8750

    詳細を見る 詳細を閉じる

    Objective Increased attention has been paid to limiting preoperative hemostatic screening because assessment of patient history can be used as an alternative. However, there may be some clinical pitfalls in overlooking acquired coagulopathies. Here, we present a case of newly diagnosed acquired hemophilia A (AHA) that manifested as a massive intracranial hemorrhage without unexplained bleeding history or abnormal hemostatic results. Case Description A 58-year-old man, who had a history of surgical clipping of an anterior communicating artery aneurysm 30 years ago, experienced subarachnoid hemorrhage because of a ruptured middle cerebral artery aneurysm. He underwent surgical clipping and external decompressive craniectomy 30 days later, cranioplasty was performed without preoperative hemostatic screening because of his normal coagulation status at the time of a previous surgery. Persistent wound bleeding and epistaxis suddenly began 6 hours after surgery. Computed tomography (CT) revealed a massive intracranial hematoma in the damaged parenchyma, although the patient was asymptomatic. At that time, laboratory tests showed isolated prolonged activated partial thromboplastin time and the presence of factor VIII inhibitor, which confirmed AHA. To manage the bleeding, fresh frozen plasma was transfused for 4 consecutive days, and hemostasis was finally achieved. Thereafter, the laboratory test results were normalized in 5 weeks. The patient's clinical course has been uneventful for 7 months without recurrence of AHA. Conclusions Acquired coagulopathies are relatively rare but life-threatening. Because clinical history is insufficient to predict an acquired coagulopathy, preoperative hemostatic screening should be performed before each neurosurgical procedure.

  40. Minimally invasive surgical approach to filum sectioning: Technical note 査読有り

    Toshiaki Hayashi, Tomomi Kimiwada, Reizo Shirane, Teiji Tominaga

    Operative Neurosurgery 14 (3) 315 2018年3月1日

    出版者・発行元:Oxford University Press

    DOI: 10.1093/ons/opx127  

    ISSN:2332-4252

  41. Clinical Characteristics of Lumbosacral Spinal Dural Arteriovenous Fistula (DAVF)–Comparison with Thoracic DAVF 査読有り

    Toshiki Endo, Takumi Kajitani, Tomoo Inoue, Kenichi Sato, Kuniyasu Niizuma, Hidenori Endo, Yasushi Matsumoto, Teiji Tominaga

    World Neurosurgery 110 e383-e388 2018年2月1日

    出版者・発行元:Elsevier Inc.

    DOI: 10.1016/j.wneu.2017.11.002  

    ISSN:1878-8769 1878-8750

    詳細を見る 詳細を閉じる

    Objective: Spinal dural arteriovenous fistula (DAVF) occurs at any spinal level, but the clinical characteristics of lumbosacral DAVF have not been well documented. The purpose of this study was to evaluate clinical characteristics of lumbosacral DAVF and compare these features with those in thoracic DAVF. Methods: Twenty-five consecutive patients with 16 thoracic and 9 lumbosacral DAVFs were included (mean age, 63.9 years 20 men). All patients presented with progressive myelopathy. Preoperative and postoperative neurologic deficits were compared between thoracic and lumbosacral DAVF groups. Using magnetic resonance imaging, the extent of T2 high-intensity areas and signal flow voids were documented. Follow-up after surgical interventions ranged from 6 to 96 months (mean, 38.1 months). Results: Preoperatively, patients suffering lumbosacral DAVF tended to be more severely disabled compared with thoracic DAVF patients. Lumbosacral DAVF patients exhibited diminished patellar (P = 0.04) and Achilles tendon reflexes (P &lt 0.01), while most thoracic DAVF patients exhibited hyperreflexia. In magnetic resonance imaging, signal flow voids around the spinal cord were evident in only 4 of 9 lumbosacral DAVF patients (P = 0.012). Rather, a serpentine signal flow void of the filum terminale was a hallmark of lumbosacral DAVFs to distinguish them from thoracic DAVFs. In the lumbosacral DAVF group, postoperative improvements were significantly better in micturition function (P = 0.02). Conclusions: In lumbosacral DAVF, postoperative micturition function recovery was superior to thoracic DAVF. Intradural lumbar signal flow void is indicative of lumbosacral DAVF. For appropriate management, it is important to recognize these differences between lumbosacral and thoracic DAVF.

  42. Expression of CD133 as a Putative Prognostic Biomarker to Predict Intracranial Dissemination of Primary Spinal Cord Astrocytoma 査読有り

    Tomoo Inoue, Toshiki Endo, Taigen Nakamura, Ichiyo Shibahara, Hidenori Endo, Teiji Tominaga

    World Neurosurgery 110 e715-e726 2018年2月1日

    出版者・発行元:Elsevier Inc.

    DOI: 10.1016/j.wneu.2017.11.089  

    ISSN:1878-8769 1878-8750

    詳細を見る 詳細を閉じる

    Objective: Spinal cord astrocytoma with intracranial dissemination carries a poor prognosis. The mechanisms leading to dissemination remain to be elucidated. A stem cell marker, CD133, was reported to predict recurrence patterns in intracranial glioblastoma. We evaluated the significance of CD133 as a putative prognostic biomarker to predict intracranial dissemination in spinal cord astrocytoma. Methods: This study included 14 consecutive patients with primary spinal cord astrocytoma treated from 1998 to 2014. Six of the patients were women and the patients’ ages ranged from 12 to 75 years. Seven and 6 patients underwent open biopsy and partial resection of the tumors, respectively. After confirmation of the histologic diagnoses, all patients were treated with postoperative radiotherapy, chemotherapy, or a combination of both. To identify factors predictive of intracranial dissemination, we analyzed their clinical data including Ki-67 labeling index, and CD133 expression. Results: Intracranial dissemination was observed in 6 of 14 patients. All 6 patients died during the follow-up period. Of the 8 patients without intracranial dissemination, 5 survived (P = 0.02). Median survival for the patients with intracranial dissemination was 22.7 months. CD133 expression was significantly higher in patients with intracranial dissemination (P = 0.04), whereas other variables did not indicate the dissemination. Conclusions: The expression of CD133 can be an efficient biomarker to predict intracranial dissemination in spinal cord astrocytoma. Recognition of high CD133 expression in surgical specimens and early detection of intracranial dissemination is important for the clinical management of spinal cord astrocytoma.

  43. [A Case of Hypertrophic Pachymeningitis with Symptomatic Venous Congestion due to Sinus Stenosis]. 査読有り

    Umegaki S, Osawa SI, Kimura K, Okushima T, Yajima N, Kawamura T, Tominaga T

    No shinkei geka. Neurological surgery 46 (2) 147-152 2018年2月

    DOI: 10.11477/mf.1436203691  

    ISSN:0301-2603

  44. Increased serum production of soluble CD163 and CXCL5 in patients with moyamoya disease: Involvement of intrinsic immune reaction in its pathogenesis. 国際誌 査読有り

    Miki Fujimura, Taku Fujimura, Aya Kakizaki, Mika Sato-Maeda, Kuniyasu Niizuma, Yasutake Tomata, Setsuya Aiba, Teiji Tominaga

    Brain research 1679 39-44 2018年1月15日

    DOI: 10.1016/j.brainres.2017.11.013  

    ISSN:0006-8993

    詳細を見る 詳細を閉じる

    Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by a progressive stenosis at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. Although its etiology is still unknown, intrinsic immune reactions such as autoimmune response has been implicated in the pathogenesis of MMD. Recently, the RING finger protein 213 (RNF213) was found to be an important risk gene for MMD, and is predominantly expressed in blood cells and the spleen. Thus, we hypothesized that patients with MMD represent an intrinsic autoimmune status mediated by M2-polarized macrophages, which play an important role in tissue remodeling and angiogenesis. We compared the serum level of soluble (s)CD163, an activating marker for CD163+ M2-polarized macrophages that has been implicated in a variety of autoimmune disorders, between MMD patients and healthy controls. We also analyzed serum levels of CXCL5, an augmented cytokines that has been correlated with the severity of autoimmune diseases. As a result, the serum sCD163 levels of MMD patients (281,465 pg/ml) were significantly higher than those of healthy controls (174,842 pg/ml) (p = .004). The serum CXCL5 levels of MMD patients (679.02 pg/ml) were significantly higher than those of healthy controls (401.79 pg/ml) (p = .046). There were no differences in the serum sCD163 and CXCL5 levels between each genotype of the RNF213 polymorphism (wild-type or variant) among MMD patients. Although this is a pilot study and further validation with larger number of samples is necessary, our results indicate that patients with MMD may have increased autoimmune activity, and our results shed light on the pathogenesis of MMD via CD163+ M2-polarized macrophages.

  45. Embolization of ruptured arteriovenous malformations in the cerebellopontine angle cistern 査読有り

    Hidenori Endo, Shin-ichiro Osawa, Yasushi Matsumoto, Toshiki Endo, Kenichi Sato, Kuniyasu Niizuma, Miki Fujimura, Teiji Tominaga

    Neurosurgical Review 41 (1) 173-182 2018年1月1日

    出版者・発行元:Springer Verlag

    DOI: 10.1007/s10143-017-0832-1  

    ISSN:1437-2320 0344-5607

    詳細を見る 詳細を閉じる

    Among brainstem arteriovenous malformations (AVMs), there exist small AVMs predominantly located in the cerebellopontine angle cistern (CPAC) with minimal extension into the pial surface of the brainstem. However, previous studies of CPAC AVMs did not particularly discuss the role of embolization in the treatment of these lesions. This study was conducted to clarify the effectiveness and validity of embolization in the treatment of CPAC AVMs. We retrospectively reviewed five patients with CPAC AVMs who underwent endovascular treatment. These patients were treated with embolization followed by open surgery or gamma knife (GK) radiosurgery. Radiological findings and clinical course for these patients were then assessed. All five patients presented with a hemorrhage. Angiography revealed that the main feeder contained a dilated pontine perforating artery in all cases. Embolization through the dilated pontine perforating artery effectively reduced shunt flow within the nidus or obliterated associated aneurysms. Magnetic resonance imaging showed infarction on the lateral pons in four patients, one of which developed transient mild dizziness and mild ataxia of the right side. Subsequent open surgery was performed in three patients, and GK radiosurgery was performed in two patients without complications. At the end of the follow-up period, all patients demonstrated favorable outcomes. Postoperative rebleeding did not occur in any of the patients. Disappearance of the AVM was confirmed in four patients, except in the one patient treated with GK. Although ischemic complications should be noted, embolization of CPAC AVMs may be an appropriate treatment option to reduce the risk of subsequent surgery or radiosurgery.

  46. A Case of Pituitary Carcinoma Initially Diagnosed as an Ectopic Growth Hormone Producing Pituitary Adenoma with a High Ki-67 Labeling Index 査読有り

    Toshiki Endo, Yoshikazu Ogawa, Mika Watanabe, Teiji Tominaga

    Journal of Neurological Surgery, Part A: Central European Neurosurgery 79 (1) 90-95 2018年1月1日

    出版者・発行元:Georg Thieme Verlag

    DOI: 10.1055/s-0037-1600515  

    ISSN:2193-6323 2193-6315

    詳細を見る 詳細を閉じる

    We report a case of a 66-year-old woman with a malignant transformation of a growth hormone (GH)-producing pituitary adenoma that was mainly located in the clivus. The patient originally presented with left oculomotor and abducens nerve palsies. Magnetic resonance imaging revealed a clival tumor separated from the normal pituitary gland, and the patient subsequently underwent transsphenoidal surgery. Analysis of the resected clival tissue revealed proliferation of tumor cells with slightly irregular nuclei but no mitosis. Although the Ki-67 labeling index was as high as 8.7%, p53 was negative. Histologic analysis confirmed the diagnosis of a GH-producing pituitary adenoma. Two months after the first operation, the tumor acutely enlarged and caused a subarachnoid hemorrhage. Pathologic findings of the second surgical specimen showed significant nuclear atypia. The Ki-67 labeling index increased to 27.7% and the p53 was positive there was no GH immunoreactivity. Following the second surgical intervention, the patient was diagnosed with an atypical pituitary adenoma and underwent postoperative local radiotherapy (50 Gy in 25 fractions). Twenty months after the first surgery, multiple bone metastases were detected that led to the diagnosis of pituitary carcinoma. This is the first report of a clival pituitary adenoma undergoing malignant transformation. Because neuroimaging may underestimate local invasiveness in ectopic pituitary tumors, it is essential to conduct a histologic examination to evaluate it. Further analysis of similar cases is necessary to improve clinical management for this confused diagnostic criterion.

  47. Convection-enhanced delivery of sulfasalazine prolongs survival in a glioma stem cell brain tumor model. 国際誌 査読有り

    Shinya Haryu, Ryuta Saito, Wenting Jia, Takuhiro Shoji, Yui Mano, Aya Sato, Masayuki Kanamori, Yukihiko Sonoda, Oltea Sampetrean, Hideyuki Saya, Teiji Tominaga

    Journal of neuro-oncology 136 (1) 23-31 2018年1月

    DOI: 10.1007/s11060-017-2621-7  

    ISSN:0167-594X

    詳細を見る 詳細を閉じる

    Expression of CD44 in glioma cells was previously correlated with tumor grade and is considered a stem cell marker. CD44 stabilizes the cystine-glutamate transporter (xCT) and inhibits apoptosis in cancer stem cells (CSCs). Recently it was found that Sulfasalazine (SSZ), an anti-inflammatory drug, acts as an inhibitor of xCT and therefore has potential as a targeted therapy for CSCs. In this study, we tested an efficacy of SSZ against glioma stem cell model developed in rats. As poor penetration of blood-brain barrier resulted in insufficient efficacy of systemic SSZ treatment, SSZ was delivered locally with convection-enhanced delivery (CED). In vitro, expression of CD44 in glioma cells and efficacy of SSZ against glioma cells and glioma stem cells were confirmed. SSZ demonstrated anti-proliferative activity in a dose dependent manner against these cells. This activity was partially reversible with the addition of antioxidant, N-acetyl-L-cysteine, to the medium. In vivo, CED successfully delivered SSZ into the rat brain parenchyma. When delivered at 5 mM concentration, which was the highest possible concentration when SSZ was dissolved in water, CED of SSZ resulted in almost no tissue damage. Against highly malignant bRiTs-G3 brain tumor xenografted rat model; the glioma stem cell model, CED of SSZ at 5 mM concentration induced apoptosis and prolonged survival. Consequently, CED of SSZ induced glioma stem cell death without evidence of tissue damage to normal brain parenchyma. This strategy may be a promising targeted treatment against glioma stem cells.

  48. Patient with Recurrent Anterior Cerebral Artery Dissecting Aneurysm After Stent-Assisted Coil Embolization Successfully Treated with A3-A3 Anastomosis 査読有り

    Yoshiharu Takahashi, Hidenori Endo, Toshiki Endo, Miki Fujimura, Kuniyasu Niizuma, Teiji Tominaga

    World Neurosurgery 109 77-81 2018年1月1日

    出版者・発行元:Elsevier Inc.

    DOI: 10.1016/j.wneu.2017.09.128  

    ISSN:1878-8769 1878-8750

    詳細を見る 詳細を閉じる

    Background With recent advances in endovascular devices and techniques, the use of endovascular treatment has been reported for intracranial dissecting aneurysms. However, the efficacy of this endovascular approach for intracranial dissection is still unknown. We report the case of a patient with a recurrent anterior cerebral artery (ACA) dissecting aneurysm after endovascular treatment. Case Description A 67-year-old woman underwent stent-assisted coil embolization for a ruptured ACA dissecting aneurysm of the left A2 segment. Aneurysmal dilatation was completely occluded after embolization. However, follow-up angiography 40 days after treatment showed compaction of the coil mass and reenlargement of the aneurysm. Open surgery was performed, considering the risk of rebleeding from the recurrent dissecting aneurysm. A3-A3 anastomosis followed by trapping of the coiled aneurysm along with the stent was successfully performed through the interhemispheric approach. The postoperative course was uneventful, and angiography 6 months after surgery revealed disappearance of the aneurysm and patency of the A3-A3 anastomosis. Conclusions Stent-assisted coil embolization for an ACA dissecting aneurysm may not be curative, and the coiled aneurysm may recur within a short time period. Microsurgical bypass trapping can be considered as the alterative or salvage treatment because of curability. Revascularization surgery, such as A3-A3 anastomosis, should be performed before trapping to avoid ischemic complications.

  49. Glioblastoma in neurofibromatosis 1 patients without IDH1, BRAF V600E, and TERT promoter mutations. 査読有り

    Ichiyo Shibahara, Yukihiko Sonoda, Hiroyoshi Suzuki, Akifumi Mayama, Masayuki Kanamori, Ryuta Saito, Yasuhiro Suzuki, Shoji Mashiyama, Hiroshi Uenohara, Mika Watanabe, Toshihiro Kumabe, Teiji Tominaga

    Brain tumor pathology 35 (1) 10-18 2018年1月

    DOI: 10.1007/s10014-017-0302-z  

    ISSN:1433-7398

    詳細を見る 詳細を閉じる

    Pilocytic astrocytomas and low-grade gliomas are more common compared with glioblastomas in patients with neurofibromatosis 1 (NF1). A recent genome-wide analysis has shown frequent NF1 gene alterations in the mesenchymal subtype of a glioblastoma; however, little is known about clinicopathological features of glioblastomas in NF1 patients (NF1 glioblastomas). We analyzed four NF1 glioblastomas. Radiographical and intraoperative findings showed well-circumscribed tumors from surrounding brain. Pathological analysis presented a paucity of processes with an eosinophilic cytoplasm, bizarre nuclei, xanthomatous-like appearance, multinucleated giant cells, and histiocytoid appearance. During the follow-up period, one patient died at 49 months and others remained alive for 60, 87, and 106 months; thus, patients with NF1 glioblastoma presented a relatively favorable survival. None of the NF1 glioblastomas harbored isocitrate dehydrogenase 1 (IDH1) gene mutation, v-RAF murine sarcoma viral oncogene homolog B1 (BRAF) gene mutation, and telomerase reverse transcriptase (TERT) gene promoter mutation. We identified that NF1 glioblastoma is a unique subset of glioblastoma.

  50. Traumatic midline subarachnoid hemorrhage on initial computed tomography as a marker of severe diffuse axonal injury. 査読有り

    Mata-Mbemba D, Mugikura S, Nakagawa A, Murata T, Ishii K, Kushimoto S, Tominaga T, Takahashi S, Takase K

    Journal of neurosurgery 1-8 2018年1月

    DOI: 10.3171/2017.6.JNS17466  

    ISSN:0022-3085

  51. Minimally invasive surgical approach to filum lipoma 査読有り

    Toshiaki Hayashi, Tomomi Kimiwada, Misaki Kohama, Reizo Shirane, Teiji Tominaga

    Neurologia Medico-Chirurgica 58 (3) 132-137 2018年

    出版者・発行元:Japan Neurosurgical Society

    DOI: 10.2176/nmc.oa.2017-0200  

    ISSN:1349-8029 0470-8105

    詳細を見る 詳細を閉じる

    Filum terminale lipoma (FTL) causes various spinal symptoms known as tethered cord syndrome. The treatment for FTL is surgical untethering by sectioning the FTL, which can prevent symptom progression and often results in improvement of symptoms. This report describes a minimally invasive surgical strategy that we have introduced for FTL sectioning. The pediatric patients with FTL since 2007 were treated using this minimally invasive surgical strategy, which we refer to as an interlaminar approach (ILA). In summary, the surgical technique involves: minimal skin incision to expose the unilateral ligamentum flavum in the lower lumbar region ligamentum flavum incision to expose the dural sac, and dural incision followed by identification and sectioning of the filum. Postoperatively, no bed rest was required. Prior to introducing ILA, we had used standard one level laminectomy/laminotomy (LL) with more than 1 week of postsurgical bed rest until 2007, providing an adequate control group for the benefit of the ILA. A total of 49 consecutive patients were treated using ILA. While 37 patients were treated using LL. Surgical complications that need surgery were seen only in one patient, who developed cerebrospinal fluid (CSF) leak in LL patients. No retethering or additional neurological symptoms were seen during follow-up. All patients complained of minimal postsurgical back pain, but no patients required postoperative bed rest in ILA patients, while LL patients need postsurgical bed rest because of back pain. The ILA strategy provides the advantage of a minimal tissue injury, associated with minimal postoperative pain, blood loss, and bed rest.

  52. Fingolimod-associated PML with mild IRIS in MS: A clinicopathologic study. 国際誌 査読有り

    Shuhei Nishiyama, Tatsuro Misu, Yukiko Shishido-Hara, Kazuo Nakamichi, Masayuki Saijo, Yoshiki Takai, Kentarou Takei, Naoki Yamamoto, Hiroshi Kuroda, Ryuta Saito, Mika Watanabe, Teiji Tominaga, Ichiro Nakashima, Kazuo Fujihara, Masashi Aoki

    Neurology(R) neuroimmunology & neuroinflammation 5 (1) e415 2018年1月

    DOI: 10.1212/NXI.0000000000000415  

    詳細を見る 詳細を閉じる

    Objective: To clarify the clinical, neuropathologic, and virologic characteristics of progressive multifocal leukoencephalopathy (PML) and its immune reconstitution inflammatory syndrome (IRIS) in a patient with fingolimod-treated MS. Methods: A case study. Results: A 34-year-old patient with MS using fingolimod for 4 years had a gradual progression of right hemiparesis and aphasia with a new subcortical white matter lesion in the precentral gyrus by initial MRI. Blood tests were normal, except for lymphopenia (160 cells/μL). One month after the cessation of fingolimod, brain MRI depicted a diffusely exacerbated hyperintensity on fluid-attenuated inversion recovery and diffusion-weighed imaging in the white matter with punctate gadolinium enhancement, suggesting PML-IRIS. A very low level of JC virus (JCV)-DNA (15 copies/mL) was detected in the CSF as judged by quantitative PCR. Brain tissues were biopsied from the left frontal lesion, which showed some small demyelinated foci with predominant loss of myelin-associated glycoprotein with infiltrations of lymphocytes and macrophages, but clear viral inclusion was not observed with hematoxylin-eosin staining. JCV-DNA was uniquely detectable in an active inflammatory demyelinating lesion by in situ hybridization, possibly suggesting an early phase of PML. DNA extracted from the brain sample was positive for JCV-DNA (151 copies/cell). It took 3 months to normalize the blood lymphocyte count. The patient was treated with 1 g of IV methylprednisolone for 3 days and a weekly oral dose (375 mg) of mefloquine, and her symptoms gradually improved. Conclusion: Low CSF JCV-DNA and unfound viral inclusions initially made her diagnosis difficult. The clinical course of fingolimod-associated PML may be associated with mild immune reconstitution.

  53. Successful presurgical endovascular management of venous sinus thrombosis associated with high-grade cerebral arteriovenous malformation: A case report 査読有り

    Yoshinari Osada, Hidenori Endo, Kenichi Sato, Yasushi Matsumoto, Toshiki Endo, Miki Fujimura, Teiji Tominaga

    Interventional Neuroradiology 23 (6) 656-660 2017年12月1日

    出版者・発行元:SAGE Publications Inc.

    DOI: 10.1177/1591019917728255  

    ISSN:1591-0199

    詳細を見る 詳細を閉じる

    We report a case of a 39-year-old man presenting with a high-grade left parieto-occipital arteriovenous malformation (AVM) complicated by superior sagittal sinus (SSS) stenosis, seven years after the first presentation. Magnetic resonance imaging revealed a newly developed perilesional edema. Venous sinus stenosis acutely progressed to occlusion and induced multiple intracerebral hemorrhages. An emergent balloon venoplasty of the SSS successfully recanalized the thrombosed sinus. Further, multistage transarterial nidus embolization was performed followed by surgical resection, resulting in a complete eradication of the large AVM. The emergence of perilesional edema is a key radiological feature for the early recognition of a newly developed venous drainage route disturbance, which would result in hemorrhagic events. Venous sinus thrombosis is a rare cause of drainage route disturbance in cerebral AVMs. For such cases, the recanalization of venous drainage concomitant with flow reduction by performing transarterial embolization is effective in preventing further hemorrhage, which enables a safe performance of subsequent radical surgery.

  54. Bath plug closure method for cerebrospinal fluid leakage by endoscopic endonasal approach cooperative treatment by neurosurgeons and otolaryngologists 査読有り

    Tomohiro Kawaguchi, Kazuya Arakawa, Kazuhiro Nomura, Yoshikazu Ogawa, Yukio Katori, Teiji Tominaga

    Neurological Surgery 45 (12) 1067-1073 2017年12月1日

    出版者・発行元:Igaku-Shoin Ltd

    DOI: 10.11477/mf.1436203648  

    ISSN:1882-1251 0301-2603

    詳細を見る 詳細を閉じる

    Endoscopic endonasal surgery, an innovative surgical technique, is used to approach sinus lesions, lesions of the skull base, and intradural tumors. The cooperation of experienced otolaryngologists and neurosurgeons is important to achieve safe and reliable surgical results. The bath plug closure method is a treatment option for patients with cerebrospinal fluid (CSF) leakage. Although it includes dural and/or intradural procedures, surgery tends to be performed by otolaryngologists because its indications, detailed maneuvers, and pitfalls are not well recognized by neurosurgeons. We reviewed the cases of patients with CSF leakage treated by using the bath plug closure method with an endoscopic endonasal approach at our institution. Three patients were treated using the bath plug closure method. CSF leakage was caused by a meningocele in two cases and trauma in one case. No postoperative intracranial complications or recurrence of CSF leakage were observed. The bath plug closure method is an effective treatment strategy and allows neurosurgeons to gain in-depth knowledge of the treatment options for CSF leakage by using an endoscopic endonasal approach.

  55. Revascularization of the anterior cerebral artery by Y-shaped superficial temporal artery interposition graft for the treatment of a de novo aneurysm arising at the site of A<sub>3</sub>-A<sub>3</sub> bypass: technical case report. 査読有り

    Endo H, Sugiyama SI, Endo T, Fujimura M, Shimizu H, Tominaga T

    Journal of neurosurgery 1-5 2017年12月

    DOI: 10.3171/2017.6.JNS17931  

    ISSN:0022-3085

  56. Predicting Tissue Breaking Strengths in the Epileptic Brain with T2 Relaxometry: Application of Pulsed Water Jet Dissection System for Epilepsy Surgery 査読有り

    Yoko Takahashi, Masaki Iwasaki, Atsuhiro Nakagawa, Shiho Sato, Nobukazu Nakasato, Teiji Tominaga

    JOURNAL OF NEUROLOGICAL SURGERY PART A-CENTRAL EUROPEAN NEUROSURGERY 78 (6) 561-565 2017年11月

    出版者・発行元:THIEME MEDICAL PUBL INC

    DOI: 10.1055/s-0036-1593959  

    ISSN:2193-6315

    eISSN:2193-6323

    詳細を見る 詳細を閉じる

    Background The piezo actuator-driven pulsed water jet (ADPJ) system is a novel surgical instrument that enables dissection of tissue without thermal damage. Using the ADPJ system in epilepsy surgery requires prediction of the tissue breaking strength of the epileptic brain. The aim of this study was to elucidate whether magnetic resonance imaging T2 relaxometry could predict the breaking strength. Methods A total of 12 patients with drug-resistant temporal lobe epilepsy who received surgical treatment were included in the study. All the patients qualified for surgery after a comprehensive preoperative evaluation for the treatment of epilepsy. T2 relaxation time, breaking strength of the hippocampus, and an anterior temporal lobe specimen obtained from surgery with dissection depth determined by the ADPJ system were examined. Results Preoperative T2 relaxation times of the anterior temporal lobe and hippocampus showed mild positive correlation with breaking strength (R (2) =0.60). The hippocampus showed higher T2 relaxation time than the temporal lobe. Hippocampal sclerosis seemed to have higher breaking strength than other pathologies, suggesting the correlation depends on the anatomical location and histopathology. The dissection depth of the extirpated lesion was negatively correlated with the breaking strength at input voltages of 10V (R (2) =- 0.34) and 20V (R (2) =- 0.20). Conclusions T2 relaxometry may be useful to predict tissue breaking strength in the epileptic brain that allows safe application of the ADPJ system in epilepsy surgery.

  57. Ruptured Vertebral Artery Dissecting Aneurysm Concurrent with Spontaneous Cervical Internal Carotid Artery Dissection: A Report of Three Cases and Literature Review 査読有り

    Yosuke Akamatsu, Kenichi Sato, Hidenori Endo, Yasushi Matsumoto, Teiji Tominaga

    WORLD NEUROSURGERY 107 1048.e1-1048.e6 2017年11月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.wneu.2017.08.016  

    ISSN:1878-8750

    eISSN:1878-8769

    詳細を見る 詳細を閉じる

    BACKGROUND: Multiple dissections rarely occur with ruptured vertebral artery dissecting aneurysms (VADAs). Here we report 3 cases of ruptured VADA concurrent with spontaneous cervical internal carotid artery (ICA) dissection. CASE DESCRIPTION: None of the 3 patients had a history of vasculopathy or trauma. All ruptured VADAs were treated with internal coil trapping in the acute stage of subarachnoid hemorrhage (SAH). Rebleeding was not observed in any patients after the treatment. In 1 patient, carotid artery stenting (CAS) was performed 3 days after VADA obliteration to improve hemodynamic compromise. In another patient, CAS was performed 3 weeks after treatment because the dissecting lesion was gradually enlarging. In the third patient, the dissecting lesion resolved with conservative management. CONCLUSIONS: The clinical management of patients with SAH and cervical ICA dissection is complicated. Given that rebleeding of VADA is fatal, achieving hemostasis is the priority. Subsequently, ICA revascularization should be considered to manage ischemic stroke or aneurysmal changes, depending on the SAH stage. In contrast to the typically benign course of sporadic cervical ICA dissection, hemodynamic changes related to SAH and internal trapping of a VADA may exacerbate the cervical ICA dissection. Careful follow-up may be required for cervical dissecting aneurysms in this specific pathological setting.

  58. Recovery from diabetes insipidus and preservation of thyroid function after craniopharyngioma removal and pituitary stalk sectioning 査読有り

    Yoshikazu Ogawa, Kuniyasu Niizuma, Teiji Tominaga

    CLINICAL NEUROLOGY AND NEUROSURGERY 162 36-40 2017年11月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.clineuro.2017.09.005  

    ISSN:0303-8467

    eISSN:1872-6968

    詳細を見る 詳細を閉じる

    Objectives: Craniopharyngioma is a slow-growing tumor, but long-term tumor control with maintenance of quality of life is sometimes very difficult to achieve, and hypothalamic disturbance should be strictly avoided in the treatment. However, management of the pituitary gland and/or pituitary stalk varies among surgeons and institutions. Patients and methods: This retrospective review identified 44 patients, 24 males and 20 females with craniopharyngiomas who were initially treated by surgery through the extended transsphenoidal approach with pituitary stalk sectioning at a single institute. If the tumor bed involved the posterior lobe of the pituitary gland, pituitary stalk, anterior and/or mid portion of the third ventricle floor, these structures were removed en-bloc together with the tumor. The closest attention was paid to preserve fine arteries running along the surface of optic chiasm and the lateral walls of the third ventricle. Surgical outcome and changes in postoperative endocrinological status were investigated. Results: Gross total removal was achieved in 40 of 44 patients (91%), and all patients could discharge without autonomic and/or thermal disturbances. Tumor remnants were identified with tight adhesion to the perforating arteries in 2 cases, tight adhesion to mammillary bodies in 1, and optic chiasm in 1. Administration of antidiuretic hormone could be discontinued in 23 of 44 patients (52.3%) with improved diabetes insipidus (DI), although no patient could discontinue glucocorticoid administration. Preservation of thyroid function was achieved in another 23 of 44 patients (52.3%), and recovery from DI was correlated with preservation of thyroid function (p = 0.016). Conclusion: Pituitary dysfunction is partially reversible even with pituitary stalk sectioning. Regrowth of tumor in the anterior and/or mid portion of the third ventricle floor including pituitary stalk can possibly be prevented by aggressive tumor removal, and co-achievement of long-term tumor control with maintenance of quality of life could be possible to preserve the lateral wall of the third ventricle.

  59. Intra-operative hemorrhage due to hyperperfusion during direct revascularization surgery in an adult patient with moyamoya disease: a case report 査読有り

    Hiroki Uchida, Hidenori Endo, Miki Fujimura, Toshiki Endo, Kuniyasu Niizuma, Teiji Tominaga

    NEUROSURGICAL REVIEW 40 (4) 679-684 2017年10月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s10143-017-0868-2  

    ISSN:0344-5607

    eISSN:1437-2320

    詳細を見る 詳細を閉じる

    Hemorrhagic complication is one of the notable surgical complications of the revascularization surgery for moyamoya disease (MMD). Cerebral hyperperfusion (CHP) has been considered as the underlying cause of this complication. It mostly occurs several days after surgery, but the intra-operative hemorrhage immediately after bypass has not been reported previously. A 21-year-old woman presented right thalamic hemorrhage and was diagnosed as having MMD by cerebral angiography. In light of the location of the hemorrhage at the vascular territory of posterior circulation and the manifestation of transient ischemic attack during the follow-up period, she underwent revascularization surgery to prevent future ischemic attack and rebleeding. Superficial temporal artery (STA) was uneventfully anastomosed to the temporal M4 branch of the middle cerebral artery in an end-to-side manner. A few minutes after the completion of the anastomosis, hemorrhage occurred in the fissure adjacent to the site of anastomosis. Indocyanine green (ICG) video angiography just before hemorrhage showed focal early filling through the STA graft with early venous filling around the site of the anastomosis. The bleeding was controlled by immediate hypotensive therapy (systolic blood pressure 117 to 91 mmHg). The mean blood flows of the STA graft measured by ultrasonic flowmetry before and after hypotensive therapy were 52.8 and 24.2 ml/min, respectively. Single-photon emission computed tomography (SPECT) on the next day after surgery showed focal hyperperfusion in the surgical side. Intra-operative ultrasonic flowmetry, ICG, and postoperative SPECT would explain that CHP was the potential cause of the hemorrhagic complication. This is the first case describing intra-operative hemorrhagic complication during revascularization surgery for MMD. Surgeons need to be aware of this rare complication and its management method.

  60. An investigation into the effects and prognostic factors of cognitive decline following subthalamic nucleus stimulation in patients with Parkinson's disease 査読有り

    Taro Nimura, Ken-ichi Nagamatsu, Tadashi Ando, Arifumi Matsumoto, Kinya Hisanaga, Teiji Tominaga

    JOURNAL OF CLINICAL NEUROSCIENCE 44 164-168 2017年10月

    出版者・発行元:ELSEVIER SCI LTD

    DOI: 10.1016/j.jocn.2017.06.018  

    ISSN:0967-5868

    eISSN:1532-2653

    詳細を見る 詳細を閉じる

    We retrospectively investigated the effects of subthalamic nucleus stimulation (STN-DBS) on new postoperative onset of cognitive decline and prognostic factors for advanced Parkinson's disease (PD). We studied 39 PD patients who had received bilateral STN-DBS. Clinical symptoms, cognitive function, psychiatric function, and health-related quality of life (HRQOL) were assessed before and six months after surgery. Based on the results of neuropsychological examinations six months after the surgery, the subjects were divided into those with and those without cognitive decline. We compared pre- and postoperative assessments between the two groups. Prognostic factors were investigated using multiple logistic regression analyses. Seven patients had cognitive decline six months after the operation (17.9%); they were significantly older than those without cognitive decline. Preoperative neuropsychological examinations revealed impairments in language and executive function. No differences were found in clinical symptoms. Patients with cognitive decline had significantly worse apathy scale scores. The HRQOL revealed significant declines in the Mental Component Summary (MCS), vitality, and mental health (MH) domains. Postoperative comparisons revealed novel significant differences in activities of daily living in the "on" and "off" states and in daytime drowsiness. Preoperative differences seen in the MCS and vitality indices were no longer present. Word fluency, and apathy scale and MH scores were independent preoperative prognostic factors for cognitive decline. New postoperative onset of cognitive decline due to STN-DBS affected activities of daily living and psychiatric function. Preoperative non motor symptoms may be prognostic factors for new onset of cognitive decline. (C) 2017 Elsevier Ltd. All rights reserved.

  61. [Current Status of Epilepsy Surgery in Adults]. 査読有り

    Shin-Ichiro Osawa, Masaki Iwasaki, Teiji Tominaga

    Brain and nerve = Shinkei kenkyu no shinpo 69 (10) 1105-1113 2017年10月

    DOI: 10.11477/mf.1416200878  

    ISSN:1881-6096

    詳細を見る 詳細を閉じる

    Epilepsy surgery is an effective way to control seizures in patients with refractory epilepsy, even in patients in whom drug therapy has not resulted in adequate seizure control. Many studies support the efficacy and safety of resective and non-resective surgeries for the treatment of refractory epilepsy in appropriately selected individuals. However, it is sometimes argued that epilepsy surgery is underutilized despite the evidence and guidelines supporting its use. Among the causes cited for underutilization of this treatment are numerous barriers to epilepsy surgery. Further strategies are needed to increase access to surgery and to improve communication about the effectiveness of this potentially life-changing procedure. In addition, epilepsy surgery is only one part of the multimodal treatment of refractory epilepsy. A comprehensive approach is required to address the medical, surgical, psychosocial, rehabilitation and moral needs of patients with epilepsy in order to improve their quality of life.

  62. Efficacy of Early Surgery for Neurological Improvement in Spinal Cord Injury without Radiographic Evidence of Trauma in the Elderly 査読有り

    Tomoo Inoue, Shinsuke Suzuki, Toshiki Endo, Hiroshi Uenohara, Teiji Tominaga

    WORLD NEUROSURGERY 105 790-795 2017年9月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.wneu.2017.06.070  

    ISSN:1878-8750

    eISSN:1878-8769

    詳細を見る 詳細を閉じる

    BACKGROUND: The optimal timing for surgery for patients with spinal cord injury without radiographic evidence of trauma (SCIWORET) remains unclear. This is especially true in the elderly, given that most studies are done with younger patients to avoid age-related comorbidities. We aimed to compare the efficacy of early (&lt;24 hours postinjury) and late (&gt;24 hours postinjury) surgery in patients with SCIWORET aged &gt;= 65 years. METHODS: We identified patients aged &gt;= 65 years who underwent surgery for SCIWORET between January 1995 and February 2016. The primary outcome was a change in the Japanese Orthopaedic Association (JOA) score at discharge, with a recovery of &gt;50% defined as a favorable neurologic outcome. Logistic regression analysis was performed, and model fit was assessed using the Hosmere Lemeshow test. RESULTS: Eighty patients aged &gt;= 65 years with SCIWORET underwent surgery were enrolled. Favorable neurologic outcomes were seen in 43.3% of those who underwent early surgery, but only in 18.0% of those who underwent late surgery. Logistic regression analysis, adjusted for age, sex, comorbidities (Charlson Comorbidity Index), and JOA score, revealed that early surgery independently predicted favorable outcomes (odds ratio, 4.06; 95% confidence interval, 1.25-13.20), with excellent calibration (HosmereLemeshow, P [0.857). CONCLUSIONS: The present study indicated that early surgery within 24 hours of injury for elderly patients with SCIWORET could lead to more favorable neurologic improvements. We believe that chronological age alone should not be considered sufficient justification to deny patients early surgical decompression for SCIWORET.

  63. Temporal and Spatial Changes in Cerebral Blood Flow during Management for Preventing Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: Serial Semiquantitative Analysis 査読有り

    Kenichi Sato, Hiroaki Shimizu, Takashi Inoue, Miki Fujimura, Hidenori Endo, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 26 (9) 2027-2037 2017年9月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.006  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Background: Delayed cerebral ischemia is a major cause of morbidity after aneurysmal subarachnoid hemorrhage. The management for preventing the delayed cerebral ischemia is clinically difficult because of its multifactorial nature. We tested the hypothesis that spatial and temporal changes of regional cerebral blood flow after subarachnoid hemorrhage might relate to the incidence of the delayed cerebral ischemia and the clinical outcome. Methods: Eighty-eight patients who underwent single-photon emission computed tomography twice during 14 days after the onset of aneurysmal subarachnoid hemorrhage were retrospectively analyzed. Regional cerebral blood flow was automatically analyzed in statistical imaging analyses using 3-dimensional stereotaxic region of interest template and 3-dimensional stereotaxic surface projection. Ratios were calculated by dividing the regional cerebral blood flow of patients by that of normal volunteers. We assessed the relation of changes in regional cerebral blood flow with the development of the delayed cerebral ischemia and the clinical outcome at 3 months. Results: The regional cerebral blood flow of areas that eventually contained infarction significantly decreased, whereas those with significant increase were associated with transient neurological symptoms during the management for the delayed cerebral ischemia. Patients with both areas of regional cerebral blood flow increasing and decreasing during this period had worse outcomes than patients with a unidirectional change. Conclusions: Cerebral perfusion may change temporally and spatially during the management for preventing the delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Regional hypoperfusion refractory to the management might exist, which could impact on the clinical outcome. An additional therapeutic approach targeting on such regions may be required.

  64. Transient Global Cerebral Ischemia Induces RNF213, a Moyamoya Disease Susceptibility Gene, in Vulnerable Neurons of the Rat Hippocampus CA1 Subregion and Ischemic Cortex 査読有り

    Mika Sato-Maeda, Miki Fujimura, Sherif Rashad, Yuiko Morita-Fujimura, Kuniyasu Niizuma, Hiroyuki Sakata, Shuntaro Ikawa, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 26 (9) 1904-1911 2017年9月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.032  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    The RING finger protein 213 (RNF213) is an important susceptibility gene for moyamoya disease (MMD) and is also implicated in other types of intracranial major artery stenosis/occlusion (ICAS); however, the role of RNF213 in the development of ICAS including MMD is unclear. The constitutive expression of the RNF213 gene is relatively weak in brain tissue, while information regarding the expression patterns of the RNF213 gene under cerebral ischemia, which is one of characteristic pathologies associated with ICAS, is currently limited. Our objective was to address this critical issue, and we investigated Rnf213 mRNA expression in rat brains after 5 minutes of transient global cerebral ischemia (tGCI) by occluding the common carotid arteries coupled with severe hypotension. Rnf213 gene expression patterns were investigated with in situ RNA hybridization and a real-time polymerase chain reaction (PCR) from 1 to 72 hours after tGCI. In situ RNA hybridization revealed a significant increase in Rnf213 mRNA levels in the hippocampus CA1 sub-region 48 hours after tGCI. The significant induction of the Rnf213 gene was also evident in the ischemic cortex. Double staining of Rnf213 mRNA with NeuN immunohistochemistry revealed Rnf213 hybridization signal expression exclusively in neurons. The real-time PCR analysis confirmed the induction of the Rnf213 gene after tGCI. The up-regulation of the Rnf213 gene in vulnerable neurons in the hippocampus CA1 after tGCI suggests its involvement in forebrain ischemia, which is an underlying pathology of MMD. Further investigations are needed to elucidate its exact role in the pathophysiology of ICAS including MMD.

  65. Factors contributing to surgical intervention for subacute subdural hematoma enlargement in patients with mild head injuries 査読有り

    Yosuke Akamatsu, Tohru Sasaki, Masayuki Kanamori, Shinsuke Suzuki, Hiroshi Uenohara, Teiji Tominaga

    Neurological Surgery 45 (9) 771-779 2017年9月1日

    出版者・発行元:Igaku-Shoin Ltd

    DOI: 10.11477/mf.1436203591  

    ISSN:1882-1251 0301-2603

    詳細を見る 詳細を閉じる

    Delayed neurological deterioration following mild head injury (MHI) usually occurs within 24 hours. However, some cases require delayed surgical evacuation of an acute subdural hematoma (ASDH), owing to subacute progressive hematoma enlargement. This study aimed to determine radiological or clinical parameters associated with surgical intervention in ASDH cases in which surgery was not initially considered necessary. From 2010 to 2015. 64 patients were non-surgically treated for ASDH following MHI. We evaluated the vanous outcomes of eventual surgical ASDH evacuation after the first 48 hours following injury, due to hematoma enlargement and clinical deterioration. Univariate and multivariate analyses were applied to both the demographic and initial radiographic features to identify risk factors for ASDH progression and surgery. Overall, at the time of their last follow-up computed tomography. 57 patients (89%) demonstrated minimal ASDH or spontaneous hematoma resolution with conservative non-surgical management. The remaining 7 patients (11%) received delayed surgical ASDH evacuation a median of 5.1 days after the head trauma. There were no significant differences between the two groups for baseline characteristics, including age. prior history of anticoagulants, the presence of cerebral contusions, or subarachnoid hemorrhages. On multivariate analysis, use of antiplatelet drugs (p = 0 013. OR = 28. 95%CI= 1.82-24) was independently associated with delayed hematoma evacuation. These data indicate that as much as 11 % of patients with minimal ASDHs after MHI can deteriorate over the course of a week and then require surgical intervention, and that patients on concurrent antiplatelet medication require especially careful monitoring of hematoma progression.

  66. Endovascular Treatment for carotid blowout syndrome after radiation for esophageal cancer: A case report 査読有り

    Shigefumi Takahashi, Tomohiro Kawaguchi, Kuniyasu Nhzuma, Atsuhiro Nakagawa, Miki Fujimura, Takenori Ogawa, Yukio Katori, Teiji Tominaga

    Neurological Surgery 45 (9) 791-798 2017年9月1日

    出版者・発行元:Igaku-Shoin Ltd

    DOI: 10.11477/mf.1436203594  

    ISSN:1882-1251 0301-2603

    eISSN:1882-1251

    詳細を見る 詳細を閉じる

    Here, we discuss a case of carotid blowout syndrome successfully treated with endovascular parent artery occlusion. A 71-year-old woman underwent treatment for esophageal cancer resection, followed by 50-Gy radiotherapy. 19 years prior. Due to local recurrence, she underwent 66- and 72-Gy radiation treatments at 2 and 4 years after the initial treatment, respectively. Afterward, tracheostomy and enterostomy were performed. This time, she was transported to our emergency department because of acute eruptive bleeding from the tracheal tube. As her vitals indicated shock, emergency endovascular treatment was performed. Digital subtraction angiography revealed that the common carotid artery in the left-sided of the neck had a pseudoaneurysm extruding to the pharyngeal cavity, which was considered to be the lesion responsible for the acute rupture. She was diagnosed as having carotid blowout syndrome. Balloon test occlusion showed that the cross flow via the anterior and posterior communicating arteries was sufficient, so parent artery occlusion was chosen for bleeding control. Carotid bifurcation was preserved to keep the collateral circulation via the external carotid artery. The patient was discharged 22 days after treatment, without any neurological deficits. Although injured vessel removal with high-flow bypass was an ideal treatment to achieve bleeding control without ischemic complication, endovascular treatment can be an efficient second-best treatment. To minimize the risk of late ischemic complications, flow preservation via carotid bifurcation might be important.

  67. The Piezo Actuator-Driven Pulsed Water Jet System for Minimizing Renal Damage after Off-Clamp Laparoscopic Partial Nephrectomy 査読有り

    Yoshihiro Kamiyama, Shinichi Yamashita, Atsuhiro Nakagawa, Shinji Fujii, Koji Mitsuzuka, Yasuhiro Kaiho, Akihiro Ito, Takaaki Abe, Teiji Tominaga, Yoichi Arai

    TOHOKU JOURNAL OF EXPERIMENTAL MEDICINE 243 (1) 57-65 2017年9月

    出版者・発行元:TOHOKU UNIV MEDICAL PRESS

    DOI: 10.1620/tjem.243.57  

    ISSN:0040-8727

    eISSN:1349-3329

    詳細を見る 詳細を閉じる

    In the setting of partial nephrectomy (PN) for renal cell carcinoma, postoperative renal dysfunction might be caused by surgical procedure. The aim of this study was to clarify the technical safety and renal damage after off-clamp laparoscopic PN (LPN) with a piezo actuator-driven pulsed water jet (ADPJ) system. Eight swine underwent off-clamp LPN with this surgical device, while off-clamp open PN was also performed with radio knife or soft coagulation. The length of the removed kidney was 40 mm, and the renal parenchyma was dissected until the renal calyx became clearly visible. The degree of renal degeneration from the resection surface was compared by Hematoxylin-Eosin staining and immunostaining for 1-methyladenosine, a sensitive marker for the ischemic tissue damage. The mRNA levels of neutrophil gelatinase-associated lipocalin (Ngal), a biomarker for acute kidney injury, were measured by quantitative real-time PCR. Off-clamp LPN with ADPJ system was successfully performed while preserving fine blood vessels and the renal calix with little bleeding. In contrast to other devices, the resection surface obtained with the ADPJ system showed only marginal degree of ischemic changes. Indeed, the expression level of Ngal mRNA was lower in the resection surface obtained with the ADPJ system than that with soft coagulation (p = 0.02). Furthermore, using the excised specimens of renal cell carcinoma, we measured the breaking strength at each site of the human kidney, suggesting the applicability of this ADPJ to clinical trials. In conclusion, off-clamp LPN with the ADPJ system could be safely performed with attenuated renal damage.

  68. Single-Session Hematoma Removal and Transcranial Coil Embolization for a Cavernous Sinus Dural Arteriovenous Fistula: A Technical Case Report 査読有り

    Yosuke Akamatsu, Kenichi Sato, Hidenori Endo, Yasushi Matsumoto, Teiji Tominaga

    WORLD NEUROSURGERY 104 1046.e7-1046.e12 2017年8月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.wneu.2017.04.009  

    ISSN:1878-8750

    eISSN:1878-8769

    詳細を見る 詳細を閉じる

    BACKGROUND: Patients with cavernous sinus dural arteriovenous fistulas (CS dAVFs) with cortical venous varix are indicated for aggressive treatment because of the associated risk for intracranial hemorrhage. CASE DESCRIPTION: We present a case of surgical transvenous embolization in an 84-year-old woman with CS dAVF who presented with massive intracerebral hematoma. Cerebral angiograms revealed the dural AVF drained only into the superficial middle cerebral vein. Because an emergent mass reduction and prevention of rebleeding were necessary, single-session hematoma removal and transcranial embolization of a CS dAVF were performed in the neurosurgical operating room, using a mobile C-arm fluoroscopy. After the right frontotemporal craniotomy, intracerebral hematoma was removed and coil packing of the affected cavernous sinus was successfully performed via the dilated superficial middle cerebral vein. CONCLUSION: The transcortical vein approach enables occlusion of CS dAVF with isolated cortical venous drainage and may be a valuable alternative approach for some cases needed emergency craniotomy.

  69. Opening the ventricle during surgery diminishes survival among patients with newly diagnosed glioblastoma treated with carmustine wafers: a multi-center retrospective study 査読有り

    Yukihiko Sonoda, Ichiyo Shibahara, Ken-ichiro Matsuda, Ryuta Saito, Tomoyuki Kawataki, Masaya Oda, Yuichi Sato, Hirokazu Sadahiro, Sadahiro Nomura, Toshio Sasajima, Takaaki Beppu, Masayuki Kanamori, Kaori Sakurada, Toshihiro Kumabe, Teiji Tominaga, Hiroyuki Kinouchi, Hiroaki Shimizu, Kuniaki Ogasawara, Michiyasu Suzuki

    JOURNAL OF NEURO-ONCOLOGY 134 (1) 83-88 2017年8月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s11060-017-2488-7  

    ISSN:0167-594X

    eISSN:1573-7373

    詳細を見る 詳細を閉じる

    Carmustine wafers (CW) were approved in Japan for newly diagnosed and recurrent malignant gliomas during 2013. The ventricle is often opened during surgery to achieve maximum resection. While not generally recommended in such situations, CW might be safely achieved by occluding an opened ventricle using gelform or collagen sheets. However, whether CW implantation actually confers a survival benefit for patients who undergo surgery with an open ventricle to treat glioblastoma remains unclear. Clinical, imaging, and survival data were collected in this multicenter retrospective study of 122 consecutive patients with newly diagnosed glioblastoma to determine adverse events and efficacy. Overall, 54 adverse events of all grades developed in 35 (28.6%) patients, with the most common being new seizures (16%). Adverse events did not significantly differ between patients with opened and closed ventricles during surgery. The 10- and 21.7-month, median, progression-free (PFS) and overall survival (OS), respectively did not significantly differ according to resection rates. However, median PFS and OS were significantly longer among patients with closed, than open ventricles (12.8 vs. 7.4 months; p = 0.0039 and 26.9 vs. 18.6 months; p = 0.011, respectively). Implanting CW into the resection cavity during concomitant radiochemotherapy with temozolomide seems to yield better survival rates without increased adverse events. Occlusion of the ventricular opening during surgery might be safe for CW implantation, but less so for treating patients with newly diagnosed glioblastoma.

  70. Clinical Characteristics and Outcome in Elderly Patients with Traumatic Brain Injury: For Establishment of Management Strategy 査読有り

    Hiroshi Karibe, Toshiaki Hayashi, Ayumi Narisawa, Motonobu Kameyama, Atsuhiro Nakagawa, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 57 (8) 418-425 2017年8月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.st.2017-0058  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    In recent years, instances of neurotrauma in the elderly have been increasing. This article addresses the clinical characteristics, management strategy, and outcome in elderly patients with traumatic brain injury (TBI). Falls to the ground either from standing or from heights are the most common causes of TBI in the elderly, since both motor and physiological functions are degraded in the elderly. Subdural, contusional and intracerebral hematomas are more common in the elderly than the young as the acute traumatic intracranial lesion. High frequency of those lesions has been proposed to be associated with increased volume of the subdural space resulting from the atrophy of the brain in the elderly. The delayed aggravation of intracranial hematomas has been also explained by such anatomical and physiological changes present in the elderly. Delayed hyperemia/hyperperfusion may also be a characteristic of the elderly TBI, although its mechanisms are not fully understood. In addition, widely used pre-injury anticoagulant and antiplatelet therapies may be associated with delayed aggravation, making the management difficult for elderly TBI. It is an urgent issue to establish preventions and treatments for elderly TBI, since its outcome has been remained poor for more than 40 years.

  71. Endoscopic third ventriculostomy for hydrocephalus in a patient with Klippel-Feil syndrome: a case report. 国際誌 査読有り

    Ishida T, Inoue T, Fujimura M, Shimoda Y, Ezura M, Uenohara H, Tominaga T

    Clinical case reports 5 (8) 1344-1347 2017年8月

    DOI: 10.1002/ccr3.1063  

  72. Subarachnoid small vein occlusion due to inflammatory fibrosis-a possible mechanism for cerebellar infarction in cryptococcal meningoencephalitis: a case report 査読有り

    Yoshiteru Shimoda, Satoru Ohtomo, Hiroaki Arai, Takashi Ohtoh, Teiji Tominaga

    BMC NEUROLOGY 17 (1) 157 2017年8月

    出版者・発行元:BIOMED CENTRAL LTD

    DOI: 10.1186/s12883-017-0934-y  

    ISSN:1471-2377

    詳細を見る 詳細を閉じる

    Background: Cryptococcal meningoencephalitis (CM) causes cerebral infarction, typically, lacunar infarction in the basal ganglia. However, massive cerebral infarction leading to death is rare and its pathophysiology is unclear. We report a case of CM causing massive cerebellar infarction, which led to cerebral herniation and death. Case presentation: A 56-year-old man who suffered from dizziness and gait disturbance for one month was admitted to our hospital and subsequently diagnosed with a cerebellar infarction. He had a past medical history of hepatitis type B virus infection and hepatic failure. Although the findings on magnetic resonance imaging (MRI) imitated an arterial infarction of the posterior inferior cerebellar artery, an accompanying irregular peripheral edema was observed. The ischemic lesion progressed, subsequently exerting a mass effect and leading to impaired consciousness. External and internal decompression surgeries were performed. Cryptococcus neoformans was confirmed in the surgical specimen, and the patient was diagnosed with CM. In addition, venule congestion in the parenchyma was observed with extensive fibrosis and compressed veins in the subarachnoid space. The patient died 26 days after admission. Autopsy revealed that pathological changes were localized in the cerebellum. Conclusion: C. neoformans can induce extensive fibrosis of the subarachnoid space, which may compress small veins mechanically inducing venule congestion and massive cerebral infarction. In such cases, the clinical course can be severe and even rapidly fatal. An atypical pattern of infarction on MRI should alert clinicians to the possibility of C. neoformans infection.

  73. Distant recurrences limit the survival of patients with thalamic high-grade gliomas after successful resection 査読有り

    Ryuta Saito, Toshihiro Kumabe, Masayuki Kanamori, Yukihiko Sonoda, Teiji Tominaga

    NEUROSURGICAL REVIEW 40 (3) 469-477 2017年7月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s10143-016-0804-x  

    ISSN:0344-5607

    eISSN:1437-2320

    詳細を見る 詳細を閉じる

    The indications of surgery for thalamic high-grade gliomas are not well established. The present study investigated the outcome of 21 patients treated by surgery and reports the high incidence of distant recurrences including disseminations after successful removal. Twenty-one patients with thalamic high-grade gliomas not invading the pyramidal tract or midbrain underwent cytoreductive surgery at our institute from June 1997 to August 2015. Surgery was performed with the aid of a neuronavigation system, electrophysiological monitoring, and fluorescence navigation. Tumor histology included 12 cases of the World Health Organization grade III and nine cases of grade IV. Gross total resection was achieved in six cases, subtotal in 13, and partial in two. Motor weakness accompanied by sensory disturbance deteriorated immediately after surgery in 13 patients. However, five patients were determined to show deterioration at 2 months after surgery. Postoperative radiation and chemotherapy were given to every patient, and median progression-free survival of patients with grade III and IV tumors was 12.1 and 7.0 months, respectively. Median overall survival of patients with grade III and IV tumors was 25.6 and 12.6 months, respectively. High incidence of distant recurrences was found, with distant lesions at recurrence in 13 of 19 patients with recurrence, suggesting the life-restricting factor in these patients. Thalamic high-grade glioma without invasion into the pyramidal tract and brainstem can be considered as a candidate for surgical resection. Distant lesion limits the survival of patients after successful resection.

  74. Application of actuator-driven pulsed water jet in aneurysmal subarachnoid hemorrhage surgery: its effectiveness for dissection around ruptured aneurysmal walls and subarachnoid clot removal 査読有り

    Hidenori Endo, Toshiki Endo, Atsuhiro Nakagawa, Miki Fujimura, Teiji Tominaga

    NEUROSURGICAL REVIEW 40 (3) 485-493 2017年7月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s10143-016-0809-5  

    ISSN:0344-5607

    eISSN:1437-2320

    詳細を見る 詳細を閉じる

    In clipping surgery for aneurysmal subarachnoid hemorrhage (aSAH), critical steps include clot removal and dissection of aneurysms without premature rupture or brain injuries. To pursue this goal, a piezo actuator-driven pulsed water jet (ADPJ) system was introduced in this study. This study included 42 patients, who suffered aSAH and underwent clipping surgery. Eleven patients underwent surgery with the assistance of the ADPJ system (ADPJ group). In the other 31 patients, surgery was performed without the ADPJ system (Control group). The ADPJ system was used for clot removal and aneurysmal dissection. The clinical impact of the ADPJ system was judged by comparing the rate of premature rupture, degree of clot removal, and clinical outcomes. Intraoperatively, a premature rupture was encountered in 18.2 and 25.8% of cases in the ADPJ and control groups, respectively. Although the differences were not statistically significant, intraoperative observation suggested that the ADPJ system was effective in clot removal and dissection of aneurysms in a safe manner. Computed tomography scans indicated the achievement of higher degrees of clot removal, especially when the ADPJ system was used for cases with preoperative clot volumes of more than 25 ml (p = 0.047, Mann-Whitney U test). Clinical outcomes, including incidence of postoperative brain injury or symptomatic vasospasm, were similar in both groups. We described our preliminary surgical results using the ADPJ system for aSAH. Although further study is needed, the ADPJ system was considered a safe and effective tool for clot removal and dissection of aneurysms.

  75. Rapid Deterioration of Latent HBV Hepatitis during Cushing Disease and Posttraumatic Stress Disorder after Earthquake 査読有り

    Ryosuke Tashiro, Yoshikazu Ogawa, Teiji Tominaga

    JOURNAL OF NEUROLOGICAL SURGERY PART A-CENTRAL EUROPEAN NEUROSURGERY 78 (4) 407-411 2017年7月

    出版者・発行元:THIEME MEDICAL PUBL INC

    DOI: 10.1055/s-0037-1598052  

    ISSN:2193-6315

    eISSN:2193-6323

    詳細を見る 詳細を閉じる

    Reactivation of the hepatitis B virus (HBV) is a risk in the 350 million HBV carriers worldwide. HBV reactivation may cause hepatocellular carcinoma, cirrhosis, and fulminant hepatitis, and HBV reactivation accompanied with malignant tumor and/or chemotherapy is a critical problem for patients with chronic HBV infection. Multiple risk factors causing an immunosuppressive state can also induce HBV reactivation. We present a case of HBV reactivation during an immunosuppressive state caused by Cushing disease and physical and psychological stress after a disaster. A 47-year-old Japanese woman was an inactive HBV carrier until the Great East Japan Earthquake occurred and follow-up was discontinued. One year after the earthquake she had intractable hypertension, and her visual acuity gradually worsened. Head magnetic resonance imaging showed a sellar tumor compressing the optic chiasm, and hepatic dysfunction with HBV reactivation was identified. Endocrinologic examination established the diagnosis as Cushing disease. After normalization of hepatic dysfunction with antiviral therapy, transsphenoidal tumor removal was performed that resulted in subtotal removal except the right cavernous portion. Steroid hormone supplementation was discontinued after 3 days of administration, and gamma knife therapy was performed for the residual tumor. Eighteen months after the operation, adrenocorticotropic hormone and cortisol values returned to normal. The patient has been free from tumor regrowth and HBV reactivation throughout the postoperative course. Accomplishment of normalization with intrinsic steroid value with minimization of steroid supplementation should be established. Precise operative procedures and careful treatment planning are essential to avoid HBV reactivation in patients with this threatening condition.

  76. Uneven cerebral hemodynamic change as a cause of neurological deterioration in the acute stage after direct revascularization for moyamoya disease: cerebral hyperperfusion and remote ischemia caused by the 'watershed shift' 査読有り

    Xian-kun Tu, Miki Fujimura, Sherif Rashad, Shunji Mugikura, Hiroyuki Sakata, Kuniyasu Niizuma, Teiji Tominaga

    NEUROSURGICAL REVIEW 40 (3) 507-512 2017年7月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s10143-017-0845-9  

    ISSN:0344-5607

    eISSN:1437-2320

    詳細を見る 詳細を閉じる

    Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is the standard surgical treatment for moyamoya disease (MMD). The main potential complications of this treatment are cerebral hyperperfusion (CHP) syndrome and ischemia, and their managements are contradictory to each other. We retrospectively investigated the incidence of the simultaneous manifestation of CHP and infarction after surgery for MMD. Of the 162 consecutive direct revascularization surgeries performed for MMD, we encountered two adult cases (1.2%) manifesting the simultaneous occurrence of symptomatic CHP and remote infarction in the acute stage. A 47-year-old man initially presenting with infarction developed CHP syndrome (aphasia) 2 days after left STA-MCA anastomosis, as assessed by quantitative single-photon emission computed tomography (SPECT). Although lowering blood pressure ameliorated his symptoms, he developed cerebral infarction at a remote area in the acute stage. Another 63-year-old man, who initially had progressing stroke, presented with aphasia due to focal CHP in the left temporal lobe associated with acute infarction at the tip of the left frontal lobe 1 day after left STA-MCA anastomosis, when SPECT showed a paradoxical decrease in cerebral blood flow (CBF) in the left frontal lobe despite a marked increase in CBF at the site of anastomosis. Symptoms were ameliorated in both patients with the normalization of CBF, and there were no further cerebrovascular events during the follow-up period. CHP and cerebral infarction may occur simultaneously not only due to blood pressure lowering against CHP, but also to the 'watershed shift' phenomenon, which needs to be elucidated in future studies.

  77. Navigation-guided clipping of a de novo aneurysm associated with superficial temporal artery-middle cerebral artery bypass combined with indirect pial synangiosis in a patient with moyamoya disease 査読有り

    Daiki Aburakawa, Miki Fujimura, Kuniyasu Niizuma, Hiroyuki Sakata, Hidenori Endo, Teiji Tominaga

    NEUROSURGICAL REVIEW 40 (3) 517-521 2017年7月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s10143-017-0866-4  

    ISSN:0344-5607

    eISSN:1437-2320

    詳細を見る 詳細を閉じる

    De novo aneurysms associated with superficial temporal artery (STA)-middle cerebral artery (MCA) bypass are an extremely rare complication of direct revascularization surgery for moyamoya disease (MMD). The basic pathology of MMD includes fragility of the intracranial arterial wall characterized by medial layer thinness and waving of the internal elastic lamina. However, the incidence of newly formed aneurysms at the site of anastomosis currently remains unknown. Among 317 consecutive direct/indirect combined revascularization surgeries performed for MMD, we encountered a 52-year-old woman manifesting a de novo aneurysm adjacent to the site of anastomosis 11 years after successful STA-MCA bypass with encephalo-duro-myo-synangiosis (EDMS). Although the patient remained asymptomatic, the aneurysm gradually increased in diameter to more than 6 mm with the formation of a daughter sac, and a computational fluid dynamic study revealed low wall shear stress at the aneurysm dome. The patient underwent microsurgical clipping of the aneurysm using a neuro-navigation system that permitted the minimally invasive dissection of the temporal muscle flap used for EDMS at the site of the aneurysm without affecting pial synangiosis. The aneurysm was successfully occluded using a titanium clip without complications. The postoperative course was uneventful, and the patient was discharged without neurological deficits. De novo aneurysms associated with STA-MCA bypass for MMD may be safely treated with microsurgical clipping, even in cases initially managed by a combined revascularization procedure that includes complex pial synangiosis. We recommend the application of the neuro-navigation system for the maximum preservation of pial synangiosis during this procedure.

  78. A hemorrhagic complication after Onyx embolization of a tentorial dural arteriovenous fistula: A caution about subdural extension with pial arterial supply 査読有り

    Kenichi Sato, Yasushi Matsumoto, Hidenori Endo, Teiji Tominaga

    INTERVENTIONAL NEURORADIOLOGY 23 (3) 307-312 2017年6月

    出版者・発行元:SAGE PUBLICATIONS INC

    DOI: 10.1177/1591019917694839  

    ISSN:1591-0199

    eISSN:2385-2011

    詳細を見る 詳細を閉じる

    We report a case of tentorial dural arteriovenous fistula (DAVF) with a severe intracranial hemorrhage occurring after Onyx embolization. A 40-year-old man presented with an asymptomatic tentorial DAVF on angiography. Transarterial embolization with Onyx was performed via the middle meningeal artery, and the cast filled the fistula itself and its proximal draining vein. Postoperative angiography confirmed complete occlusion of the DAVF. A computed tomography scan performed immediately after the procedure demonstrated an acute subdural hematoma with the temporal hemorrhage. Emergency craniotomy revealed continuous arterial bleeding from a viable glomus-like vascular structure around the proximal part of the embolized draining vein, fed by a pial artery arising from the posterior cerebral artery. Pathologic findings suggested diagnosis of vascular malformation extending into the subdural space. Tentorial DAVFs can extend to the subdural space along their drainage route, and may be involved in severe hemorrhagic complications of curative endovascular treatment using Onyx, particularly those with pial arterial supply.

  79. Suprasellar Hemangioblastoma Unrelated to von Hippel-Lindau Disease Successfully Treated through Extended Transsphenoidal Approach: Diagnostic Value of Von Hippel-Lindau Disease Gene-Derived Protein 査読有り

    Jia Wenting, Yoshikazu Ogawa, Jun Ito, Teiji Tominaga

    JOURNAL OF NEUROLOGICAL SURGERY PART A-CENTRAL EUROPEAN NEUROSURGERY 78 (3) 296-301 2017年5月

    出版者・発行元:THIEME MEDICAL PUBL INC

    DOI: 10.1055/s-0036-1582016  

    ISSN:2193-6315

    eISSN:2193-6323

    詳細を見る 詳細を閉じる

    Hemangioblastoma tends to occur in the infratentorial regions and rarely in the supratentorial regions. This tumor is strongly associated with von Hippel-Lindau disease (VHLD), especially in the supratentorial regions, with only 12 cases of suprasellar hemangioblastoma unrelated to VHLD. However, all these cases were diagnosed based on clinical screening and confirmation of family history. We report a case of suprasellar hemangioblastoma that was successfully removed through an extended transsphenoidal approach and diagnosed as a sporadic case unrelated to VHLD by immunohistochemical examination. A 67-year-old woman had mild diabetes insipidus and a visual field defect. Head magnetic resonance imaging revealed a suprasellar tumor compressing the optic chiasm upward. The tumor was totally removed without complication through an extended transsphenoidal approach. Postoperative histologic examination disclosed large vacuolated stromal cells and rich capillary networks, and the diagnosis was established as hemangioblastoma. Clinical screening and confirmation of family history revealed no specific results, and additional immunohistochemical staining showed diffuse cytoplasmic expression of anti-VHLD gene-derived protein (pVHL). We emphasize that pVHL immunohistochemical evaluation would be wise to adopt, especially for patients with a high risk of VHLD related to younger age and supratentorial lesions.

  80. Fine morphological evaluation of hypothalamus in patients with hyperphagia 査読有り

    Yoshikazu Ogawa, Kuniyasu Niizuma, Teiji Tominaga

    ACTA NEUROCHIRURGICA 159 (5) 865-871 2017年5月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-017-3112-5  

    ISSN:0001-6268

    eISSN:0942-0940

    詳細を見る 詳細を閉じる

    Various metabolic diseases induced by eating disorders are some of the most serious and difficult problems for modern public healthcare. However, little is known about hyperphagia, partly because of the lack of a clear definition. Several basic studies have analyzed eating habits using endocrinological or neurophysiological approaches, which have suggested a controlled balance between the hunger and satiety centers in the central nervous system. However, more detailed neuro-radiologic evaluations have not been achieved for the hypothalamus, and evaluations were limited only to the floor of the third ventricles. Fine structures of hypothalamic morphology were investigated using high-resolution magnetic resonance imaging in seven patients with hypothalamo-pituitary tumors, who suffered from preoperative hyperphagia-induced severe obesity and metabolic disorders. Body mass index (BMI) varied from 22.4 to 40.5 kg/m(2) (mean 32.8 kg/m(2)). Clinical data were compared with the data of nine patients without hyperphagia and seven healthy volunteers. Morphological evaluation was possible in all patients and control subjects, and patients with hyperphagia had significantly shortened maximum distances between the ependymal layers of the lateral wall of the third ventricle and fornixes (hyperphagia group right side 0.30 mm, left side 0.23 mm vs. patients without hyperphagia group right side 1.60, left side 1.53 vs. healthy group right side 1.73 mm, left side 1.85 mm) (p &lt; 0.01). Two patients achieved postoperative improvement in both clinical and neuro-radiological findings. Eating and metabolic disorders are related to strong dysfunction of the medial nuclei of the hypothalamus in patients with hypothalamo-pituitary tumors. We report the first case of dynamic improvement from hyperphagia, with both symptomatic and neuro-radiological findings.

  81. Intraoperative Visualization of Subependymal Arteries at the Atrium Supplying the Descending Motor Pathway 査読有り

    Mitsuto Hanihara, Sumito Sato, Ichiyo Shibahara, Ryuta Saito, Masayuki Kanamori, Yukihiko Sonoda, Hiroyuki Kinouchi, Teiji Tominaga, Toshihiro Kumabe

    WORLD NEUROSURGERY 101 296-303 2017年5月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.wneu.2017.02.022  

    ISSN:1878-8750

    eISSN:1878-8769

    詳細を見る 詳細を閉じる

    OBJECTIVE: We previously disclosed that damage to the subependymal arteries (SEAs) caused by coagulation of the choroid plexus at the atrium can result in infarction within the lateral posterior choroidal artery territory, followed by hemiparesis. The present study describes the intra-operative anatomical findings of the SEAs and choroid plexus at the atrium, which were verified only by a few cadaveric studies. METHODS: Locations of the SEA and descending motor pathway were determined with the neuronavigation system and subcortical electrical stimulation in 8 cases of periatrial brain tumor. Indocyanine green videoangiography was performed to verify the blood flowin the choroid plexus and SEAs. RESULTS: Intraoperative visualization of the SEAs was performed successfully in all patients. The neuronavigation system and subcortical electrical stimulation mapping demonstrated that these SEAs penetrated into the descending motor pathway. Indocyanine green depicted the blood flow of the SEAs entering the wall of the lateral ventricle and adjacent brain parenchyma. The blood flow directions between the SEAs and choroid plexus were not uniform, because the SEAs were filled ahead of the choroid plexus in 3 cases, whereas the choroid plexus was filled first in the other 2 cases. CONCLUSIONS: Manipulations to the inner side of the choroid plexus at the transition from the atrium to the body of lateral ventricle can damage the SEAs. Not only coagulation of the SEAs themselves, but also coagulation of choroid plexus itself may reduce the blood flow in the SEAs, resulting in ischemic complications at descending motor pathway.

  82. Convection-enhanced delivery of a hydrophilic nitrosourea ameliorates deficits and suppresses tumor growth in experimental spinal cord glioma models 査読有り

    Shogo Ogita, Toshiki Endo, Shinichiro Sugiyama, Ryuta Saito, Tomoo Inoue, Akira Sumiyoshi, Hiroi Nonaka, Ryuta Kawashima, Yukihiko Sonoda, Teiji Tominaga

    ACTA NEUROCHIRURGICA 159 (5) 939-946 2017年5月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-017-3123-2  

    ISSN:0001-6268

    eISSN:0942-0940

    詳細を見る 詳細を閉じる

    Convection-enhanced delivery (CED) is a technique allowing local infusion of therapeutic agents into the central nervous system, circumventing the blood-brain or spinal cord barrier. To evaluate the utility of nimustine hydrochloride (ACNU) CED in controlling tumor progression in an experimental spinal cord glioma model. Toxicity studies were performed in 42 rats following the administration of 4 mu l of ACNU CED into the mid-thoracic spinal cord at concentrations ranging from 0.1 to 10 mg/ml. Behavioral analyses and histological evaluations were performed to assess ACNU toxicity in the spinal cord. A survival study was performed in 32 rats following the implantation of 9 L cells into the T8 spinal cord. Seven days after the implantation, rats were assigned to four groups: ACNU CED (0.25 mg/ml; n = 8); ACNU intravenous (i.v.) (0.4 mg; n = 8); saline CED (n = 8); saline i.v. (n = 8). Hind limb movements were evaluated daily in all rats for 21 days. Tumor sizes were measured histologically. The maximum tolerated ACNU concentration was 0.25 mg/ml. Preservation of hind limb motor function and tumor growth suppression was observed in the ACNU CED (0.25 mg/ml) and ACNU i.v. groups. Antitumor effects were more prominent in the ACNU CED group especially in behavioral analyses (P &lt; 0.05; log-rank test). ACNU CED had efficacy in controlling tumor growth and preserving neurological function in an experimental spinal cord tumor model. ACNU CED can be a viable treatment option for spinal cord high-grade glioma.

  83. Use of Indocyanine Green Fluorescence Endoscopy to Treat Concurrent Perimedullary and Dural Arteriovenous Fistulas in the Cervical Spine 査読有り

    Akira Ito, Toshiki Endo, Tomoo Inoue, Hidenori Endo, Kenichi Sato, Teiji Tominaga

    WORLD NEUROSURGERY 101 814.e1-814.e6 2017年5月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.wneu.2017.03.032  

    ISSN:1878-8750

    eISSN:1878-8769

    詳細を見る 詳細を閉じる

    BACKGROUND: Intraoperative microscopic fluorescence angiography using indocyanine green (ICG) provides visual information on real-time blood flow. However, this method cannot be applied for lesions that are not visible under microscopic imaging because excitation light does not reach the targeted vascular structures. Endoscope-integrated ICG video-angiography has recently been advocated to compensate for this limitation. This is the first reported case of a spinal arteriovenous malformation in which endoscope-integrated ICG video-angiography was successfully used. CASE DESCRIPTION: We report the case of a 63-year-old man who presented with a subarachnoid hemorrhage from a spinal arteriovenous malformation at the C3 level. We chose the direct surgery option with a posterior approach to treat this lesion. Although the preoperative diagnosis was a perimedullary arteriovenous fistula (AVF) with multiple feeders, we found concurrent dural AVF and perimedullary AVFs during surgery. We introduced an endoscope and performed endoscope-integrated ICG video-angiography because it was difficult to identify the angioarchitectures of the perimedural and dural AVFs on the ventral surface of the spinal cord under microscopic view alone. Endoscope-integrated ICG video-angiography gave us clear and magnified angioarchitectures of these lesions. The fistulous point and the varix of the perimedullary AVF was coagulated and dissected under endoscopic view, and the draining vein of the dural AVF was also coagulated and dissected at the origin from the dura mater under microscopic view. CONCLUSIONS: A posterior approach with the assistance of an endoscope and endoscope-integrated ICG video-angiography is feasible for spinal vascular diseases located ventrally.

  84. Embolization of the choroidal artery in the treatment of cerebral arteriovenous malformations 査読有り

    Alaa Elkordy, Hidenori Endo, Kenichi Sato, Yasushi Matsumoto, Ryushi Kondo, Kuniyasu Niizuma, Toshiki Endo, Miki Fujimura, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 126 (4) 1114-1122 2017年4月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2016.2.JNS152370  

    ISSN:0022-3085

    eISSN:1933-0693

    詳細を見る 詳細を閉じる

    OBJECTIVE The anterior and posterior choroidal arteries are often recruited to supply arteriovenous malformations (AVMs) involving important paraventricular structures, such as the basal ganglia, internal capsule, optic radiation, lateral geniculate body, and medial temporal lobe. Endovascular embolization through these arteries is theoretically dangerous because they supply eloquent territories, are of small caliber, and lack collaterals. This study aimed to investigate the safety and efficacy of embolization through these arteries. METHODS This study retrospectively reviewed 13 patients with cerebral AVMs who underwent endovascular embolization through the choroidal arteries between 2006 and 2014. Embolization was performed as a palliative procedure before open surgery or Gamma Knife radiosurgery. Computed tomography and MRI were performed the day after embolization to assess any surgical complications. The incidence and type of complications and their association with clinical outcomes were analyzed. RESULTS Decreased blood flow was achieved in all patients after embolization. Postoperative CT detected no hemorrhagic complications. In contrast, postoperative MRI detected that 4 of the 13 patients (30.7%) developed infarctions: 3 patients after embolization through the anterior choroidal artery, and 1 patient after embolization through the lateral posterior choroidal artery. Two of the 4 patients in whom embolization was from the cisternal segment of the anterior choroidal artery (proximal to the plexal point) developed symptomatic infarction of the posterior limb of the internal capsule, 1 of whom developed morbidity (7.7%). The treatment-related mortality rate was 0%. Additional treatment was performed in 12 patients: open surgery in 9 and Gamma Knife radiosurgery in 3 patients. Complete obliteration was confirmed by angiography at the last follow-up in 10 patients. Recurrent bleeding from the AVMs did not occur in any of the cases during the follow-up period. CONCLUSIONS Ischemic complications are possible following the embolization of cerebral AVMs through the choroidal artery, even with modern neurointerventional devices and techniques. Although further study is needed, embolization through the choroidal artery may be an appropriate treatment option when the risk of surgery or radiosurgery is considered to outweigh the risk of embolization.

  85. Stereotactic radiosurgery as a feasible treatment for intramedullary spinal arteriovenous malformations: a single-center observation 査読有り

    Sherif Rashad, Toshiki Endo, Yoshihiro Ogawa, Kenichi Sato, Hidenori Endo, Yasushi Matsumoto, Akira Takahashi, Teiji Tominaga

    NEUROSURGICAL REVIEW 40 (2) 259-266 2017年4月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s10143-016-0758-z  

    ISSN:0344-5607

    eISSN:1437-2320

    詳細を見る 詳細を閉じる

    Spinal cord intramedullary arteriovenous malformations are rare. For patients suffering from either hemorrhage or myelopathy, surgical or endovascular interventions are indicated. However, complete eradication of the nidus is often difficult because of its intramedullary location and complex angioarchitecture. In this report, we evaluate the feasibility and safety of stereotactic radiosurgery as a treatment modality for intramedullary spinal arteriovenous malformations (AVMs). Between 2010 and 2014, we performed stereotactic radiosurgery to treat four patients with intramedullary AVM and one with spinal arteriovenous metameric syndrome (one woman and four men; age range, 31-66 years). Three patients presented with myelopathy, and two suffered hemorrhages. Nidi were located in the cervical (three cases) and thoracic (two cases) spinal cord regions. Based on the angioarchitecture, surgery and endovascular embolization were indicated. When both modalities were deemed hazardous, radiosurgery using CyberKnife (TM) was offered. Radiation using marginal doses of 18 Gy was administered in three fractions. The mean follow-up period was 37.2 months (range, 16-62 months). After treatment, two of the three patients with myelopathy experienced either improvement or stabilization of their symptoms and one experienced worsening of dysesthesia. In two patients with hemorrhage, symptoms improved in one and remained stable in the other. No further hemorrhagic episodes were evident during follow-up. Follow-up angiograms showed marked shrinkage of the nidus located in the thoracic spinal cord in one case and angiographic stabilization in the others. As a treatment modality for intramedullary AVMs, CyberKnife (TM) is safe and can be considered when surgery or endovascular therapy is not indicated. To determine optimum radiation doses and protocols for treating spinal AVMs, further studies with more patients and long-term follow-up are required.

  86. Fourth Ventricle Outlet Obstruction with Expanding Space on the Surface of Cerebellum 査読有り

    Yoshiteru Shimoda, Kensuke Murakami, Norio Narita, Teiji Tominaga

    WORLD NEUROSURGERY 100 711.e1-711.e5 2017年4月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.wneu.2017.01.088  

    ISSN:1878-8750

    eISSN:1878-8769

    詳細を見る 詳細を閉じる

    BACKGROUND: Hydrocephalus is classified as noncommunicating and communicating based on whether all ventricular and subarachnoid spaces are communicating. Although the diagnosis between the two different states is crucial, it is difficult in certain conditions. In particular, communicating hydrocephalus and noncommunicating hydrocephalus owing to fourth ventricle outlet obstruction are highly misdiagnosed. We describe a case of fourth ventricle outlet obstruction of unknown origin that was initially misdiagnosed as communicating hydrocephalus. CASE DESCRIPTION: A 66-year-old woman with gait disturbance and incontinence caused by hydrocephalus underwent ventriculoperitoneal shunt surgery. After 9 months, her fourth ventricle became enlarged and could not be controlled by lowering the shunt pressure. Magnetic resonance imaging (MRI) demonstrated obstruction at the foramen of Magendie, foramina of Luschka, and the cerebral aqueduct. Endoscopic surgery for aqueduct plasty with third ventriculostomy was planned. Because the aqueduct was observed to open spontaneously, only the standard third ventriculostomy was performed. When MRI findings were reviewed retrospectively, an unnatural space was observed between the lower cranial nerves and cerebellar hemisphere that grew along with the fourth ventricular enlargement. This space was determined by MRI cisternography to be the cystic membrane ballooning out from the foramen of Luschka. The primary hydrocephalus likely resulted from fourth ventricle outlet obstruction. CONCLUSIONS: Enlargement of the whole ventricular system with an expanded space between the lower cranial nerves and cerebellar hemisphere can be caused by fourth ventricle outlet obstruction. In such cases, preoperative evaluation of anatomic architecture and cerebrospinal fluid obstruction using MRI cisternography is essential and leads to a successful endoscopic strategy.

  87. New Application of Actuator-Driven Pulsed Water Jet for Spinal Cord Dissection: An Experimental Study in Pigs 査読有り

    Toshiki Endo, Jia Wenting, Atsuhiro Nakagawa, Hidenori Endo, Yuto Sagae, Masaki Iwasaki, Teiji Tominaga

    JOURNAL OF NEUROLOGICAL SURGERY PART A-CENTRAL EUROPEAN NEUROSURGERY 78 (2) 137-143 2017年3月

    出版者・発行元:THIEME MEDICAL PUBL INC

    DOI: 10.1055/s-0036-1584919  

    ISSN:2193-6315

    eISSN:2193-6323

    詳細を見る 詳細を閉じる

    Background Surgery for intramedullary tumors is technically demanding because it requires surgical resection along with functional preservation of the spinal cord. The water jet dissector is an emerging tool in neurologic surgeries and a novel tool in spinal cord surgeries. This article evaluates the usefulness and safety of water jet dissection in an experimental study. Methods A pulsed water jet was applied to dissect the posterior median sulcus of the spinal cords of seven anesthetized pigs. In four pigs, the water jet was delivered on the dorsal spinal cord at different input voltages (5, 10, and 15 V) and for durations of either 15 or 30 seconds. The depth and dissected areas were measured histologically and compared. In three separate pigs, somatosensory evoked potentials (SEPs) were recorded before and after dissection (10 V for 30 seconds) to evaluate the function of the dorsal column sensory pathway. Results Increased pressure and duration of exposure to the pulsed water jet led to deeper and wider dissection of the dorsal spinal cord. Application of the water jet at 5 or 10 V allowed precise dissection along the dorsal columns along with the preservation of microvasculature. During SEP monitoring, responses were maintained after application of the water jet to the posterior column at 10 V for 30 seconds. Conclusions The pulsed water jet is a feasible option for spinal cord dissection. Characteristics of this water jet may help surgeons achieve complete resection of intramedullary tumors along with preserving satisfactory postoperative neurologic functions.

  88. Genome-wide methylation profiles in primary intracranial germ cell tumors indicate a primordial germ cell origin for germinomas 査読有り

    Shintaro Fukushima, Satoshi Yamashita, Hisato Kobayashi, Hirokazu Takami, Kohei Fukuoka, Taishi Nakamura, Kai Yamasaki, Yuko Matsushita, Hiromi Nakamura, Yasushi Totoki, Mamoru Kato, Tomonari Suzuki, Kazuhiko Mishima, Takaaki Yanagisawa, Akitake Mukasa, Nobuhito Saito, Masayuki Kanamori, Toshihiro Kumabe, Teiji Tominaga, Motoo Nagane, Toshihiko Iuchi, Koji Yoshimoto, Masahiro Mizoguchi, Kaoru Tamura, Keiichi Sakai, Kazuhiko Sugiyama, Mitsutoshi Nakada, Kiyotaka Yokogami, Hideo Takeshima, Yonehiro Kanemura, Masahide Matsuda, Akira Matsumura, Kazuhiko Kurozumi, Keisuke Ueki, Masahiro Nonaka, Akio Asai, Nobutaka Kawahara, Yuichi Hirose, Tatusya Takayama, Yoichi Nakazato, Yoshitaka Narita, Tatsuhiro Shibata, Masao Matsutani, Toshikazu Ushijima, Ryo Nishikawa, Koichi Ichimura

    ACTA NEUROPATHOLOGICA 133 (3) 445-462 2017年3月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00401-017-1673-2  

    ISSN:0001-6322

    eISSN:1432-0533

    詳細を見る 詳細を閉じる

    Intracranial germ cell tumors (iGCTs) are the second most common brain tumors among children under 14 in Japan. The World Health Organization classification recognizes several subtypes of iGCTs, which are conventionally subclassified into pure germinoma or non-germinomatous GCTs. Recent exhaustive genomic studies showed that mutations of the genes involved in the MAPK and/or PI3K pathways are common in iGCTs; however, the mechanisms of how different subtypes develop, often as a mixed-GCT, are unknown. To elucidate the pathogenesis of iGCTs, we investigated 61 GCTs of various subtypes by genome-wide DNA methylation profiling. We showed that pure germinomas are characterized by global low DNA methylation, a unique epigenetic feature making them distinct from all other iGCTs subtypes. The patterns of methylation strongly resemble that of primordial germ cells (PGC) at the migration phase, possibly indicating the cell of origin for these tumors. Unlike PGC, however, hypomethylation extends to long interspersed nuclear element retrotransposons. Histologically and epigenetically distinct microdissected components of mixed-GCTs shared identical somatic mutations in the MAPK or PI3K pathways, indicating that they developed from a common ancestral cell.

  89. Human Muse Cells Reconstruct Neuronal Circuitry in Subacute Lacunar Stroke Model 査読有り

    Hiroki Uchida, Kuniyasu Niizuma, Yoshihiro Kushida, Shohei Wakao, Teiji Tominaga, Cesario V. Borlongan, Mari Dezawa

    STROKE 48 (2) 428-435 2017年2月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1161/STROKEAHA.116.014950  

    ISSN:0039-2499

    eISSN:1524-4628

    詳細を見る 詳細を閉じる

    Background and Purpose Multilineage-differentiating stress-enduring (muse) cells are endogenous nontumorigenic stem cells with pluripotency harvestable as pluripotent marker SSEA-3(+) cells from the bone marrow from cultured bone marrow-mesenchymal stem cells. After transplantation into neurological disease models, muse cells exert repair effects, but the exact mechanism remains inconclusive. Methods We conducted mechanism-based experiments by transplanting serum/xeno-free cultured-human bone marrow-muse cells into the perilesion brain at 2 weeks after lacunar infarction in immunodeficient mice. Results Approximately 28% of initially transplanted muse cells remained in the host brain at 8 weeks, spontaneously differentiated into cells expressing NeuN (approximate to 62%), MAP2 (approximate to 30%), and GST-pi (approximate to 12%). Dextran tracing revealed connections between host neurons and muse cells at the lesioned motor cortex and the anterior horn. Muse cells extended neurites through the ipsilateral pyramidal tract, crossed to contralateral side, and reached to the pyramidal tract in the dorsal funiculus of spinal cord. Muse-transplanted stroke mice displayed significant recovery in cylinder tests, which was reverted by the human-selective diphtheria toxin. At 10 months post-transplantation, human-specific Alu sequence was detected only in the brain but not in other organs, with no evidence of tumor formation. Conclusions Transplantation at the delayed subacute phase showed muse cells differentiated into neural cells, facilitated neural reconstruction, improved functions, and displayed solid safety outcomes over prolonged graft maturation period, indicating their therapeutic potential for lacunar stroke.

  90. Response by Sugiyama and Tominaga to Letter Regarding Article, "Blood Flow Into Basilar Tip Aneurysms: A Predictor for Recanalization After Coil Embolization". 査読有り

    Sugiyama SI, Tominaga T

    Stroke 48 (2) e77 2017年2月

    DOI: 10.1161/STROKEAHA.116.016034  

    ISSN:0039-2499

  91. Preoperative embolization and immediate removal of a giant pituitary adenoma: A case report 査読有り

    Shunsuke Omodaka, Yoshikazu Ogawa, Kenichi Sato, Yasushi Matsumoto, Teiji Tominaga

    BMC Research Notes 10 (1) 63 2017年1月26日

    出版者・発行元:BioMed Central Ltd.

    DOI: 10.1186/s13104-017-2383-5  

    ISSN:1756-0500

    詳細を見る 詳細を閉じる

    Background: Giant pituitary adenomas, with maximum diameter of at least 40 mm, continue to involve high surgical risks despite recent advances in microsurgical and/or endoscopic surgery. We treated a case of giant pituitary adenoma with preoperative endovascular embolization in an attempt to reduce blood loss. Case presentation: A 48-year-old Japanese Woman presented with severe right visual disturbance. Magnetic resonance imaging revealed a giant pituitary adenoma with maximum diameter of 82 mm. Angiography revealed significant tumor stain, with blood supply mainly from the branches of the right meningohypophyseal trunk. These feeding arteries were endovascularly embolized with n-butyl cyanoacrylate. Subsequently, the tumor was safely removed by transsphenoidal surgery in two stages. The patient showed significant improvement of visual disturbance postoperatively, and was discharged without other neurological deficit. The surgical policy was explained preoperatively to the patients and written informed consents were obtained. Conclusions: Preoperative embolization of a giant pituitary adenoma is a useful procedure that can potentially decrease the morbidity and mortality of this devastating tumor.

  92. De Novo Development of Moyamoya Disease in an Adult Female with a Genetic Variant of the RNF-213 Gene: Case Report 査読有り

    Ryosuke Tashiro, Miki Fujimura, Kuniyasu Niizuma, Hidenori Endo, Hiroyuki Sakata, Mika Sato-Maeda, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 26 (1) E8-E11 2017年1月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.035  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Background: The de novo development of moyamoya disease (MMD) in adults is extremely rare, with only 2 cases being previously reported. Furthermore, the mechanisms underlying the progression of adult MMD have not been elucidated yet. Case report: A transient ischemic attack occurred in a 46-year-old woman, owing to progressive MMD. Magnetic resonance (MR) angiography performed 7 years before the diagnosis of MMD did not detect any steno-occlusive changes in the major intracranial vessels, including the internal carotid artery (ICA) and the middle cerebral artery (MCA). However, during the last 2 years, serial MR angiography revealed the gradual progression of left MCA stenosis and ultimately showed apparent stenosis of the bilateral terminal ICA to proximal MCA. Catheter angiography confirmed the definitive diagnosis of MMD. A genetic analysis of RING-finger protein (RNF)-13, an MMD susceptibility gene, revealed that not only the patient, but also her sister, brother, and daughter had the heterozygous variant of the RNF-213 gene. Because of hemodynamic compromise with ischemic symptoms, the patient underwent revascularization surgery on the affected hemisphere, without complications. She had no cerebrovascular event in the postoperative follow-up period of 8 months, and there was no evidence of the further progression of MMD. Conclusion: We herein present the entire clinical course of the de novo development of MMD in a female adult. Newly developed MMD in an adult patient with a characteristic variant of the RNF-213 gene appears to be unique. Key Words: Moyamoya disease-de novo-development-adult-RNF-213 gene. (C) 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  93. Extremely Late Recurrence 21 Years after Total Removal of Immature Teratoma: A Case Report and Literature Review 査読有り

    Yui Mano, Masayuki Kanamori, Toshihiro Kumabe, Ryuta Saito, Mika Watanabe, Yukihiko Sonoda, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 57 (1) 51-56 2017年1月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.cr.2016-0241  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Immature teratoma (IMT) is normally treated by resection and adjuvant therapy. The present unusual case of recurrent germinoma occurred 21 years after total resection of pineal IMT. A 3-year-old boy presented with headache, disturbance of consciousness, and Parinaud's syndrome. Magnetic resonance (MR) imaging revealed a pineal mass lesion, and total resection of the tumor was achieved. The histological diagnosis was mature teratoma. He did not receive further treatment, and did well without recurrence for 20 years. However, he suffered headache 21 years after resection, and MR imaging revealed a homogeneously enhanced pineal mass with low minimum apparent diffusion coefficient value and proton MR spectroscopy showed a huge lipid peak. The levels of tumor markers were not elevated. Cerebrospinal fluid (CSF) cytology found atypical cells with large nuclei and irregularly shaped nucleoli. To elucidate the relationship between the primary and recurrent tumors, we reviewed the histological specimens and CSF cytology at the initial treatment and found a subset of incompletely differentiated components resembling fetal tissues in the histological specimen and atypical large cells in the CSF. Based on these radiological and histological findings, we presume that the recurrent disease was disseminated germinoma after the resection of disseminated IMT. He received chemotherapy and craniospinal radiation therapy, and the enhanced lesion and atypical cells in the CSF disappeared. This case demonstrates that disseminated IMT can be controlled for the long term without adjuvant therapy, but may recur as germinoma. Tumor dormancy may account for this unusual course.

  94. Convection-enhanced Delivery of Therapeutics for Malignant Gliomas 査読有り

    Ryuta Saito, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 57 (1) 8-16 2017年1月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.ra.2016-0071  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Convection-enhanced delivery (CED) circumvents the blood-brain barrier by delivering agents directly into the tumor and surrounding parenchyma. CED can achieve large volumes of distribution by continuous positive-pressure infusion. Although promising as an effective drug delivery method in concept, the administration of therapeutic agents via CED is not without challenges. Limitations of distribution remain a problem in large brains, such as those of humans. Accurate and consistent delivery of an agent is another challenge associated with CED. Similar to the difficulties caused by immunosuppressive environments associated with gliomas, there are several mechanisms that make effective local drug distribution difficult in malignant gliomas. In this review, methods for local drug application targeting gliomas are discussed with special emphasis on CED. Although early clinical trials have failed to demonstrate the efficacy of CED against gliomas, CED potentially can be a platform for translating the molecular understanding of glioblastomas achieved in the laboratory into effective clinical treatments. Several clinical studies using CED of chemotherapeutic agents are ongoing. Successful delivery of effective agents should prove the efficacy of CED in the near future.

  95. Preventive Effect of Clazosentan against Cerebral Vasospasm after Clipping Surgery for Aneurysmal Subarachnoid Hemorrhage in Japanese and Korean Patients 査読有り

    Miki Fujimura, Jin-Yang Joo, Jong-Soo Kim, Motonori Hatta, Yoshinari Yokoyama, Teiji Tominaga

    CEREBROVASCULAR DISEASES 44 (1-2) 59-67 2017年

    出版者・発行元:KARGER

    DOI: 10.1159/000475824  

    ISSN:1015-9770

    eISSN:1421-9786

    詳細を見る 詳細を閉じる

    Background: Clazosentan has been explored worldwide for the prophylaxis of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). In a dose-finding trial (CONSCIOUS-1) conducted in Israel, Europe, and North America, clazosentan (1, 5, and 15 mg/h) significantly reduced the incidence of cerebral vasospasm, but its efficacy in Japanese and Korean patients was unknown. We conducted a double-blind comparative study to evaluate the occurrence of cerebral vasospasm in Japanese and Korean patients with aSAH. Methods: The aim of this multicenter, double-blind, randomized, placebo-controlled, dose-finding phase 2 clinical trial, was to evaluate the efficacy, pharmacokinetics, and safety of clazosentan (5 and 10 mg/h) against cerebral vasospasm after clipping surgery in Japanese and Korean patients with aSAH. Patients aged between 20 and 75 years were administered the study drug within 56 h after the aneurysm rupture and up to day 14 post-aSAH. The incidence of vasospasm, defined as an inner artery diameter reduction of major intracranial arteries &gt;= 34% based on catheter angiography, was compared between each treatment group. Cerebral infarction due to vasospasm at 6 weeks and patients' outcome at 3 months was also compared. Results: Among 181 enrolled patients, 158 completed the study and were analyzed. The incidence of vasospasm up to day 14 after aSAH onset was 80.0% in the placebo group (95% CI 67.0-89.6), 38.5% in the 5 mg/h clazosentan group (95% CI 25.3-53.0), and 35.3% in the 10 mg/h clazosentan group (95% CI 22.4-49.9), indicating that the incidence of vasospasm was significantly reduced by clazosentan treatment (placebo vs. 5 mg/h clazosentan, p &lt; 0.0001; placebo vs. 10 mg/h clazosentan, p &lt; 0.0001). The occurrence of cerebral infarction due to vasospasm was 20.8% in the placebo group (95% CI 10.8-34.1), 3.8% in the 5 mg/h clazosentan group (95% CI 0.5-13.2), and 4.2% in the 10 mg/h clazosentan group (95% CI 0.5-14.3), indicating that clazosentan significantly reduced the occurrence of cerebral infarctions caused by vasospasm (placebo vs. 5 mg/h clazosentan, p = 0.0151; placebo vs. 10 mg/h clazosentan, p = 0.0165). The overall incidence of allcause death and/or vasospasm-related morbidity/mortality was significantly reduced in the 10 mg/h clazosentan group compared with the placebo group (p = 0.0003). Conclusion: These results suggest that clazosentan prevents cerebral vasospasm and subsequent cerebral infarction, and could thereby improve outcomes after performing a clipping surgery for aSAH in Japanese and Korean patients. (C) 2017 The Author(s) Published by S. Karger AG, Basel

  96. Satellite Sign: A Poor Outcome Predictor in Intracerebral Hemorrhage 査読有り

    Yoshiteru Shimoda, Satoru Ohtomo, Hiroaki Arai, Ken Okada, Teiji Tominaga

    CEREBROVASCULAR DISEASES 44 (3-4) 105-112 2017年

    出版者・発行元:KARGER

    DOI: 10.1159/000477179  

    ISSN:1015-9770

    eISSN:1421-9786

    詳細を見る 詳細を閉じる

    Background: The presence of high-density starry dots around the intracerebral hemorrhage (ICH), which we termed as a satellite sign, is occasionally observed in CT. The relationship between ICH with a satellite sign and its functional outcome has not been identified. This study aimed to determine whether the presence of a satellite sign could be an independent prognostic factor for patients with ICH. Methods: Patients with acute spontaneous ICH were retrospectively identified and their initial CT scans were reviewed. A satellite sign was defined as scattered high-density lesions completely separate from the main hemorrhage in at least the single axial slice. Functional outcome was evaluated using the modified Rankin Scale (mRS) at discharge. Poor functional outcome was defined as mRS scores of 3-6. Univariate and multivariate logistic regression analyses were applied to assess the presence of a satellite sign and its association with poor functional outcome. Results: A total of 241 patients with ICH were enrolled in the study. Of these, 98 (40.7%) had a satellite sign. Patients with a satellite sign had a significantly higher rate of poor functional outcome (95.9%) than those without a satellite sign (55.9%, p &lt; 0.0001). Multivariate logistic regression analysis revealed that higher age (OR 1.06; 95% CI 1.03-1.10; p = 0.00016), large hemorrhage size (OR 1.06; 95% CI 1.03-1.11; p = 0.00015), and ICH with a satellite sign (OR 13.5; 95% CI 4.42-53.4; p &lt; 0.0001) were significantly related to poor outcome. A satellite sign was significantly related with higher systolic blood pressure (p = 0.0014), higher diastolic blood pressure (p = 0.0117), shorter activated partial thromboplastin time (p = 0.0427), higher rate of intraventricular bleeding (p &lt; 0.0001), and larger main hemorrhage (p &lt; 0.0001). Conclusions: The presence of a satellite sign in the initial CT scan is associated with a significantly worse functional outcome in ICH patients. (C) 2017 S. Karger AG, Basel

  97. Traumatic Spinal Perimedullary Arteriovenous Fistula Induced by a Cervical Glass Stab Injury 査読有り

    Shogo Ogita, Toshiki Endo, Tomoo Inoue, Kenichi Sato, Hidenori Endo, Teiji Tominaga

    WORLD NEUROSURGERY 96 610.e9-610.e13 2016年12月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.wneu.2016.09.024  

    ISSN:1878-8750

    eISSN:1878-8769

    詳細を見る 詳細を閉じる

    BACKGROUND: In the literature, perimedullary arteriovenous fistula (AVF) is an uncommon spinal vascular malformation that is generally regarded as a congenital lesion. To our knowledge, only a few cases of traumatic perimedullary AVF have been reported in the literature so far. CASE DESCRIPTION: A 58-year-old man presented with subarachnoid hemorrhage (SAH) resulting from a secondary perimedullary arteriovenous fistula (AVF) induced by a glass stab injury to his right posterior neck. The glass had been removed, and the lacerated dura mater was closed. Hydrocephalus was diagnosed 2 months later, and the patient underwent ventriculoperitoneal shunt placement. Magnetic resonance imaging and digital subtraction angiography subsequently revealed dissection of the extradural right vertebral artery. However, there were no signs of perimedullary AVF. The patient presented 9 months after injury with sudden onset of severe headache, and SAH was diagnosed. Repeat digital subtraction angiography showed that the right vertebral artery dissection remained unchanged and was unlikely to be the underlying cause of SAH. However, a new diagnosis of perimedullary AVF at the craniocervical junction was made, and this was considered as a potential cause of SAH. The lesion was surgically obliterated. The hemosiderin deposits on the surface of the spinal cord confirmed that perimedullary AVF was the origin of SAH. - CONCLUSIONS: Cervical trauma should be considered as a possible cause of de novo perimedullary AVF. Recognition of this phenomenon is important.

  98. Daughter Sac Formation Related to Blood Inflow Jet in an Intracranial Aneurysm 査読有り

    Sin-ichiro Sugiyama, Hidenori Endo, Shunsuke Omodaka, Toshiki Endo, Kuniyasu Niizuma, Sherif Rashad, Toshio Nakayama, Kenichi Funamoto, Makoto Ohta, Teiji Tominaga

    WORLD NEUROSURGERY 96 396-402 2016年12月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.wneu.2016.09.040  

    ISSN:1878-8750

    eISSN:1878-8769

    詳細を見る 詳細を閉じる

    OBJECTIVE: We performed a hemodynamic study of an intracranial aneurysm with a newly developed daughter sac during observation to investigate the role of hemodynamics on the formation of a daughter sac. METHODS: A 75-year-old man underwent magnetic resonance angiography that revealed a large internal carotid artery aneurysm with inflow jet inside the aneurysm. The aneurysm was stable for 18 months, but a new daughter sac developed at the tip of the aneurysm during the next 6 months. The daughter sac seemed to be related to the inflow jet on magnetic resonance angiography. Aneurysm geometries before and after daughter sac formation were reconstructed using the longitudinal data of magnetic resonance angiography. Computational fluid dynamic simulations were conducted under the patient-specific pulsatile inlet conditions measured by magnetic resonance velocimetry. RESULTS: The hemodynamic simulation revealed that the inflow jet impinged on 2 sites of the aneurysm: the right side of the aneurysmal dome and the tip of the aneurysm. The flow impingement caused elevation of pressure at both sites. However, the daughter sac formed at the latter site surrounded by the basal cistern but did not form at the former site that was in contact with the right temporal lobe. CONCLUSIONS: Blood inflow jet caused local elevation of pressure, and the formation of the daughter sac occurred at the site with high pressure but without the surrounding structure, which may cancel the perpendicular wall tension.

  99. Impaired Collateral Flow Compensation During Chronic Cerebral Hypoperfusion in the Type 2 Diabetic Mice 査読有り

    Yasuo Nishijima, Yosuke Akamatsu, Shih Yen Yang, Chih Cheng Lee, Utku Baran, Shaozhen Song, Ruikang K. Wang, Teiji Tominaga, Jialing Liu

    STROKE 47 (12) 3014-3021 2016年12月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1161/STROKEAHA.116.014882  

    ISSN:0039-2499

    eISSN:1524-4628

    詳細を見る 詳細を閉じる

    Background and Purpose-The presence of collaterals is associated with a reduced risk of stroke and transient ischemic attack in patients with steno-occlusive carotid artery disease. Although metabolic syndrome negatively impacts collateral status, it is unclear whether and to what extent type 2 diabetes mellitus affects cerebral collateral flow regulation during hypoperfusion. Methods-We examined the spatial and temporal changes of the leptomeningeal collateral flow and the flow dynamics of the penetrating arterioles in the distal middle cerebral artery and anterior cerebral artery branches over 2 weeks after unilateral common carotid artery occlusion (CCAO) using optical coherent tomography in db/+ and db/db mice. We also assessed the temporal adaptation of the circle of Willis after CCAO by measuring circle of Willis vessel diameters. Results-After unilateral CCAO, db/db mice exhibited diminished leptomeningeal collateral flow compensation compared with db/+ mice, which coincided with a reduced dilation of distal anterior cerebral artery branches, leading to reduced flow not only in pial vessels but also in penetrating arterioles bordering the distal middle cerebral artery and anterior cerebral artery. However, no apparent cell death was detected in either strain of mice during the first week after CCAO. db/db mice also experienced a more severe early reduction in the vessel diameters of several ipsilateral main feeding arteries in the circle of Willis, in addition to a delayed post-CCAO adaptive response by 1 to 2 weeks, compared with db/+ mice. Conclusions-Type 2 diabetes mellitus is an additional risk factor for hemodynamic compromise during cerebral hypoperfusion, which may increase the severity and the risk of stroke or transient ischemic attack.

  100. Convection-enhanced delivery of SN-38-loaded polymeric micelles (NK012) enables consistent distribution of SN-38 and is effective against rodent intracranial brain tumor models 査読有り

    Rong Zhang, Ryuta Saito, Yui Mano, Akira Sumiyoshi, Masayuki Kanamori, Yukihiko Sonoda, Ryuta Kawashima, Teiji Tominaga

    DRUG DELIVERY 23 (8) 2780-2786 2016年10月

    出版者・発行元:TAYLOR & FRANCIS LTD

    DOI: 10.3109/10717544.2015.1081994  

    ISSN:1071-7544

    eISSN:1521-0464

    詳細を見る 詳細を閉じる

    Convection-enhanced delivery (CED) of therapeutic agents is a promising local delivery technique that has been extensively studied as a treatment for CNS diseases over the last two decades. One continuing challenge of CED is accurate and consistent delivery of the agents to the target. The present study focused on a new type of therapeutic agent, NK012, a novel SN-38-loaded polymeric micelle. Local delivery profiles of NK012 and SN-38 were studied using rodent brain and intracranial rodent brain tumor models. First, the cytotoxicity of NK012 against glioma cell lines was determined in vitro. Proliferations of glioma cells were significantly reduced after exposure to NK012. Then, the distribution and local toxicity after CED delivery of NK012 and SN-38 were evaluated in vivo. Volume of distribution of NK012 after CED was much larger than that of SN-38. Histological examination revealed minimum brain tissue damage in rat brains after delivery of 40 mg NK012 but severe damage with SN-38 at the same dose. Subsequently, the efficacy of NK012 delivered via CED was tested in 9L and U87MG rodent orthotopic brain tumor models. CED of NK012 displayed excellent efficacy in the 9L and U87MG orthotopic brain tumor models. Furthermore, NK012 and gadolinium diamide were co-delivered via CED to monitor the NK012 distribution using MRI. Volume of NK012 distribution evaluated by histology and MRI showed excellent agreement. CED of NK012 represents an effective treatment option for malignant gliomas. MRI-guided CED of NK012 has potential for clinical application.

  101. Long-term follow-up of pediatric moyamoya disease treated by combined direct-indirect revascularization surgery: single institute experience with surgical and perioperative management. 査読有り

    Rashad S, Fujimura M, Niizuma K, Endo H, Tominaga T

    Neurosurgical review 39 (4) 615-623 2016年10月

    DOI: 10.1007/s10143-016-0734-7  

    ISSN:0344-5607

  102. Sarcoma-like tumor originating from oligodendroglioma 査読有り

    Takuhiro Shoji, Ryuta Saito, Masayuki Kanamori, Yukihiko Sonoda, Mika Watanabe, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 33 (4) 255-260 2016年10月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1007/s10014-016-0268-2  

    ISSN:1433-7398

    eISSN:1861-387X

    詳細を見る 詳細を閉じる

    We present a case of sarcoma occurring at a site of resected oligodendroglioma without preceding radiotherapy or chemotherapy. Oligosarcoma occurring at sites of resected oligodendroglioma or anaplastic oligodendroglioma with sarcomatous components are rare. Although meningioma or sarcoma-like lesions are sometimes reported after glioma-targeted radiotherapy, those without preceding radiotherapy are quite rare. Moreover, cases of sarcoma without oligodendroglial components occurring at a site of resected oligodendroglioma have never been reported. In this case, fluorescent in situ hybridization analysis revealed 1p/19q co-deletion in both the first tumor and second tumors. Additionally, immunohistochemistry revealed mutated isocitrate dehydrogenase 1 in both tumors. Taken together, these findings suggest a monoclonal tumor origin. Consequently, this case may indicate a new mechanism of development of sarcomatous lesions occurring at the site of a resected glioma.

  103. T2 relaxometry improves detection of non-sclerotic epileptogenic hippocampus 査読有り

    Shiho Sato, Masaki Iwasaki, Hiroyoshi Suzuki, Shunji Mugikura, Kazutaka Jin, Teiji Tominaga, Kei Takase, Shoki Takahashi, Nobukazu Nakasato

    EPILEPSY RESEARCH 126 1-9 2016年10月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.eplepsyres.2016.06.001  

    ISSN:0920-1211

    eISSN:1872-6844

    詳細を見る 詳細を閉じる

    Object: The use of T2 relaxometry was investigated to detect non-sclerotic epileptogenic abnormality of the hippocampus in presurgical evaluation of temporal lobe epilepsy (TLE). Methods: This prospective study included 30 patients who underwent hippocampectomy as part of surgical treatment of refractory TLE. Ten patients had structural epileptogenic lesions in the extra-hippocampal temporal lobe. Twelve patients underwent intracranial electroencephalography (iEEG) study before surgery. Visual assessment of atrophy and increased T2 signal intensity, volumetry, and T2 relaxometry of hippocampus were performed pre-operatively using 3 T magnetic resonance imaging, and compared with the neuropathological findings and iEEG findings. Magnetic resonance imaging of 30 age- and sex matched healthy controls was used to establish normal values, which were defined as z score within 2. Results: Visual assessment, volumetry, and T2 relaxometry detected hippocampal abnormalities on the surgical side in 16 (53%), 16 (53%), and 26 (87%) patients, respectively. Hippocampal volume loss was always associated with prolonged T2 relaxation time, and supported by histopathological diagnosis of HS in all cases except one. Hippocampal abnormality was detected only by T2 relaxometry in nine patients (30%). Pathological diagnosis of these cases included mild HS in one, microdysgenesis in one, and granule cell pathology in three. Four patients with normal hippocampal volume and T2 relaxation time had no HS or granule cell pathology. Prolonged T2 relaxation time was associated with medial temporal seizure onset in iEEG (p &lt; 0.05). Conclusions: T2 relaxometry improves the detection of non-sclerotic epileptogenic abnormality of the hippocampus. (C) 2016 Elsevier B.V. All rights reserved.

  104. Development of Abnormal Hemispheric Vascular Networks Mimicking Cerebral Proliferative Angiopathy in a Child Originally Diagnosed with Deep-Seated Arteriovenous Fistula 査読有り

    Hiroyuki Sakata, Miki Fujimura, Kenichi Sato, Kuniyasu Niizuma, Hidenori Endo, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 25 (10) E200-E204 2016年10月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.042  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Cerebral proliferative angiopathy (CPA), which is characterized by diffuse vascular abnormalities with intermingled normal brain parenchyma, is a rare clinical entity distinct from classical cerebral arteriovenous malformations. Its pathology at initial state and subsequent course of progression has totally been undetermined. We herein presented a case of a child who was initially diagnosed with deep-seated arteriovenous fistula (AVF), and ultimately developed symptomatic CPA-like vascular lesion over a long period of clinical follow-up. A 7-month-old boy was incidentally found to have an AVF in the right basal ganglia and conservatively followed up. Serial magnetic resonance angiograms revealed the gradual proliferation and enlargement of pial and medullary vessels surrounding the AVF. Seven years later, he had a transient ischemic attack followed by intraventricular hemorrhage. A catheter angiogram showed a diffuse large vascular malformation composed of 2 distinct structures, including AVF in the right basal ganglia and the surrounding proliferated pial and medullary arteries in the right hemisphere. Single-photon emission computed tomography with N-isopropyl[123I]-p-iodoamphetamine revealed apparent hemodynamic compromise on the right hemisphere. Targeted embolization of the pseudoaneurysm originating from the right A1 perforator was performed to prevent rebleeding without complications. The patient had no further cerebrovascular events. Perinidal hypoperfusion induced by a deep-seated AVF could be one of the underlying pathologies of progressive angiogenic activity. This is the first case showing the development of abnormal hemispheric vascular networks mimicking CPA, which offers insight into the pathogenesis of this new entity. (C) 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  105. Blood Flow Into Basilar Tip Aneurysms: A Predictor for Recanalization After Coil Embolization 査読有り

    Shin-ichiro Sugiyama, Kuniyasu Niizuma, Kenichi Sato, Sherif Rashad, Misaki Kohama, Hidenori Endo, Toshiki Endo, Yasushi Matsumoto, Makoto Ohta, Teiji Tominaga

    STROKE 47 (10) 2541-2547 2016年10月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1161/STROKEAHA.116.013555  

    ISSN:0039-2499

    eISSN:1524-4628

    詳細を見る 詳細を閉じる

    Background and Purpose-Hemodynamic forces may play a role in the recanalization of coiled aneurysms. The purpose of this study was to investigate the influence of presurgical hemodynamics on the efficacy of coil embolization for basilar tip aneurysms. Methods-We identified 82 patients who underwent endovascular coil embolization for basilar tip aneurysms with a followup of &gt; 1 year. Presurgical hemodynamics were investigated using computational fluid dynamics with 3-dimensional data derived from rotational angiography. During postprocessing, we quantified the rate of net flow entering the aneurysm through its neck and calculated the proportion of the aneurysmal inflow rate to the basilar artery flow rate. In addition, we investigated the correlation between the basilar bifurcation configuration and the hemodynamics. Results-Twenty-five of the 82 patients were excluded because of difficult vascular geometry reconstruction. Among the 57 examined patients, angiographic recanalization was observed in 19 patients (33.3%). The proportion of the aneurysmal inflow rate to the basilar artery flow rate and a coil packing density &lt; 30% were independent and significant predictors for the recanalization of coiled aneurysms. Additional investigation revealed that a small branch angle formed by the basilar artery and the posterior cerebral artery increased blood flow into the aneurysm. Conclusions-The proportion of the aneurysmal inflow rate to the basilar artery flow rate, influenced by the basilar bifurcation configuration, was an independent and significant predictor for recanalization after coil embolization in basilar tip aneurysms.

  106. A case of thrombectomy to treat acute occlusion of the vertebral artery due to a fracture of the lateral mass of the first cervical vertebra 査読有り

    Michiko Yokosawa, Masahiro Yoshida, Masaki Mino, Naoko Yamashita, Teiji Tominaga

    Neurological Surgery 44 (10) 875-880 2016年10月1日

    出版者・発行元:Igaku-Shoin Ltd

    DOI: 10.11477/mf.1436203394  

    ISSN:1882-1251 0301-2603

  107. Sturge-Weber syndrome with intracerebral hemorrhage: a case report 査読有り

    Masashi Chonan, Yasuhiro Suzuki, Shinya Haryu, Shoji Mashiyama, Teiji Tominaga

    SPRINGERPLUS 5 (1) 1746 2016年10月

    出版者・発行元:SPRINGER INTERNATIONAL PUBLISHING AG

    DOI: 10.1186/s40064-016-3439-z  

    ISSN:2193-1801

    詳細を見る 詳細を閉じる

    Introduction: Sturge-Weber syndrome (SWS) is a rare congenital disease that affects the brain, skin, and eyes, and is a sporadically occurring neurocutaneous syndrome that affects intracerebral veins, which is associated with venous thrombosis. However, intracranial hemorrhage in patients with SWS is rare. We herein report a rare case of SWS with intracerebral hemorrhage derived from sinus thrombosis. Case description: A 62-year-old man suddenly fell into a coma and was admitted to our hospital. His neurological status was assessed as GCS 6 (E1V1M4) with right-sided hemiparesis. At birth, he had a right-sided facial port-wine stain typical of SWS that involved the ophthalmic division of the trigeminal nerve. Laboratory findings showed that he was dehydrated, and his serum D-dimer concentration was increased. Computed tomography revealed left thalamic hemorrhage with acute hydrocephalus and cortical calcification in the right occipital lobe. Magnetic resonance imaging displayed a vascular malformation of the right cerebral hemisphere consistent with SWS. Magnetic resonance venography showed steno-occlusion of the superior sagittal sinus, straight sinus, and left internal cerebral vein (ICV). Emergency ventricular drainage was performed. Seven days after surgery, his consciousness improved to GCS 14 (E4V4M6). Rehydration therapy was performed to prevent sinus thrombosis. Discussion and Evaluation: His postoperative course was uneventful. Sudden congestion of the left ICV may have caused left thalamic hemorrhage. Conclusions: SWS with major sinus occlusion needs to be diagnosed with utmost caution in order to allow for preoperative neurological and radiological assessments.

  108. The Tohoku Medical Megabank Project: Design and Mission 査読有り

    Shinichi Kuriyama, Nobuo Yaegashi, Fuji Nagami, Tomohiko Arai, Yoshio Kawaguchi, Noriko Osumi, Masaki Sakaida, Yoichi Suzuki, Keiko Nakayama, Hiroaki Hashizume, Gen Tamiya, Hiroshi Kawame, Kichiya Suzuki, Atsushi Hozawa, Naoki Nakaya, Masahiro Kikuya, Hirohito Metoki, Ichiro Tsuji, Nobuo Fuse, Hideyasu Kiyomoto, Junichi Sugawara, Akito Tsuboi, Shinichi Egawa, Kiyoshi Ito, Koichi Chida, Tadashi Ishii, Hiroaki Tomita, Yasuyuki Taki, Naoko Minegishi, Naoto Ishii, Jun Yasuda, Kazuhiko Igarashi, Ritsuko Shimizu, Masao Nagasaki, Seizo Koshiba, Kengo Kinoshita, Soichi Ogishima, Takako Takai-Igarashi, Teiji Tominaga, Osamu Tanabe, Noriaki Ohuchi, Toru Shimosegawa, Shigeo Kure, Hiroshi Tanaka, Sadayoshi Ito, Jiro Hitomi, Kozo Tanno, Motoyuki Nakamura, Kuniaki Ogasawara, Seiichiro Kobayashi, Kiyomi Sakata, Mamoru Satoh, Atsushi Shimizu, Makoto Sasaki, Ryujin Endo, Kenji Sobue, Masayuki Yamamoto

    JOURNAL OF EPIDEMIOLOGY 26 (9) 493-511 2016年9月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.2188/jea.JE20150268  

    ISSN:0917-5040

    詳細を見る 詳細を閉じる

    The Great East Japan Earthquake (GEJE) and resulting tsunami of March 11, 2011 gave rise to devastating damage on the Pacific coast of the Tohoku region. The Tohoku Medical Megabank Project (TMM), which is being conducted by Tohoku University Tohoku Medical Megabank Organization (ToMMo) and Iwate Medical University Iwate Tohoku Medical Megabank Organization (IMM), has been launched to realize creative reconstruction and to solve medical problems in the aftermath of this disaster. We started two prospective cohort studies in Miyagi and Iwate Prefectures: a population-based adult cohort study, the TMM Community-Based Cohort Study (TMM CommCohort Study), which will recruit 80 000 participants, and a birth and three-generation cohort study, the TMM Birth and Three-Generation Cohort Study (TMM BirThree Cohort Study), which will recruit 70 000 participants, including fetuses and their parents, siblings, grandparents, and extended family members. The TMM CommCohort Study will recruit participants from 2013 to 2016 and follow them for at least 5 years. The TMM BirThree Cohort Study will recruit participants from 2013 to 2017 and follow them for at least 4 years. For children, the ToMMo Child Health Study, which adopted a cross-sectional design, was also started in November 2012 in Miyagi Prefecture. An integrated biobank will be constructed based on the two prospective cohort studies, and ToMMo and IMM will investigate the chronic medical impacts of the GEJE. The integrated biobank of TMM consists of health and clinical information, biospecimens, and genome and omics data. The biobank aims to establish a firm basis for personalized healthcare and medicine, mainly for diseases aggravated by the GEJE in the two prefectures. Biospecimens and related information in the biobank will be distributed to the research community. TMM itself will also undertake genomic and omics research. The aims of the genomic studies are: 1) to construct an integrated biobank; 2) to return genomic research results to the participants of the cohort studies, which will lead to the implementation of personalized healthcare and medicine in the affected areas in the near future; and 3) to contribute the development of personalized healthcare and medicine worldwide. Through the activities of TMM, we will clarify how to approach prolonged healthcare problems in areas damaged by large-scale disasters and how useful genomic information is for disease prevention.

  109. Impact of gross total resection in patients with WHO grade III glioma harboring the IDH 1/2 mutation without the 1p/19q co-deletion 査読有り

    Tomohiro Kawaguchi, Yukihiko Sonoda, Ichiyo Shibahara, Ryuta Saito, Masayuki Kanamori, Toshihiro Kumabe, Teiji Tominaga

    JOURNAL OF NEURO-ONCOLOGY 129 (3) 505-514 2016年9月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s11060-016-2201-2  

    ISSN:0167-594X

    eISSN:1573-7373

    詳細を見る 詳細を閉じる

    The prognosis of patients with WHO grade III gliomas is highly dependent on their genomic status such as the isocitrate dehydrogenase (IDH) 1/2 mutation and1p/19q co-deletion. However, difficulties have been associated with determining which tumors have certain genomic profiles by preoperative radiographical modalities, and the role of surgical resection in achieving better outcomes remains unclear. This retrospective study included 124 consecutive patients with newly diagnosed grade III gliomas. The genomic status of IDH1/2 and 1p/19q was analyzed in these patients. Tumors were then divided into 3 subgroups based on their genomic status; the IDH 1/2 mutation with the 1p/19q co-deletion (1p/19q co-del), the IDH 1/2 mutation without the 1p/19q co-deletion (non-1p/19q co-del), and the IDH 1/2 wild type (IDH wt). Survival times were compared between patients who underwent gross total resection and those who did not (GTR versus non-GTR). The relationships between genomic statuses and MR imaging characteristics such as ring-like or nodular enhancements by gadolinium, and very low intensity on T1-weighted images with blurry enhancements (T1VL) were also examined. Among all patients with grade III gliomas, GTR patients had longer median survival and progression-free times than those of non-GTR patients (undefined versus 87 months, p = 0.097, and 124 versus 34 months, p = 0.059, respectively). No significant differences were observed in survival between GTR and non-GTR patients in the 1p/19q co-del group (p = 0.14), or between GTR and non-GTR patients in the IDH wt group (26 and 27 months, p = 0.29). On the other hand, in non-1p/19q co-del group, survival was significantly longer in GTR patients than in non-GTR patients (undefined versus 77 months, p = 0.005). Radiographically, T1VL was detected in most tumors in the non-1p/19q co-del group (78.2 %), but only 6 (21.4 %) and 17 (41.5 %) tumors in the 1p/19q co-del and IDH wt groups, respectively. A correlation was not found between other genomic subgroups and MR imaging findings. Strict surgical removal is important to improve the prognosis of patients with grade III gliomas, especially for tumors with the IDH 1/2 mutation without the 1p/19q co-deletion. The MR finding of T1VL can be used to select candidates for more radical resection.

  110. Ischemic pituitary adenoma apoplexy-Clinical appearance and prognosis after surgical intervention 査読有り

    Yoshikazu Ogawa, Kuniyasu Niizuma, Shunji Mugikura, Teiji Tominaga

    CLINICAL NEUROLOGY AND NEUROSURGERY 148 142-146 2016年9月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.clineuro.2016.07.013  

    ISSN:0303-8467

    eISSN:1872-6968

    詳細を見る 詳細を閉じる

    Background: Several retrospective investigations have recommended more passive surgical indications for intratumoral hemorrhage of pituitary adenomas due to probable spontaneous resolution. However, no definitive analyses have compared pituitary adenomas with hemorrhagic apoplexy and intratumoral hemorrhage without evident apoplectic symptoms or pituitary adenoma infarction. Methods: This study retrospectively identified 43 patients with symptomatic pituitary apoplexy among 1067 patients with pituitary adenomas initially treated by surgery at a single institute between April 2005 and May 2015, with 27 cases of hemorrhagic (2.53%) and 16 cases of ischemic apoplexy (1.50%). The inclusion criteria involved evident and sudden onset of symptoms and simultaneous histological confirmation as hemorrhagic or ischemic pituitary apoplexy. Diagnostic differentiation with magnetic resonance (MR) imaging was performed to examine the agreement between MR imaging and histological findings, and the clinical appearance and mid-term prognosis were compared for ischemic pituitary apoplexy and hemorrhagic apoplexy. Results: Diagnostic matching with MR imaging could be performed in 41 of 43 patients (25 with hemorrhagic and 16 with ischemic apoplexy). Agreement with the histological finding was found in 32 of 41 patients overall (78%), 23 of 25 patients with hemorrhagic apoplexy (92%), and 9 of 16 patients with ischemic apoplexy (56%). The main reason for diagnostic discrepancy was thought to be the difficulty in identifying ischemic lesion. All patients in the ischemic group suffered progression of symptoms from initial onset including various cranial nerve palsies, aseptic meningitis, and decreased level of consciousness, whereas the hemorrhagic group suffered progression in 4 of 27 patients. Ischemic group showed a statistically stronger tendency to disease progression than the hemorrhagic group (P &lt; 0.001). Endocrinological examinations showed 4 patients required no hormone supplement therapies but the other 11 patients had persistent hypopituitarism and required hormone supplementation in the ischemic group, whereas 2 of 25 patients required hormone supplementation in the hemorrhagic group. Endocrinological recovery showed a significant difference between the ischemic group and hemorrhagic group (P &lt; 0.01). Conclusions: Ischemic pituitary adenoma apoplexy has a more severe clinical course than hemorrhagic apoplexy. Development of preoperative diagnostic technology to differentiate ischemic from hemorrhagic apoplexy is required to improve the low rate of agreement between the histological and MR imaging findings in patients with ischemic apoplexy. (C) 2016 Elsevier B.V. All rights reserved.

  111. A study of prognostic factors in 45 cases of atypical meningioma 査読有り

    Toshiki Endo, Ayumi Narisawa, Hosam Shata Mohamed Ali, Kensuke Murakami, Takashi Watanabe, Mika Watanabe, Hidefumi Jokura, Hidenori Endo, Miki Fujimura, Yukihiko Sonoda, Teiji Tominaga

    ACTA NEUROCHIRURGICA 158 (9) 1661-1667 2016年9月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-016-2900-7  

    ISSN:0001-6268

    eISSN:0942-0940

    詳細を見る 詳細を閉じる

    Atypical meningioma differs from Grade I meningioma in terms of high recurrence rate and short life expectancy. We evaluated the clinical course of atypical meningioma and investigated prognostic factors affecting its outcomes. We reviewed 45 patients with atypical meningioma who underwent surgical intervention between January 2000 and December 2013. The mean age of the patients and mean follow-up period was 58.7 years and 81.0 months, respectively. Analyses included factors such as patient age, gender, location and size of tumor, extent of surgical resection (Simpson Grading System), and MIB-1 labeling index (LI). Univariate analysis was used to detect prognostic factors associated with recurrence and survival. The 5-year recurrence-free rate for all 45 patients was 58.4 %; 5- and 10-year survival rates were 83.2 % and 79.9 %, respectively. In univariate analyses, age &gt; 60 years, and MIB-1 LI correlated with disease recurrence, whereas age &gt; 60 years, subtotal surgical resection, MIB-1 LI, and indication for radiotherapy correlated with death. MIB-1 LI levels higher than 12.8 % and 19.7 % predicted recurrence and death, respectively. In our cohort, 26 patients received postoperative radiotherapy including conventional radiation (n = 21) or gamma knife radiosurgery (n = 5). Postoperative radiotherapy did not decrease recurrence rates in our cohort (p = 0.63). Six and two patients who died during the study period underwent conventional radiation and radiosurgery, respectively. Age, male gender, extent of surgical resection, and higher MIB-1 LI influenced the outcome of atypical meningioma. In our cohort, postoperative radiotherapy failed to provide long-term tumor control. Following incomplete surgical resection of atypical meningioma in elderly patients, adjuvant postoperative radiotherapy may not be an ideal treatment option, particularly when MIB-1 LI is higher than 19.7 %.

  112. A case of hydrocephalus in listeria meningitis treated by endoscopic third ventriculostomy 査読有り

    Takatsugu Abe, Tomohiro Kawaguchi, Miki Fujimura, Teiji Tominaga

    Neurological Surgery 44 (9) 761-766 2016年9月1日

    出版者・発行元:Igaku-Shoin Ltd

    DOI: 10.11477/mf.1436203373  

    ISSN:1882-1251 0301-2603

    詳細を見る 詳細を閉じる

    A 69-year-old woman presented with anorexia, fever, and vomiting. The patient was not a compromised host. She was finally diagnosed with Listeria meningitis and treated with ampicillin and gentamicin. However, her condition worsened over time. Non-contrast head CT showed ventricular dilatation. As a result, continuous nght ventricular drainage was performed. Non-contrast MRI revealed hydrocephalus due to stenosis of the fourth ventricle. She underwent endoscopic third ventriculostomy (ETV) to improve cerebrospinal fluid circulation. This procedure achieved a good result. The efficacy of ETV for post-infectious hydrocephalus has not been proven, but previous cases suggest that ETV would be effective in non-communicating hydrocephalus, even if it were a result of neuroinfection.

  113. Local convection-enhanced delivery of an anti-CD40 agonistic monoclonal antibody induces antitumor effects in mouse glioma models 査読有り

    Takuhiro Shoji, Ryuta Saito, Masashi Chonan, Ichiyo Shibahara, Aya Sato, Masayuki Kanamori, Yukihiko Sonoda, Toru Kondo, Naoto Ishii, Teiji Tominaga

    NEURO-ONCOLOGY 18 (8) 1120-1128 2016年8月

    出版者・発行元:OXFORD UNIV PRESS INC

    DOI: 10.1093/neuonc/now023  

    ISSN:1522-8517

    eISSN:1523-5866

    詳細を見る 詳細を閉じる

    Glioblastoma is one of the most malignant brain tumors in adults and has a dismal prognosis. In a previous report, we reported that CD40, a TNF-R-related cell surface receptor, and its ligand CD40L were associated with glioma outcomes. Here we attempted to activate CD40 signaling in the tumor and determine if it exerted therapeutic efficacy. CD40 expression was examined in 3 mouse glioma cell lines (GL261, NSCL61, and bRiTs-G3) and 5 human glioma cell lines (U87, U251, U373, T98, and A172). NSCL61 and bRiTs-G3, as glioma stem cells, also expressed the glioma stem cell markers MELK and CD44. In vitro, we demonstrated direct antitumor effects of an anti-CD40 agonistic monoclonal antibody (FGK45) against the cell lines. The efficacy of FGK45 was examined by local convection-enhanced delivery of the monoclonal antibody against each glioma model. CD40 was expressed in all mouse and human cell lines tested and was found at the cell membrane of each of the 3 mouse cell lines. FGK45 administration induced significant, direct antitumor effects in vitro. The local delivery of FGK45 significantly prolonged survival compared with controls in the NSCL61 and bRiTs-G3 models, but the effect was not significant in the GL261 model. Increases in apoptosis and CD4(+) and CD8(+) T cell infiltration were observed in the bRiTs-G3 model after FGK45 treatment. Local delivery of FGK45 significantly prolonged survival in glioma stem cell models. Thus, local delivery of this monoclonal antibody is promising for immunotherapy against gliomas.

  114. Temporal profile of magnetic resonance angiography and decreased ratio of regulatory T cells after immunological adjuvant administration to mice lacking RNF213, a susceptibility gene for moyamoya disease 査読有り

    Atsushi Kanoke, Miki Fujimur, Kuniyasu Niizuma, Taku Fujimura, Aya Kakizaki, Akira Ito, Hiroyuki Sakata, Mika Sato-Maeda, Shigeo Kure, Teiji Tominaga

    BRAIN RESEARCH 1642 1-9 2016年7月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.brainres.2016.03.009  

    ISSN:0006-8993

    eISSN:1872-6240

    詳細を見る 詳細を閉じる

    Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disease with an unknown etiology and is characterized by an abnormal vascular network at the base of the brain. Recent studies identified the RNF213 gene (RNF213) as an important susceptibility gene for MMD; however, the mechanisms underlying the RNF213 abnormality related to MMD have not yet been elucidated. We previously reported that Rnf213-deficient mice and Rnf213 p. R4828K knock-in mice did not spontaneously develop MMD, indicating the importance of secondary insults in addition to genetic factors in the pathogenesis of MMD. The most influential secondary insult is considered to be an immunological reaction because RNF213 is predominantly expressed in immunological tissues. Therefore, we herein attempted to evaluate the role of an immunological stimulation as a supplementary insult to the target disruption of RNF213 in the pathophysiology of MMD. Rnf213-deficient mice were treated with strong immunological adjuvants including muramyl dipeptide (MDP)-Lys (L18), and then underwent time-sequential magnetic resonance angiography (MRA) up to 40 weeks of age. The results obtained did not reveal any characteristic finding of MMD, and no significant difference was observed in MRA findings or the anatomy of the circle of Willis between Rnf213-deficient mice and wild-type mice after the administration of MDP-Lys (L18). The ratio of regulatory T cells after the administration of MDP-Lys (L18) was significantly decreased in Rnf213-deficient mice (p &lt; 0.01), suggesting the potential role of the RNF213 abnormality in the differentiation of regulatory T cells. Although the mechanisms underlying the development of MMD currently remain unclear, the RNF213 abnormality may compromise immunological self-tolerance, thereby contributing to the development of MMD. (C) 2016 Elsevier B.V. All rights reserved.

  115. Central Retinal Artery Occlusion after the Endovascular Treatment of Unruptured Ophthalmic Artery Aneurysm: A Case Report and a Literature Review. 査読有り

    Elkordy AM, Sato K, Inoue Y, Mano Y, Matsumoto Y, Takahashi A, Tominaga T

    NMC case report journal 3 (3) 71-74 2016年7月

    出版者・発行元:一般社団法人 日本脳神経外科学会

    DOI: 10.2176/nmccrj.cr.2015-0243  

    ISSN:2188-4226

    詳細を見る 詳細を閉じる

    Endovascular coil embolization for ophthalmic artery (OphA) aneurysms has a risk of occlusion of the OphA, which can lead to loss of vision. The authors report a patient with unruptured OphA aneurysm which treated with endovascular coiling and were complicated by blindness due to OphA thromboembolic occlusion after the procedure. The OphA successfully recanalized using local intra-arterial fibrinolysis with complete regain of visual acuity. The risk of visual loss due to thromboembolic complications cannot be ignored during endovascular coiling of the OphA aneurysm despite of good retrograde flow during OphA occlusion test using a balloon catheter. Rapid intervention is required for recovering visual disturbance in such a situation.

  116. Recurrent neomorphic mutations of MTOR in central nervous system and testicular germ cell tumors may be targeted for therapy 査読有り

    Koichi Ichimura, Shintaro Fukushima, Yasushi Totoki, Yuko Matsushita, Ayaka Otsuka, Arata Tomiyama, Tohru Niwa, Hirokazu Takami, Taishi Nakamura, Tomonari Suzuki, Kohei Fukuoka, Takaaki Yanagisawa, Kazuhiko Mishima, Yoichi Nakazato, Fumie Hosoda, Yoshitaka Narita, Soichiro Shibui, Akihiko Yoshida, Akitake Mukasa, Nobuhito Saito, Toshihiro Kumabe, Masayuki Kanamori, Teiji Tominaga, Keiichi Kobayashi, Saki Shimizu, Motoo Nagane, Toshihiko Iuchi, Masahiro Mizoguchi, Koji Yoshimoto, Kaoru Tamura, Taketoshi Maehara, Kazuhiko Sugiyama, Mitsutoshi Nakada, Keiichi Sakai, Yonehiro Kanemura, Masahiro Nonaka, Akio Asai, Kiyotaka Yokogami, Hideo Takeshima, Nobutaka Kawahara, Tatsuya Takayama, Masahiro Yao, Mamoru Kato, Hiromi Nakamura, Natsuko Hama, Ryuichi Sakai, Toshikazu Ushijima, Masao Matsutani, Tatsuhiro Shibata, Ryo Nishikawa

    ACTA NEUROPATHOLOGICA 131 (6) 889-901 2016年6月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00401-016-1557-x  

    ISSN:0001-6322

    eISSN:1432-0533

    詳細を見る 詳細を閉じる

    Germ cell tumors constitute a heterogeneous group that displays a broad spectrum of morphology. They often arise in testes; however, extragonadal occurrence, in particular brain, is not uncommon, and whether they share a common pathogenesis is unknown. We performed whole exome sequencing in 41 pairs of central nervous system germ cell tumors (CNS GCTs) of various histology and their matched normal tissues. We then performed targeted sequencing of 41 selected genes in a total of 124 CNS GCTs, 65 testicular germ cell tumors (tGCTs) and 8 metastatic GCTs to the CNS. The results showed that mutually exclusive mutations of genes involved in the MAPK pathway were most common (48.4 %), typically in KIT (27.4 %), followed by those in the PI3K pathway (12.9 %), particularly in MTOR (6.5 %), among the 124 CNS GCTs. Pure germinomas and non-germinomatous germ cell tumors (NGGCTs), as well as CNS and testicular GCTs, showed similar mutational profiles, suggesting that GCTs share a common molecular pathogenesis. Mutated MTOR identified in CNS GCTs upregulated phosphorylation of the AKT pathway proteins including AKT and 4EBP1 in nutrient-deprived conditions and enhanced soft-agar colony formation; both events were suppressed in a dose-dependent manner by addition of the MTOR inhibitor pp242. Our findings indicate that the dominant genetic drivers of GCTs regardless of the site of origin are activation of the MAPK and/or PI3K pathways by somatic point mutations. Mutated MTOR represents a potential target for novel targeted therapies for refractory GCTs.

  117. Brain Stem Infarction Due to Basilar Artery Dissection in a Patient with Moyamoya Disease Four Years after Successful Bilateral Revascularization Surgeries 査読有り

    Takatsugu Abe, Miki Fujimura, Shunji Mugikura, Hidenori Endo, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 25 (6) E79-E82 2016年6月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.024  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Moyamoya disease (MMD) is a rare cerebrovascular disease with an unknown etiology and is characterized by intrinsic fragility in the intracranial vascular walls such as the affected internal elastic lamina and thinning medial layer. The association of MMD with intracranial arterial dissection is extremely rare, whereas that with basilar artery dissection (BAD) has not been reported previously. A 46-year-old woman developed brain stem infarction due to BAD 4 years after successful bilateral superficial temporal artery-middle cerebral artery anastomosis with indirect pial synangiosis for ischemic-onset MMD. She presented with sudden occipitalgia and subsequently developed transient dysarthria and mild hemiparesis. Although a transient ischemic attack was initially suspected, her condition deteriorated in a manner that was consistent with left hemiplegia with severe dysarthria. Magnetic resonance (MR) imaging revealed brain stem infarction, and MR angiography delineated a double-lumen sign in the basilar artery, indicating BAD. She was treated conservatively and brain stem infarction did not expand. One year after the onset of brain stem infarction, her activity of daily living is still dependent (modified Rankin Scale of 4), and there were no morphological changes associated with BAD or recurrent cerebrovascular events during the follow-up period. The association of MMD with BAD is extremely rare. While considering the common underlying pathology such as an affected internal elastic lamina and fragile medial layer, the occurrence of BAD in a patient with MMD in a stable hemodynamic state is apparently unique. (C) 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  118. Nonaneurysmal Subarachnoid Hemorrhage Due to Unfused or Twiglike Middle Cerebral Artery Rupture: Two Case Reports 査読有り

    Ryosuke Tashiro, Takashi Inoue, Ichiyo Shibahara, Masayuki Ezura, Hiroshi Uenohara, Miki Fujimura, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 25 (6) E77-E78 2016年6月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.029  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Background: An unfused or twiglike middle cerebral artery (MCA) is a congenital anomaly related to the abnormal development of the MCA. An unfused or twiglike MCA can cause both ischemic and hemorrhagic strokes. Previous reports have shown that an unfused or twiglike MCA with coexisting aneurysms can cause subarachnoid hemorrhage (SAH). Cases: Two patients presented with nonaneurysmal SAH due to an unfused or twiglike MCA. Both patients had stenosis of the proximal M1 segment of the left MCA and abnormal vascular nets distal to the stenotic lesion. Vasculature distal to the abnormal vascular nets remained grossly normal. These findings were not evident in computed tomography or magnetic resonance angiography. Conclusion: An unfused or twiglike MCA can cause nonaneurysmal SAH. Digital subtraction angiography is necessary for accurate diagnosis. (C) 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  119. Intraparenchymal ultrasound application and improved distribution of infusate with convection-enhanced delivery in rodent and nonhuman primate brain 査読有り

    Yui Mano, Ryuta Saito, Yoichi Haga, Tadao Matsunaga, Rong Zhang, Masashi Chonan, Shinya Haryu, Takuhiro Shoji, Aya Sato, Yukihiko Sonoda, Noriko Tsuruoka, Keisuke Nishiyachi, Akira Sumiyoshi, Hiroi Nonaka, Ryuta Kawashima, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 124 (5) 1490-1500 2016年5月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2015.3.JNS142152  

    ISSN:0022-3085

    eISSN:1933-0693

    詳細を見る 詳細を閉じる

    OBJECTIVE Convection-enhanced delivery (CED) is an effective drug delivery method that delivers high concentrations of drugs directly into the targeted lesion beyond the blood-brain barrier. However, the drug distribution attained using CED has not satisfactorily covered the entire targeted lesion in tumors such as glioma. Recently, the efficacy of ultrasound assistance was reported for various drug delivery applications. The authors developed a new ultrasound facilitated drug delivery (UFD) system that enables the application of ultrasound at the infusion site. The purpose of this study was to demonstrate the efficacy of the UFD system and to examine effective ultrasound profiles. METHODS The authors fabricated a steel bar based device that generates ultrasound and enables infusion of the aqueous drug from one end of the bar. The volume of distribution (Vd) after infusion of 10 mu l of 2% Evans blue dye (EBD) into rodent brain was tested with different frequencies and applied voltages: 252 kHz/30 V; 252 kHz/60 V; 524 kHz/13 V; 524 kHz/30 V; and 524 kHz/60 V. In addition, infusion of 5 mM gadopentetate dimeglumine (Gd-DTPA) was tested with 260 kHz/60 V, the distribution of which was evaluated using a 7-T MRI unit. In a nonhuman primate (Macaca fascicularis) study, 300 mu l of 1 mM Gd-DTPA/EBD was infused. The final distribution was evaluated using MRI. Two-sample comparisons were made by Student t-test, and 1-way ANOVA was used for multiple comparisons. Significance was set at p &lt; 0.05. RESULTS After infusion of 10 mu l of EBD into the rat brain using the UFD system, the Vds of EBD in the UFD groups were significantly larger than those of the control group. When a frequency of 252 kHz was applied, the Vd of the group in which 60 V was applied was significantly larger than that of the group in which 30 V was used. When a frequency of 524 kHz was applied, the Vd tended to increase with application of a higher voltage; however, the differences were not significant (1-way ANOVA). The Vd of Gd-DTPA was also significantly larger in the UFD group than in the control group (p &lt; 0.05, Student t-test). The volume of Gd-DTPA in the nonhuman primate used in this study was 1209.8 +/- 193.6 mm(3). This volume was much larger than that achieved by conventional CED (568.6 +/- 141.0 mm(3)). CONCLUSIONS The UFD system facilitated the distribution of EBD and Gd-DTPA more effectively than conventional CED. Lower frequency and higher applied voltage using resonance frequencies might be more effective to enlarge the Vd. The UFD system may provide a new treatment approach for CNS disorders.

  120. Clinical features of subarachnoid hemorrhage in patients with positive cancer history 査読有り

    Ichiyo Shibahara, Takashi Watanabe, Masayuki Ezura, Takashi Inoue, Miki Fujimura, Naoto Kimura, Tomoo Inoue, Ichiro Suzuki, Akiko Nishino, Shinjitsu Nishimura, Hiroshi Uenohara, Teiji Tominaga

    JOURNAL OF NEURO-ONCOLOGY 128 (1) 129-136 2016年5月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s11060-016-2085-1  

    ISSN:0167-594X

    eISSN:1573-7373

    詳細を見る 詳細を閉じる

    Advances in cancer treatment have dramatically increased long-term survivors. Prolonged survival increases comorbidity risk, but there is a paucity of studies on how cancer history alters clinical outcomes from subsequent diseases. This study aims to investigate whether positive cancer history influences clinical outcome following subarachnoid hemorrhage (SAH). We retrospectively reviewed consecutive SAH patients admitted between January 2008 and March 2014. Medical histories, known SAH risk factors, and outcome were compared between SAH patients with and without cancer history. Out of the 498 SAH patients, 55 cases had cancer history, 438 cases had no cancer history and 5 cases had an unknown cancer history. Compared with SAH patients without cancer history, those with cancer history had poorer Hunt & Hess grade at SAH presentation (P = 0.021), and poorer modified Rankin Scale (mRS) score at discharge (P &lt; 0.001). After adjustment for age, sex, modified Fisher, previous SAH, history of hypertension, current smoking status, and current alcohol consumption, positive cancer history remained an independent risk factor for poorer mRS0-6 [odds ratio (OR) = 2.25, 95 % confidence interval (CI) 1.28-3.94] and mRS6 (OR = 2.74, 95 % CI 1.40-5.37). Furthermore, stratified analysis by Hunt & Hess grade adjusted by age, sex, and modified Fisher scale, OR of poorer mRS0-6 was 2.12 (95 % CI 0.89-5.05) and OR of mRS6 was 3.68 (95 % CI 1.35-10.04). After adjustment of patients for demographic factors, classical risk factors for SAH and Hunt & Hess grade, previous cancer history is a risk factor for the poor functional outcome of SAH.

  121. Prognostic value of medulloblastoma extent of resection after accounting for molecular subgroup: a retrospective integrated clinical and molecular analysis 査読有り

    Eric M. Thompson, Thomas Hielscher, Eric Bouffet, Marc Remke, Betty Luu, Sridharan Gururangan, Roger E. McLendon, Darell D. Bigner, Eric S. Lipp, Sebastien Perreault, Yoon-Jae Cho, Gerald Grant, Seung-Ki Kim, Ji Yeoun Lee, Amulya A. Nageswara Rao, Caterina Giannini, Kay Ka Wai Li, Ho-Keung Ng, Yu Yao, Toshihiro Kumabe, Teiji Tominaga, Wieslawa A. Grajkowska, Marta Perek-Polnik, David C. Y. Low, Wan Tew Seow, Kenneth T. E. Chang, Jaume Mora, Ian F. Pollack, Ronald L. Hamilton, Sarah Leary, Andrew S. Moore, Wendy J. Ingram, Andrew R. Hallahan, Anne Jouvet, Michelle Fevre-Montange, Alexandre Vasiljevic, Cecile Faure-Conter, Tomoko Shofuda, Naoki Kagawa, Naoya Hashimoto, Nada Jabado, Alexander G. Weil, Tenzin Gayden, Takafumi Wataya, Tarek Shalaby, Michael Grotzer, Karel Zitterbart, Jaroslav Sterba, Leos Kren, Tibor Hortobagyi, Almos Klekner, Bognar Laszlo, Timea Pocza, Peter Hauser, Ulrich Schueller, Shin Jung, Woo-Youl Jang, Pim J. French, Johan M. Kros, Marie-Lise C. van Veelen, Luca Massimi, Jeffrey R. Leonard, Joshua B. Rubin, Rajeev Vibhakar, Lola B. Chambless, Michael K. Cooper, Reid C. Thompson, Claudia C. Faria, Alice Carvalho, Sofi Nunes, Jose Pimentel, Xing Fan, Karin M. Muraszko, Enrique Lopez-Aguilar, David Lyden, Livia Garzia, David J. H. Shih, Noriyuki Kijima, Christian Schneider, Jennifer Adamski, Paul A. Northcott, Marcel Kool, David T. W. Jones, Jennifer A. Chan, Ana Nikolic, Maria Luisa Garre, Erwin G. Van Meir, Satoru Osuka, Jeffrey J. Olson, Arman Jahangiri, Brandyn A. Castro, Nalin Gupta, William A. Weiss, Iska Moxon-Emre, Donald J. Mabbott, Alvaro Lassaletta, Cynthia E. Hawkins, Uri Tabori, James Drake, Abhaya Kulkarni, Peter Dirks, James T. Rutka, Andrey Korshunov, Stefan M. P. fister, Roger J. Packer, Vijay Ramaswamy, Michael D. Taylor

    LANCET ONCOLOGY 17 (4) 484-495 2016年4月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/S1470-2045(15)00581-1  

    ISSN:1470-2045

    eISSN:1474-5488

    詳細を見る 詳細を閉じる

    Background Patients with incomplete surgical resection of medulloblastoma are controversially regarded as having a marker of high-risk disease, which leads to patients undergoing aggressive surgical resections, so-called second-look surgeries, and intensified chemoradiotherapy. All previous studies assessing the clinical importance of extent of resection have not accounted for molecular subgroup. We analysed the prognostic value of extent of resection in a subgroup-specific manner. Methods We retrospectively identified patients who had a histological diagnosis of medulloblastoma and complete data about extent of resection and survival from centres participating in the Medulloblastoma Advanced Genomics International Consortium. We collected from resections done between April, 1997, and February, 2013, at 35 international institutions. We established medulloblastoma subgroup affiliation by gene expression profiling on frozen or formalin-fixed paraffin-embedded tissues. We classified extent of resection on the basis of postoperative imaging as gross total resection (no residual tumour), near-total resection (&lt; 1.5 cm(2) tumour remaining), or sub-total resection (&gt;= 1.5 cm(2) tumour remaining). We did multivariable analyses of overall survival and progression-free survival using the variables molecular subgroup (WNT, SHH, group 4, and group 3), age (&lt; 3 vs &gt;= 3 years old), metastatic status (metastases vs no metastases), geographical location of therapy (North America/Australia vs rest of the world), receipt of chemotherapy (yes vs no) and receipt of craniospinal irradiation (&lt; 30 Gy or &gt; 30 Gy vs no craniospinal irradiation). The primary analysis outcome was the effect of extent of resection by molecular subgroup and the effects of other clinical variables on overall and progression-free survival. Findings We included 787 patients with medulloblastoma (86 with WNT tumours, 242 with SHH tumours, 163 with group 3 tumours, and 296 with group 4 tumours) in our multivariable Cox models of progression-free and overall survival. We found that the prognostic benefit of increased extent of resection for patients with medulloblastoma is attenuated after molecular subgroup affiliation is taken into account. We identified a progression-free survival benefit for gross total resection over sub-total resection (hazard ratio [HR] 1.45, 95% CI 1.07-1.96, p=0.16) but no overall survival benefit (HR 1.23, 0.87-1.72, p=0.24). We saw no progression-free survival or overall survival benefit for gross total resection compared with near-total resection (HR 1.05, 0.71-1.53, p=0.8158 for progression-free survival and HR 1.14, 0.75-1.72, p=0.55 for overall survival). No significant survival benefit existed for greater extent of resection for patients with WNT, SHH, or group 3 tumours (HR 1.03, 0.67-1.58, p=0.89 for sub-total resection vs gross total resection). For patients with group 4 tumours, gross total resection conferred a benefit to progression-free survival compared with sub-total resection (HR 1.97, 1.22-3.17, p= 0.0056), especially for those with metastatic disease (HR 2.22, 1.00-4.93, p= 0.050). However, gross total resection had no effect on overall survival compared with sub-total resection in patients with group 4 tumours (HR 1.67, 0.93-2.99, p= 0.084). Interpretation The prognostic benefit of increased extent of resection for patients with medulloblastoma is attenuated after molecular subgroup affiliation is taken into account. Although maximum safe surgical resection should remain the standard of care, surgical removal of small residual portions of medulloblastoma is not recommended when the likelihood of neurological morbidity is high because there is no definitive benefit to gross total resection compared with near-total resection.

  122. Peri-tumoral leakage during intra-tumoral convection-enhanced delivery has implications for efficacy of peri-tumoral infusion before removal of tumor 査読有り

    Xiaoliang Yang, Ryuta Saito, Taigen Nakamura, Rong Zhang, Yukihiko Sonoda, Toshihiro Kumabe, John Forsayeth, Krystof Bankiewicz, Teiji Tominaga

    DRUG DELIVERY 23 (3) 781-786 2016年3月

    出版者・発行元:TAYLOR & FRANCIS LTD

    DOI: 10.3109/10717544.2014.914987  

    ISSN:1071-7544

    eISSN:1521-0464

    詳細を見る 詳細を閉じる

    In cases of malignant brain tumors, infiltrating tumor cells that exist at the tumor-surrounding brain tissue always escape from cytoreductive surgery and, protected by blood-brain barrier (BBB), survive the adjuvant chemoradiotherapy, eventually leading to tumor recurrence. Local interstitial delivery of chemotherapeutic agents is a promising strategy to target these cells. During our effort to develop effective drug delivery methods by intra-tumoral infusion of chemotherapeutic agents, we found consistent pattern of leakage from the tumor. Here we describe our findings and propose promising strategy to cover the brain tissue surrounding the tumor with therapeutic agents by means of convection-enhanced delivery. First, the intracranial tumor isograft model was used to define patterns of leakage from tumor mass after intra-tumoral infusion of the chemotherapeutic agents. Liposomal doxorubicin, although first distributed inside the tumor, distributed diffusely into the surrounding normal brain once the leakage happen. Trypan blue dye was used to evaluate the distribution pattern of peri-tumoral infusions. When infused intra- or peri-tumorally, infusates distributed robustly into the tumor border. Subsequently, volume of distributions with different infusion scheduling; including intra-tumoral infusion, peri-tumoral infusion after tumor resection, peri-tumoral infusion without tumor removal with or without systemic infusion of steroids, were compared with Evans-blue dye. Peri-tumoral infusion without tumor removal resulted in maximum volume of distribution. Prior use of steroids further increased the volume of distribution. Local interstitial drug delivery targeting tumor surrounding brain tissue before tumor removal should be more effective when targeting the invading cells.

  123. Ventricle wall dissection and vascular preservation with the pulsed water jet device: novel tissue dissector for flexible neuroendoscopic surgery 査読有り

    Tomohiro Kawaguchi, Atsuhiro Nakagawa, Toshiki Endo, Miki Fujimura, Yukihiko Sonoda, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 124 (3) 817-822 2016年3月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2015.3.JNS142121  

    ISSN:0022-3085

    eISSN:1933-0693

    詳細を見る 詳細を閉じる

    OBJECTIVE Neuroendoscopic surgery allows minimally invasive surgery, but lacks effective methods to control bleeding. Water jet dissection with continuous flow has been used in liver and kidney surgery since the 1980s, and is effective for tissue manipulation with vascular preservation, but involves some potential risks, such as elevation of intracranial pressure during application in the ventricles. The authors previously reported the efficacy of the actuator-driven pulsed water jet device (ADPJ) to dissect soft tissue with vascular preservation in microscopic neurosurgery. This feasibility study investigated the use of the ADPJ to reduce the amount of water usage, leading to more safety with sustained efficacy. METHODS A small-diameter pulsed water jet device was developed for use with the flexible neuroendoscope. To identify the optimal conditions for the water jet, the flow rate, water pressure, and distance between the nozzle and target were analyzed in an in vitro study by using a gelatin brain phantom. A ventricle model was used to monitor the internal pressure and temperature. For ex vivo experiments the porcine brain was harvested and ventricle walls were exposed, and subsequently immersed into physiological saline. For in vivo experiments the cortex was microsurgically resected to make the small cortico-ventricle window, and then the endoscope was introduced to dissect ventricle walls. RESULTS In the in vitro experiments, water pressure was approximately 6.5 bar at 0.5 mm from the ADPJ nozzle and was maintained at 1 mm, but dropped rapidly toward 50% at 2 mm, and became 10% at 3.5 mm. The ADPJ required less water to achieve the same dissection depth compared with the continuous-flow water jet. With the ventricle model, the internal pressure and temperature were well controlled at the baseline, with open water drainage. These results indicated that the ADPJ can be safely applied within the ventricles. The ADPJ was introduced into a flexible endoscope and the ventricle walls were dissected in both the ex vivo and in vivo conditions. The ventricle wall was dissected without obscuring the view, and the vascular structures were anatomically preserved under direct application. Histological examination revealed that both the vessels on the ventricle wall and the fine vessels in the parenchyma were preserved. CONCLUSIONS The ADPJ can safely and effectively dissect the ventricle wall, with vascular preservation in immersed conditions. To achieve the optimal result of tissue dissection with minimal surgical risk, the ADPJ is a potential device for neuroendoscopic surgery of the ventricles.

  124. Noninvasive targeting delivery and in vivo magnetic resonance tracking method for live apoptotic cells in cerebral ischemia with functional Fe2O3 magnetic nanoparticles 査読有り

    Atsushi Saito, Moataz M. Mekawy, Akira Sumiyoshi, Jorge J. Riera, Hiroaki Shimizu, Ryuta Kawashima, Teiji Tominaga

    JOURNAL OF NANOBIOTECHNOLOGY 14 19 2016年3月

    出版者・発行元:BIOMED CENTRAL LTD

    DOI: 10.1186/s12951-016-0173-1  

    ISSN:1477-3155

    詳細を見る 詳細を閉じる

    Background: Apoptotic neuronal death is known as programmed cell death. Inhibition of this progression might contribute to a new treatment strategy. However, methods for in vivo detection of live apoptotic cells are in need to be developed and established. Context and purpose: The purpose of this study is to develop a new method for in vivo brain imaging for live apoptotic lesions using magnetic resonance imaging (MRI). We focused on the specific accumulation of our recently developed functional magnetic nanoparticles (FMNPs) into apoptotic cells using a rat cerebral ischemia model. Sulphorhodamine B, fluorescent dye was linked to valylalanylaspartic acid fluoromethyl ketone as a pan-caspase inhibitor to form SR-FLIVO. SR-FLIVO was bound with FMNPs to develop SR-FLIVO-FMNP probe. Ischemic rat brains were scanned by 7T MRI before and after intravenous injection of SR-FLIVO-FMNP and the distribution was evaluated by subtraction images of T2* colored mapping. SR-FLIVO, intracellular FMNPs, and T2* reduction area were histologically analyzed. The distribution of SR-FLIVO-FMNP was evaluated by subtracting the T2* signal images and was significantly correlated with the histological findings by TUNEL staining. Results: Our experimental results revealed several findings where our newly developed probe SR-FLIVO-FMNP was intravenously administered into ischemic rats and FLIVO expression was tracked and found in apoptotic cells in rat brains after cerebral ischemia. A remarkable T2* reduction within the ischemic lesion was recorded using MRI based SR-FLIVO-FMNP probe as a contrasting agent due to the specific probe accumulation in apoptotic cells whereas, no observation of T2* reduction within the non-ischemic lesion due to no probe accumulation in non-apoptotic cells. Histological analysis based on the correlation between FLIVO and TUNEL staining showed that almost all FLIVO-positive cells were positive for TUNEL staining. These findings suggest the possibility for establishment of in vivo targeting delivery methods to live apoptotic cells based on conjugation of magnetic and fluorescent dual functional probes. Conclusion: A newly developed probe SR-FLIVO-FMNP might be considered as a useful probe for in vivo apoptotic detection, and FMNPs might be a strong platform for noninvasive imaging and targeting delivery.

  125. Bone regeneration after chemotherapy for vault lymphoma 査読有り

    Yosuke Akamatsu, Masayuki Kanamori, Hiroshi Uenohara, Teiji Tominaga

    BMJ Case Reports 2016 2016年2月22日

    出版者・発行元:BMJ Publishing Group

    DOI: 10.1136/bcr-2015-213524  

    ISSN:1757-790X

    詳細を見る 詳細を閉じる

    A 76-year-old woman presented with a mass in the left frontal region of the scalp. On admission, neurological examination found no deficits. CT revealed an osteolytic mass lesion in the left frontal cranial vault. She underwent open biopsy of the subcutaneous lesion. Histological examination identified cells with pleomorphic nuclei and marked nucleoli, and immunohistochemical staining showed these cells were positive for CD20, but negative for CD3. The histological diagnosis was diffuse large B-cell lymphoma. The patient received chemotherapy consisting of rituximab, cyclophosphamide, adriamycin, vincristine and prednisolone. Fluorine-18 fluorodeoxyglucose positron emission tomography demonstrated complete response. Follow-up CT revealed that the tumour had completely disappeared, with regeneration of the destroyed bone. The regenerated skull bone had adequate strength without significant deformity, so cranioplasty was unnecessary. The present case demonstrates the regeneration of destroyed skull bone after chemotherapy for cranial vault lymphoma.

  126. Properties of convective delivery in spinal cord gray matter: laboratory investigation and computational simulations 査読有り

    Toshiki Endo, Yushi Fujii, Shin-ichiro Sugiyama, Rong Zhang, Shogo Ogita, Kenichi Funamoto, Ryuta Saito, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-SPINE 24 (2) 359-366 2016年2月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2015.5.SPINE141148  

    ISSN:1547-5654

    eISSN:1547-5646

    詳細を見る 詳細を閉じる

    OBJECTIVE Convection-enhanced delivery (CED) is a method for distributing small and large molecules locally into the interstitial space of the spinal cord. Delivering these molecules to the spinal cord is otherwise difficult due to the blood spinal cord barrier. Previous research has proven the efficacy of CED for delivering molecules over long distances along the white matter tracts in the spinal cord. Conversely, the characteristics of CED for delivering molecules to the gray matter of the spinal cord remain unknown. The purpose of this study was to reveal regional distribution of macromolecules in the gray and white matter of the spinal cord with special attention to the differences between the gray and white matter. METHODS Sixteen rats (F344) underwent Evans blue dye CED to either the white matter (dorsal column, 8 rats) or the gray matter (ventral horn, 8 rats) of the spinal cord. The rates and total volumes of infusion were 0.2 mu l/min and 2.0 mu l, respectively. The infused volume of distribution was visualized and quantified histologically. Computational models of the rat spinal cord were also obtained to perform CED simulations in the white and gray matter. RESULTS The ratio of the volume of distribution to the volume of infusion in the gray matter of the spinal cord was 3.60 +/- 0.69, which was comparable to that of the white matter (3.05 +/- 0.88). When molecules were injected into the white matter, drugs remained in the white matter tract and rarely infused into the adjacent gray matter. Conversely, when drugs were injected into the gray matter, they infiltrated laterally into the white matter tract and traveled longitudinally and preferably along the white matter. In the infusion center, the areas were larger in the gray matter CED than in the white matter (Mann-Whitney U-test, p &lt; 0.01). In computational simulations, the aforementioned characteristics of CED to the gray and white matter were reaffirmed. CONCLUSIONS In the spinal cord, the gray and white matter have distinct characteristics of drug distribution by CED. These differences between the gray and white matter should be taken into account when considering drug delivery to the spinal cord. Computational simulation is a useful tool for predicting drug distributions in the normal spinal cord.

  127. Effects of Surgery and Antiplatelet Therapy in Ten-Year Follow-Up from the Registry Study of Research Committee on Moyamoya Disease in Japan 査読有り

    Satoshi Yamada, Koichi Oki, Yoshiaki Itoh, Satoshi Kuroda, Kiyohiro Houkin, Teiji Tominaga, Susumu Miyamoto, Nobuo Hashimoto, Norihiro Suzuki

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 25 (2) 340-349 2016年2月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2015.10.003  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Background: Despite the common practice of surgery and antiplatelet therapy for the prevention of recurrent stroke in patients with moyamoya disease, the benefit of these treatments is controversial. We analyzed the stroke recurrence rate in the Registry Study of Research Committee on Moyamoya Disease in Japan funded by the Health, Labor and Welfare Ministry of Japan. Methods: An annual follow-up study of the registered cases was continued for 10 years. The rate of recurrent stroke, including cerebral infarction and hemorrhage but not transient ischemic attack and seizure, was evaluated with Kaplan-Meier analysis. Results: The proportion of childhood-onset cases decreased in recently registered cases (within 10 years, n = 541) compared to remote cases (&gt; 10 years, n = 735). Among types at disease onset in adult-onset cases, intracerebral hemorrhage decreased recently. In recent cases, the rate of subsequent cerebral hemorrhage was much higher in the hemorrhagic group (10.9 +/- 3.3%/5 years) than in the ischemic group (2.0 +/- .9%/5 years). The recurrence rate of cerebral infarction was lower in the surgery group (1.8 +/- .9%/5 years) than in the nonsurgery group (3.8 +/- 2.2%/5 years). In the adult-onset ischemic group, the proportion of surgically treated patients increased and their recurrence rate was lower than that of nonsurgery patients. In the ischemic group, the rate of cerebral infarction was not significantly different between the antiplatelet subgroup and the non-antiplatelet subgroup, whereas the rate of cerebral hemorrhage was higher in the non-antiplatelet subgroup than in the antiplatelet subgroup. Conclusions: Our results suggest revascularization surgery may suppress recurrent ischemic attacks in patients with moyamoya disease. (C) 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  128. Canadian CT head rule and New Orleans Criteria in mild traumatic brain injury: comparison at a tertiary referral hospital in Japan 査読有り

    Daddy Mata-Mbemba, Shunji Mugikura, Atsuhiro Nakagawa, Takaki Murata, Yumiko Kato, Yasuko Tatewaki, Kei Takase, Shigeki Kushimoto, Teiji Tominaga, Shoki Takahashi

    SPRINGERPLUS 5 176 2016年2月

    出版者・発行元:SPRINGER INTERNATIONAL PUBLISHING AG

    DOI: 10.1186/s40064-016-1781-9  

    ISSN:2193-1801

    詳細を見る 詳細を閉じる

    We compared Canadian computed tomography (CT) head rule (CCHR) and New Orleans Criteria (NOC) in predicting important CT findings in patients with mild traumatic brain injury (TBI). We included 142 consecutive patients with mild TBI [Glasgow coma scale (GCS) 13-15] who showed at least one of the risk factors stated in the CCHR or the NOC. We introduced two scores: a Canadian from the CCHR and a New Orleans from the NOC. A patient's score represented a sum of the number of positive items. We examined the relationship between scores or items and the presence of important CT findings. Only the Canadian was significantly associated with important CT findings in multivariate analyses and showed higher area under the receiver operating characteristic curve (AUC) either in all 142 patients (GCS 13-15: P = 0.0130; AUC = 0.69) or in the 67 with a GCS = 15 (P = 0.0128, AUC = 0.73). Of items, "&gt;60 years" or "&gt;= 65 years" included in either guideline was the strongest predictor of important CT finding, followed by "GCS &lt; 15 after 2 h" included only in the CCHR. In a tertiary referral hospital in Japan, CCHR had higher performance than the NOC in predicting important CT findings.

  129. Total regression of brain metastases in non-small cell lung cancer patients harboring EGFR mutations treated with gefitinib without radiotherapy: Two case reports Case Reports 査読有り

    Masashi Chonan, Norio Narita, Teiji Tominaga

    BMC Research Notes 9 (1) 2 2016年1月2日

    出版者・発行元:BioMed Central Ltd.

    DOI: 10.1186/s13104-015-1834-0  

    ISSN:1756-0500

    詳細を見る 詳細を閉じる

    Background: Gefitinib is an epidermal growth factor receptor tyrosine kinase inhibitor. Clinical trials have reported its effectiveness in the treatment of brain metastases from non-small cell lung cancer by overcoming the blood-brain barrier. Gefitinib is generally regarded as a relatively safe agent, and several reports have described its efficacy in patients with epidermal growth factor receptor mutation-positive non-small cell lung cancer and a poor performance status. Case presentation: We herein described two patients with brain metastasis from non-small cell lung cancer who achieved the total regression of metastasis with the administration of gefitinib. A 70-year-old Japanese woman was referred to our hospital with a severe cough. Brain magnetic resonance imaging revealed a metastatic lesion in the left temporal lobe. The tumor was positive for an epidermal growth factor receptor L858R mutation in exon 21 using the peptide nucleic acid-locked nucleic acid polymerase chain reaction clamp method. She was treated with 250 mg gefitinib per day, and, 1 month later, the primary lesion and brain metastasis had totally resolved. A 58-year-old Japanese woman was referred to our hospital with nausea and headache. Brain magnetic resonance imaging revealed a metastatic lesion in the left cerebellar hemisphere and meningeal dissemination. The tumor was positive for the epidermal growth factor receptor L858R mutation in exon 21. She was treated with 250 mg gefitinib per day, and, 3 weeks later, the primary lesion, brain metastasis, and meningeal dissemination had completely resolved. Conclusion: We successfully treated two lung cancer patients with brain metastasis using gefitinib. Gefitinib therapy may be a suitable treatment for brain metastasis in lung cancer with an epidermal growth factor receptor mutation, particularly in elderly patients with a poor performance status.

  130. Clinical profiles for seizure remission and developmental gains after total corpus callosotomy 査読有り

    Masaki Iwasaki, Mitsugu Uematsu, Naomi Hino-Fukuyo, Shin-ichiro Osawa, Yoshiteru Shimoda, Kazutaka Jin, Nobukazu Nakasato, Teiji Tominaga

    BRAIN & DEVELOPMENT 38 (1) 47-53 2016年1月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.braindev.2015.04.010  

    ISSN:0387-7604

    eISSN:1872-7131

    詳細を見る 詳細を閉じる

    Purpose: This study was aimed to determine what preoperative profiles were associated with seizure remission after corpus callosotomy and whether such seizure outcome was associated with the postoperative developmental outcome. Methods: This retrospective study included 26 consecutive patients with childhood onset epilepsy who underwent one-stage total corpus callosotomy at our institution and were followed up for a minimum of 1 year. The age at surgery ranged from 13 months to 32 years (median 6 years). The association between postoperative seizure freedom and preoperative profiles, post-operative developmental gains was examined. Results: Five patients achieved seizure freedom (Engel class I), and 10 patients achieved worthwhile reduction of seizures (class III), whereas the remaining patients had a class IV outcome. All five seizure-free patients had "lack of abnormal magnetic resonance imaging findings", "lack of proven etiology of seizures", and underwent "surgery at age 6 years or younger". These three factors were associated with seizure freedom (p &lt; 0.05, Fisher exact test). Post-operative gains in developmental quotient were significantly better in patients with seizure freedom than in those without (p &lt; 0.05, Mann Whitney U test). Conclusion: Our study replicated the notion that seizure remission can be achieved after total corpus callosotomy in subsets of patients with medically-uncontrolled epilepsy, and suggested that a better developmental outcome can be expected in patients benefiting from seizure freedom. (c) 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  131. High frequency oscillations are less frequent but more specific to epileptogenicity during rapid eye movement sleep 査読有り

    Rie Sakuraba, Masaki Iwasaki, Eiichi Okumura, Kazutaka Jin, Yosuke Kakisaka, Kazuhiro Kato, Teiji Tominaga, Nobukazu Nakasato

    CLINICAL NEUROPHYSIOLOGY 127 (1) 179-186 2016年1月

    出版者・発行元:ELSEVIER IRELAND LTD

    DOI: 10.1016/j.clinph.2015.05.019  

    ISSN:1388-2457

    eISSN:1872-8952

    詳細を見る 詳細を閉じる

    Objective: We hypothesized that high frequency oscillations (HFOs) are differently suppressed during rapid eye movement sleep (REM) between epileptogenic and less epileptogenic cortices, and that the suppressive effect can serve as a specific marker of epileptogenicity. Methods: Intracranial electroencephalography (EEG) was recorded in 13 patients with drug-resistant epilepsy. HFOs between 80 and 200 Hz were semi-automatically detected from total 15-min EEG epochs each for REM and slow wave sleep (SWS). z-Score of HFO occurrence rate was calculated from the baseline rate derived from non-epileptogenic cortex. Intracranial electrodes were labeled as REM dominant HFO (RdH) if REM z-score was greater than SWS z-score or as SWS dominant HFO (SdH) if SWS z-score was greater than REM z-score. Relationship of electrode location to the area of surgical resection was compared between RdH and SdH electrodes. Results: Out of 1070 electrodes, 101 were defined as RdH electrodes and 115 as SdH electrodes. RdH electrodes were associated with the area of resection in patients with postoperative seizure freedom (P &lt; 0.001), but not in patients without seizure freedom. Conclusions: HFOs near the epileptogenic zone are less suppressed during REM. Significance: The less suppressive effect of REM may provide a specific marker of epileptogenicity. (C) 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  132. Somatic BRAF c.1799T>A p.V600E Mosaicism syndrome characterized by a linear syringocystadenoma papilliferum, anaplastic astrocytoma, and ocular abnormalities. 国際誌 査読有り

    Yuko Watanabe, Kosuke Shido, Tetsuya Niihori, Hidetaka Niizuma, Yu Katata, Chie Iizuka, Daiju Oba, Kunihiko Moriya, Yuka Saito-Nanjo, Masaei Onuma, Takeshi Rikiishi, Yoji Sasahara, Mika Watanabe, Setsuya Aiba, Ryuta Saito, Yukihiko Sonoda, Teiji Tominaga, Yoko Aoki, Shigeo Kure

    American journal of medical genetics. Part A 170A (1) 189-94 2016年1月

    DOI: 10.1002/ajmg.a.37376  

    ISSN:1552-4825

    詳細を見る 詳細を閉じる

    Genetic mosaicism for somatic mutations of oncogenes is common in genodermatoses, which can be complicated with extra-cutaneous abnormalities. Here we describe an infant with a congenital anaplastic astrocytoma, a linear syringocystadenoma papilliferum, and ocular abnormalities. The BRAF c.1799T>A p.V600E mutation was detected in both the brain and skin tumor cells but not in the blood or normal skin cells, suggesting somatic mosaicsism for the mutation. Clinically, the brain tumor gradually became life threatening without any response to conventional chemotherapies including carboplatin, etoposide, and temozolomide. Vemurafenib, a BRAF p.V600E inhibitor, was administered daily after the detection of the BRAF mutation. This single-agent therapy was dramatically effective against the anaplastic astrocytoma; the tumor regressed, the cerebrospinal fluid cell count and protein levels decreased to normal levels, and hydrocephalus resolved. Moreover, other lesions including a corneal cyst also responded to vemurafenib. The brain tumor continued shrinking after 6 months of treatment. We present a genodermatosis syndrome associated with BRAF c.1799T>A p.V600E mosaicism. This syndrome may represent a new entity in the mosaic RASopathies, partly overlapping with Schimmelpenning-Feuerstein-Mims syndrome, which is driven by mosaicism of HRAS and/or KRAS activating mutations. Screening for BRAF c.1799T>A p.V600E is especially useful for those with malignant tumors, because it is one of the most-druggable targets.

  133. Transplantation of Unique Subpopulation of Fibroblasts, Muse Cells, Ameliorates Experimental Stroke Possibly via Robust Neuronal Differentiation 査読有り

    Hiroki Uchida, Takahiro Morita, Kuniyasu Niizuma, Yoshihiro Kushida, Yasumasa Kuroda, Shohei Wakao, Hiroyuki Sakata, Yoshiya Matsuzaka, Hajime Mushiake, Teiji Tominaga, Cesario V. Borlongan, Mari Dezawa

    STEM CELLS 34 (1) 160-173 2016年1月

    出版者・発行元:WILEY-BLACKWELL

    DOI: 10.1002/stem.2206  

    ISSN:1066-5099

    eISSN:1549-4918

    詳細を見る 詳細を閉じる

    Objective: Muse cells reside as pre-existing pluripotent-like stem cells within the fibroblasts, are nontumorigenic, exhibit differentiation capacity into triploblastic-lineage cells, and replenish lost cells when transplanted in injury models. Cell fate and function of human skin fibroblast-derived Muse cells were evaluated in a rat stroke model. Methods: Muse cells (30,000), collected by pluripotent surface marker stage-specific embryonic antigen-3, were injected stereotaxically into three deposits within the rat ischemic cortex at 2 days after transient middle cerebral artery occlusion, and the cells' biological effects were examined for more than 84 days. Results: Muse cells spontaneously and promptly committed to neural/neuronal-lineage cells when cocultured with stroke brain slices. Muse-transplanted stroke rats exhibited significant improvements in neurological and motor functions compared to control groups at chronic days 70 and 84, without a reduction in the infarct size. Muse cells survived in the host brain for up to 84 days and differentiated into NeuN (similar to 65%), MAP-2 (similar to 32%), calbindin (similar to 28%), and GST-pi (similar to 25%)-positive cells in the cortex, but glial fibrillary acidic protein-positive cells were rare. Tumor formation was not observed. Muse cells integrated into the sensory-motor cortex, extended their neurites into cervical spinal cord, and displayed normalized hind limb somatosensory evoked potentials. Interpretation: Muse cells are unique from other stem cells in that they differentiate with high ratio into neuronal cells after integration with host brain microenvironment, possibly reconstructing the neuronal circuit to mitigate stroke symptoms. Human fibroblast-derived Muse cells pose as a novel source of transplantable stem cells, circumventing the need for gene manipulations, especially when contemplating autologous cell therapy for stroke.

  134. Malignant transformation of diffuse astrocytoma to glioblastoma associated with newly developed BRAF V600E mutation 査読有り

    Masayuki Kanamori, Hiroyoshi Suzuki, Hidehiro Takei, Yukihiko Sonoda, Hiroshi Uenohara, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 33 (1) 50-56 2016年1月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1007/s10014-015-0231-7  

    ISSN:1433-7398

    eISSN:1861-387X

    詳細を見る 詳細を閉じる

    A 29-year-old man presented with scintillation scotoma. MR imaging demonstrated a diffuse lesion in right parahippocampal gyrus. He underwent a biopsy, and the diagnosis was diffuse astrocytoma. Because of enlargement and new areas of gadolinium enhancement, the tumor was resected 18 months after biopsy. Histological examination revealed malignant transformation to glioblastoma with small areas of epithelioid component. He received radiation and temozolomide chemotherapy. Local recurrence was found 20 months after first resection. He underwent second resection, and the diagnosis was glioblastoma. DNA from the micro-dissected paraffin-embedded sections were analyzed for the mutation of the isocitrate dehydrogenase1 (IDH1) and IDH2 and v-RAF murine sarcoma viral oncogene homolog B1 (BRAF) genes. No mutations of the IDH genes were detected in any tumor specimen. In contrast, missense mutation at codon 600 in the BRAF gene (BRAF V600E) was found exclusively in the malignant areas from both resected glioblastoma specimens. We screened other genetic aberrations commonly seen in glioblastoma with multiplex ligation-dependent probe analysis. Deletion of CDKN2A and CDKN2B loci was found both in diffuse astrocytoma and glioblastoma component, but no other significant alterations were found. This case suggests that the BRAF V600E mutation may be involved in the malignant transformation to glioblastoma.

  135. Evaluation of Fine Feeding System and Angioarchitecture of Giant Pituitary Adenoma-Implications for Establishment of Surgical Strategy 査読有り

    Yoshikazu Ogawa, Kenichi Sato, Yasushi Matsumoto, Teiji Tominaga

    WORLD NEUROSURGERY 85 244-251 2016年1月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.wneu.2015.09.087  

    ISSN:1878-8750

    eISSN:1878-8769

    詳細を見る 詳細を閉じる

    BACKGROUND: Giant pituitary adenomas carry higher surgical risks despite recent advances in microsurgical and/or endoscopic surgery, and postoperative acute catastrophic changes without major vessel disturbance are still extremely difficult to predict, may manifest as postoperative pituitary apoplexy, and are associated with poor outcomes. METHODS: Eight males and 4 females aged 31-72 years (mean 50.7 years) with giant pituitary adenomas underwent preoperative investigation of fine angioarchitecture using C-arm cone-beam computed tomography with a flat-panel detector. Angiographical findings were used to decide the surgical routes and compared with clinical outcome. RESULTS: Feeding arteries were verified in 10 of 12 patients, whereas no feeding arteries were evident in 2 patients. The patients were divided into the faint tumor staining group and the significant staining group, which was reconfirmed by region of interest analysis. The former group had faint supply from the ipsilateral superior hypophyseal arteries and meningohypophyseal trunk, and the latter group had significant supply from the meningohypophyseal and inferolateral trunks, which passed centrifugally from the inferoposterior pole of the tumor. All patients were treated through the extended transsphenoidal approach. Intraoperative bleeding was significantly greater in the latter group (P = 0.013). All patients had improvement of neurologic deficit and were released from the intensive care unit within a few days. CONCLUSIONS: Major blood supply of giant pituitary adenomas originates from branches of the infraclinoidal portion of the internal carotid artery, different from the normal anterior pituitary gland. Surgical route should depend on not only tumor shape and extension but also feeding systems.

  136. Temozolomide reverses doxorubicin resistance by inhibiting P-glycoprotein in malignant glioma cells 査読有り

    Rong Zhang, Ryuta Saito, Ichiyo Shibahara, Shinichiro Sugiyama, Masayuki Kanamori, Yukihiko Sonoda, Teiji Tominaga

    JOURNAL OF NEURO-ONCOLOGY 126 (2) 235-242 2016年1月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s11060-015-1968-x  

    ISSN:0167-594X

    eISSN:1573-7373

    詳細を見る 詳細を閉じる

    Temozolomide is a standard chemotherapy agent for malignant gliomas, but the efficacy is still not satisfactory. Therefore, combination chemotherapy using temozolomide with other anti-tumor compounds is now under investigation. Here we studied the mechanism of the synergistic anti-tumor effect achieved by temozolomide and doxorubicin, and elucidated the inhibitory effect of temozolomide on P-glycoprotein (P-gp). Temozolomide significantly enhanced sensitivity to P-gp substrate in glioma cells, particularly in P-gp-overexpressed cells. Synergetic effects, as determined by isobologram analysis, were observed by combining temozolomide and doxorubicin. Subsequently, flow cytometry was utilized to assess the intracellular retention of doxorubicin in cells treated with doxorubicin with or without temozolomide. Temozolomide significantly increased the accumulation of doxorubicin in these cells. The P-gp adenosine triphosphatase (ATPase) assay showed that temozolomide inhibited the ATPase activity of P-gp. In addition, temozolomide combined with doxorubicin significantly prolonged the survival of 9L intracranial allografted glioma-bearing rats compared to single agent treatment. Collectively, our findings suggest that temozolomide can reverse doxorubicin resistance by directly affecting P-gp transport activity. Combination chemotherapy using temozolomide with other agents may be effective against gliomas in clinical applications.

  137. Transient middle cerebral artery occlusion in mice induces neuronal expression of RNF213, a susceptibility gene for moyamoya disease 査読有り

    Mika Sato-Maeda, Miki Fujimura, Atsushi Kanoke, Yuiko Morita-Fujimura, Kuniyasu Niizuma, Teiji Tominaga

    BRAIN RESEARCH 1630 50-55 2016年1月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.brainres.2015.10.055  

    ISSN:0006-8993

    eISSN:1872-6240

    詳細を見る 詳細を閉じる

    Although recent genome-wide and locus-specific association studies revealed that the RING finger protein 213 (RNF213) gene is an important susceptibility gene for moyamoya disease (MMD), the exact mechanism by which the genetic alteration of RNF213 contributes to the development of MMD has not yet been elucidated. A quantitative reverse transcription polymerase chain reaction (PCR) analysis revealed that the constitutive expression of the RNF213 gene was very low in adult and embryonic brain tissue. However, information regarding the temporal and spatial expression patterns of the RNF213 gene under the condition of cerebral ischemia, which is one of characteristic pathologies associated with MMD, is currently limited. In order to address this critical issue, Rnf213 mRNA expression was investigated in mouse brains subjected to 60 min of transient middle cerebral artery occlusion (tMCAO). Male C57BL6/j mice underwent tMCAO through the intraluminal blockade of MCA. Expression of the Rnf213 gene in the tMCAO brain was investigated with in situ RNA hybridization and a real-time PCR analysis from 1 to 72 h after tMCAO. In situ RNA hybridization revealed a significant increase in Rnf213 mRNA levels in the cerebral cortex supplied by the affected MCA, especially at the penumbra area, as early as 6 h after tMCAO, and these levels had increased further by 24 h. Rnf213 gene expression remained unchanged in the non-ischemic hemisphere or control specimens. Double staining of Rnf213 mRNA with NeuN immunohistochemisty revealed Rnf213 hybridization signal expression mostly in neurons. The real-time PCR analysis confirmed induction of the Rnf213 gene after tMCAO. Therefore, the Rnf213 gene was up-regulated in the ischemic brain, especially at the penumbra area, 6 h after tMCAO. Early increases in RNF213 gene expression in neurons after tMCAO indicate its involvement in cerebral ischemia, which is an underlying pathology of MMD. Further investigation is required to clarify its exact role in the pathophysiology of MMD. (C) 2015 Elsevier B.V. All rights reserved.

  138. Divergent clonal selection dominates medulloblastoma at recurrence 査読有り

    A. Sorana Morrissy, Livia Garzia, David J. H. Shih, Scott Zuyderduyn, Xi Huang, Patryk Skowron, Marc Remke, Florence M. G. Cavalli, Vijay Ramaswamy, Patricia E. Lindsay, Salomeh Jelveh, Laura K. Donovan, Xin Wang, Betty Luu, Kory Zayne, Yisu Li, Chelsea Mayoh, Nina Thiessen, Eloi Mercier, Karen L. Mungall, Yusanne Ma, Kane Tse, Thomas Zeng, Karey Shumansky, Andrew J. L. Roth, Sohrab Shah, Hamza Farooq, Noriyuki Kijima, Borja L. Holgado, John J. Y. Lee, Stuart Matan-Lithwick, Jessica Liu, Stephen C. Mack, Alex Manno, K. A. Michealraj, Carolina Nor, John Peacock, Lei Qin, Juri Reimand, Adi Rolider, Yuan Y. Thompson, Xiaochong Wu, Trevor Pugh, Adrian Ally, Mikhail Bilenky, Yaron S. N. Butterfield, Rebecca Carlsen, Young Cheng, Eric Chuah, Richard D. Corbett, Noreen Dhalla, An He, Darlene Lee, Haiyan I. Li, William Long, Michael Mayo, Patrick Plettner, Jenny Q. Qian, Jacqueline E. Schein, Angela Tam, Tina Wong, Inanc Birol, Yongjun Zhao, Claudia C. Faria, Jose Pimentel, Sofia Nunes, Tarek Shalaby, Michael Grotzer, Ian F. Pollack, Ronald L. Hamilton, Xiao-Nan Li, Anne E. Bendel, Daniel W. Fults, Andrew W. Walter, Toshihiro Kumabe, Teiji Tominaga, V. Peter Collins, Yoon-Jae Cho, Caitlin Hoffman, David Lyden, Jeffrey H. Wisoff, James H. Garvin, Duncan S. Stearns, Luca Massimi, Ulrich Schueller, Jaroslav Sterba, Karel Zitterbart, Stephanie Puget, Olivier Ayrault, Sandra E. Dunn, Daniela P. C. Tirapelli, Carlos G. Carlotti, Helen Wheeler, Andrew R. Hallahan, Wendy Ingram, Tobey J. MacDonald, Jeffrey J. Olson, Erwin G. Van Meir, Ji-Yeoun Lee, Kyu-Chang Wang, Seung-Ki Kim, Byung-Kyu Cho, Torsten Pietsch, Gudrun Fleischhack, Stephan Tippelt, Young Shin Ra, Simon Bailey, Janet C. Lindsey, Steven C. Clifford, Charles G. Eberhart, Michael K. Cooper, Roger J. Packer, Maura Massimino, Maria Luisa Garre, Ute Bartels, Uri Tabori, Cynthia E. Hawkins, Peter Dirks, Eric Bouffet, James T. Rutka, Robert J. Wechsler-Reya, William A. Weiss, Lara S. Collier, Adam J. Dupuy, Andrey Korshunov, David T. W. Jones, Marcel Kool, Paul A. Northcott, Stefan M. Pfister, David A. Largaespada, Andrew J. Mungall, Richard A. Moore, Nada Jabado, Gary D. Bader, Steven J. M. Jones, David Malkin, Marco A. Marra, Michael D. Taylor

    NATURE 529 (7586) 351-+ 2016年1月

    出版者・発行元:NATURE PUBLISHING GROUP

    DOI: 10.1038/nature16478  

    ISSN:0028-0836

    eISSN:1476-4687

    詳細を見る 詳細を閉じる

    The development of targeted anti-cancer therapies through the study of cancer genomes is intended to increase survival rates and decrease treatment-related toxicity. We treated a transposon-driven, functional genomic mouse model of medulloblastoma with 'humanized' in vivo therapy (microneurosurgical tumour resection followed by multi-fractionated, image-guided radiotherapy). Genetic events in recurrent murine medulloblastoma exhibit a very poor overlap with those in matched murine diagnostic samples (&lt;5%). Whole-genome sequencing of 33 pairs of human diagnostic and post-therapy medulloblastomas demonstrated substantial genetic divergence of the dominant clone after therapy (&lt;12% diagnostic events were retained at recurrence). In both mice and humans, the dominant clone at recurrence arose through clonal selection of a pre-existing minor clone present at diagnosis. Targeted therapy is unlikely to be effective in the absence of the target, therefore our results offer a simple, proximal, and remediable explanation for the failure of prior clinical trials of targeted therapy.

  139. Evaluation of a newly developed piezo actuator-driven pulsed water jet system for liver resection in a surviving swine animal model 査読有り

    Chikashi Nakanishi, Toru Nakano, Atsuhiro Nakagawa, Chiaki Sato, Masato Yamada, Naoki Kawagishi, Teiji Tominaga, Noriaki Ohuchi

    BIOMEDICAL ENGINEERING ONLINE 15 9 2016年1月

    出版者・発行元:BIOMED CENTRAL LTD

    DOI: 10.1186/s12938-016-0126-9  

    ISSN:1475-925X

    詳細を見る 詳細を閉じる

    Background: Preservation of the hepatic vessels while dividing the parenchyma is key to achieving safe liver resection in a timely manner. In this study, we assessed the feasibility of a newly developed, piezo actuator-driven pulsed water jet (ADPJ) for liver resection in a surviving swine model. Methods: Ten domestic pigs underwent liver resection. Parenchymal transection and vessel skeletonization were performed using the ADPJ (group A, n = 5) or an ultrasonic aspirator (group U, n = 5). The water jet was applied at a frequency of 400 Hz and a driving voltage of 80 V. Physiological saline was supplied at a flow rate of 7 ml/min. After 7 days, the animals were killed and their short-term complications were examined and compared between the two groups. Results: No significant complications, such as massive bleeding, occurred in either group during the surgical procedures. The transection time per transection area was significantly shorter in group A than in group U (1.5 +/- 0.3 vs. 2.3 +/- 0.5 min/cm(2), respectively, P = 0.03). Blood loss per transection area was not significantly different between groups A and U (9.3 +/- 4.2 vs. 11.7 +/- 2.3 ml/cm(2), P = 0.6). All pigs in group A survived for 7 days. No postoperative bleeding or bile leakage was observed in any animal at necropsy. Conclusion: The present results suggested that the ADPJ reduces transection time without increasing blood loss. ADPJ is a safe and feasible device for liver parenchymal transection.

  140. A case of ruptured infectious anterior cerebral artery aneurysm treated by interposition graft bypass using the superficial temporal artery. 査読有り

    Abe T, Endo H, Shimizu H, Fujimura M, Endo T, Sakata H, Watanabe M, Tominaga T

    Surgical neurology international 7 5 2016年

    DOI: 10.4103/2152-7806.173319  

    ISSN:2229-5097

  141. Grossly calcified choroid plexus concealing foramen of Monro meningiomas as an unusual cause of obstructive hydrocephalus. 査読有り

    Kawaguchi T, Fujimura M, Tominaga T

    Asian journal of neurosurgery 11 (1) 74 2016年1月

    DOI: 10.4103/1793-5482.165779  

    ISSN:1793-5482

  142. Surgical and Endovascular Treatment for Spinal Arteriovenous Malformations 査読有り

    Toshiki Endo, Hidenori Endo, Kenichi Sato, Yasushi Matsumoto, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 56 (8) 457-464 2016年

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.ra.2015-0327  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Spinal arteriovenous malformation (AVM) is a broad term that constitutes diverse vascular pathologies. To date, various classification schemes for spinal AVM have been proposed in literature, which helped neurosurgeons understand the pathophysiology of the disease and determine an optimal treatment strategy. To discuss indications and results of surgical and endovascular interventions for spinal AVM, this article refers to the following classification proposed by Anson and Spetzler in 1992: type I, dural arteriovenous fistula (AVF); type II, glomus intramedullary AVM; type III, juvenile malformations; and type IV, perimedullary AVF. In general, complete obliteration of the fistula is a key for better outcome in type I dural and type IV perimedullary AVFs. On the other hand, in type II glomus and type III juvenile malformations, functional preservation, instead of pursuing angiographical cure, is the main goal of the treatment. In such cases, reduction of the shunt flow can alleviate clinical symptoms. Proper management of spinal AVM should start with neurological examination and understanding of angioarchitectures, which provide critical information that guides the indication and modality of intervention. Finally, close collaboration of the microsurgical and endovascular teams are mandatory for successful treatment.

  143. Acute Subdural Hematoma in Infants with Abusive Head Trauma: A Literature Review 査読有り

    Hiroshi Karibe, Motonobu Kameyama, Toshiaki Hayashi, Ayumi Narisawa, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 56 (5) 264-273 2016年

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.ra.2015-0308  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    The number of cases with child abuse is increasing in Japan, and abusive head trauma (AHT) is a major cause of death in abused children. Child abuse has been recognized by the late 19th century, and widely accepted as battered child syndrome in the middle of the 20th century. As terms, there had been considerable mechanistic controversies between shaken-baby and -impact syndrome until the beginning of the 21st century. In recent years, AHT has been utilized as a less mechanistic term. Most of the characteristics of AHT in Japan have been similar to those in the United States as follows: infant is the most common victim, acute subdural hematoma (SDH) is the most common intracranial lesion, and retinal hemorrhage is often complicated. On the other hand, several characteristics have been different as follows: mother is the most common perpetrators, impact is a more common mechanism of trauma than shaking, and external trauma is more common reflecting the existence of impact. Since AHT as well as child abuse is a social pathological phenomenon influenced by victims, perpetrators, socioeconomic circumstances, and so on, various aspects of AHT as well as child abuse can be changed with times. Actually, a recent paper suggests such changes in infants with acute SDH due to AHT. In this review article, AHT, abusive infantile acute SDH in particular, are reviewed from the aspect of neurosurgical perspectives, including its mechanisms of trauma, biomechanics, clinical features, management, and prognosis, to update the trend in Japan.

  144. Intraparenchymal infiltration of Rathke's cleft cysts manifesting as severe neurological deficits and hypopituitarism: 2 Case reports 査読有り

    Yoshikazu Ogawa, Mika Watanabe, Teiji Tominaga

    BMC Research Notes 9 (1) 225 2016年

    出版者・発行元:BioMed Central Ltd.

    DOI: 10.1186/s13104-016-2035-1  

    ISSN:1756-0500

    詳細を見る 詳細を閉じる

    Background: Rathke's cleft cysts generally remain asymptomatic throughout life, but a few patients may suffer severe neurological and/or endocrinological deficits. The symptoms include visual disturbances caused by compression of the optic chiasm, and severe endocrinological deficits caused by repeated intracystic hemorrhage or leakage of cyst content. However, no case of Rathke's cleft cyst has infiltrated into neuroglial tissue with marked cerebral edema. Case presentation: Two patients presented with non-infectious re-deterioration of Rathke's cleft cysts with intraparenchymal infiltration and marked cerebral edema, to ipsilateral hypothalamus in one case and to the bilateral frontal lobes in the other. Both patients were surgically treated by extended transsphenoidal surgery, and showed remarkable improvement with postoperative pulse-dose steroid therapy, including disappearance/shrinkage of abnormal enhanced lesion and cerebral edema on magnetic resonance imaging. Histological examination disclosed significant squamous metaplasia in epithelia and marked infiltration of inflammatory cells into the pituitary gland and neuroglial tissues. Most infiltrated cells were lymphocytes and plasma cells, thought to indicate the involvement of long-term underling inflammatory processes in this phenomenon. Conclusion: Long-term subclinical inflammation may be the mechanism of this extraordinary aggressive clinical course. Postoperative steroid administration should be reduced prudently, and careful follow-up imaging is essential in cases of Rathke's cleft cyst with abnormal histological findings.

  145. Mechanism of Traumatic Brain Injury at Distant Locations After Exposure to Blast Waves: Preliminary Results from Animal and Phantom Experiments 査読有り

    Atsuhiro Nakagawa, Kiyonobu Ohtani, Keisuke Goda, Daisuke Kudo, Tatsuhiko Arafune, Toshikatsu Washio, Teiji Tominaga

    INTRACRANIAL PRESSURE AND BRAIN MONITORING XV 122 3-7 2016年

    出版者・発行元:SPRINGER

    DOI: 10.1007/978-3-319-22533-3_1  

    ISSN:0065-1419

    詳細を見る 詳細を閉じる

    Purpose Primary blast-induced traumatic brain injury (bTBI) is the least understood of the four phases of blast injury. Distant injury induced by the blast wave, on the opposite side from the wave entry, is not well understood. This study investigated the mechanism of distant injury in bTBI. Materials and Methods Eight 8-week-old male Sprague-Dawley rats were divided into two groups: group 1 served as the control group and did not receive any shock wave (SW) exposure; group 2 was exposed to SWs (12.5 +/- 2.5 MPa). Propagation of SWs within a brain phantom was evaluated by visualization, pressure measurement, and numerical simulation. Results Intracerebral hemorrhage near the ignition site and elongation of the distant nucleus were observed, despite no apparent damage between the two locations in the animal experiment. Visualization, pressure measurement, and numerical simulation indicated the presence of complex wave dynamics accompanying a sudden increase in pressure, followed by negative pressure in the phantom experiment. Conclusion A local increase in pressure above the threshold caused by interference of reflection and rarefaction waves in the vicinity of the brain-skull surface may cause distant injury in bTBI.

  146. Nasal cavity epithelioid hemangioendothelioma invading the anterior skull base. 国際誌 査読有り

    Shogo Ogita, Toshiki Endo, Kazuhiro Nomura, Takenori Ogawa, Mika Watanabe, Kenjiro Higashi, Yukio Katori, Teiji Tominaga

    Surgical neurology international 7 53-53 2016年

    DOI: 10.4103/2152-7806.181902  

    ISSN:2229-5097

    詳細を見る 詳細を閉じる

    BACKGROUND: Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor that frequently occurs in soft tissues. Patients suffer from local recurrence and remote metastasis because of its malignant potential. Here, we present a rare case of EHE that originated from nasal cavity and invaded intracranially through the anterior skull base. CASE DESCRIPTION: This is a 27-year-old woman who presented a local physician with intermittent epistaxis and a facial pain around her nose. Preoperative studies demonstrated that the tumor invaded into anterior skull base and the dura matter. Therefore, we performed combined skull base and transnasal surgery, which achieved complete resection of the tumor. Postoperative course of the patient was uneventful. No recurrence or distant metastasis was observed in the patient for 2 years following the radical resection. CONCLUSIONS: To date, four cases of EHE in the nasal cavity were reported. This is the first case in which EHE demonstrated invasive potentials with intracranial extension. Radical surgical resection plays an important role for better management of invasive paranasal EHE.

  147. Verbal Dominant Memory Impairment and Low Risk for Post-operative Memory Worsening in Both Left and Right Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis 査読有り

    Amr Farid Khalil, Masaki Iwasaki, Yoshiyuki Nishio, Kazutaka Jin, Nobukazu Nakasato, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 56 (11) 716-723 2016年

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.oa.2016-0004  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Post-operative memory changes after temporal lobe surgery have been established mainly by group analysis of cognitive outcome. This study investigated individual patient-based memory outcome in surgically-treated patients with mesial temporal lobe epilepsy (TLE). This study included 84 consecutive patients with intractable TLE caused by unilateral hippocampal sclerosis (HS) who underwent epilepsy surgery (47 females, 41 left [Lt] TLE). Memory functions were evaluated with the Wechsler Memory Scale-Revised before and at 1 year after surgery. Pre-operative memory function was classified into three patterns: verbal dominant memory impairment (Verb-D), visual dominant impairment (Vis-D), and no material-specific impairment. Post-operative changes in verbal and visual memory indices were classified into meaningful improvement, worsening, or no significant changes. Pre-operative patterns and post-operative changes in verbal and visual memory function were compared between the Lt and right (Rt) TLE groups. Pre-operatively, Verb-D was the most common type of impairment in both the Lt and Rt TLE groups (65.9 and 48.8%), and verbal memory indices were lower than visual memory indices, especially in the Lt compared with Rt TLE group. Vis-D was observed only in 11.6% of Rt and 7.3% of Lt TLE patients. Post-operatively, meaningful improvement of memory indices was observed in 23.3-36.6% of the patients, and the memory improvement was equivalent between Lt and Rt TLE groups and between verbal and visual materials. In conclusion, Verb-D is most commonly observed in patients with both the Lt and Rt TLE associated with HS. Hippocampectomy can improve memory indices in such patients regardless of the side of surgery and the function impaired.

  148. Non-invasive Evaluation for Epilepsy Surgery 査読有り

    Masaki Iwasaki, Kazutaka Jin, Nobukazu Nakasato, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 56 (10) 632-640 2016年

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.ra.2016-0186  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Epilepsy surgery is aimed to remove the brain tissues that are indispensable for generating patient's epileptic seizures. There are two purposes in the pre-operative evaluation: localization of the epileptogenic zone and localization of function. Surgery is planned to remove possible epileptogenic zone while preserving functional area. Since no single diagnostic modality is superior to others in identifying and localizing the epileptogenic zone, multiple non-invasive evaluations are performed to estimate the location of the epileptogenic zone after concordance between evaluations. Essential components of non-invasive pre-surgical evaluation of epilepsy include detailed clinical history, long-term video-electroencephalography monitoring, epilepsy-protocol magnetic resonance imaging (MRI), and neuropsychological testing. However, a significant portion of drug-resistant epilepsy is associated with no or subtle MRI lesions or with ambiguous electro-clinical signs. Additional evaluations including fluoro-deoxy glucose positron emission tomography (FDG-PET), magnetoencephalography and ictal single photon emission computed tomography can play critical roles in planning surgery. FDG-PET should be registered on three--dimensional MRI for better detection of focal cortical dysplasia. All diagnostic tools are complementary to each other in defining the epileptogenic zone, so that it is always important to reassess the data based on other results to pick up or confirm subtle abnormalities.

  149. Difference in Transcranial Doppler Velocity and Patient Age between Proximal and Distal Middle Cerebral Artery Vasospasms after Aneurysmal Subarachnoid Hemorrhage. 国際誌 査読有り

    Misaki Kohama, Shinichiro Sugiyama, Kenichi Sato, Hidenori Endo, Kuniyasu Niizuma, Toshiki Endo, Makoto Ohta, Yasushi Matsumoto, Miki Fujimura, Teiji Tominaga

    Cerebrovascular diseases extra 6 (2) 32-9 2016年

    DOI: 10.1159/000447330  

    詳細を見る 詳細を閉じる

    BACKGROUND: Transcranial Doppler (TCD) is used to monitor cerebral vasospasm after subarachnoid hemorrhage (SAH), but its diagnostic ability is reported to be limited. Therefore, the purpose of this study was to investigate the relationship between the diagnosability of TCD and the localization of the vasospasm. METHODS: This retrospective study included 20 patients who presented with symptomatic vasospasm after SAH. All 20 patients underwent daily TCD examinations and cerebral angiography after the onset of delayed cerebral ischemia. We defined positive findings on TCD as a maximum flow velocity >200 cm/s or as a mean flow velocity >120 cm/s at the horizontal part of the middle cerebral artery (MCA). We also examined the site of vasospasm on cerebral angiography. RESULTS: Fourteen patients had true-positive findings on TCD examination, and cerebral angiography showed diffuse vasospasm involving the horizontal segment of the MCA. However, 6 patients had false-negative findings on TCD examination, and cerebral angiography showed vasospasm localized at the distal part of the MCA (the insular and/or cortical segments). The patients with proximal vasospasm were significantly younger than those with distal vasospasm. Blood flow velocity at initial TCD and the increase in velocity at the onset of vasospasm were lower and smaller, respectively, in the distal vasospasm group. CONCLUSIONS: In patients with cerebral vasospasm localized at the distal part of the MCA, flow velocity at the horizontal segment of the MCA did not increase to the level we defined as positive. To avoid such false negatives, a slight increase in velocity on TCD should be considered as positive in distal vasospasm cases, especially in older patients.

  150. Computational Hemodynamic Analysis for the Diagnosis of Atherosclerotic Changes in Intracranial Aneurysms: A Proof-of-Concept Study Using 3 Cases Harboring Atherosclerotic and Nonatherosclerotic Aneurysms Simultaneously 査読有り

    Shin-ichiro Sugiyama, Hidenori Endo, Kuniyasu Niizuma, Toshiki Endo, Kenichi Funamoto, Makoto Ohta, Teiji Tominaga

    COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2016 2386031 2016年

    出版者・発行元:HINDAWI PUBLISHING CORP

    DOI: 10.1155/2016/2386031  

    ISSN:1748-670X

    eISSN:1748-6718

    詳細を見る 詳細を閉じる

    This was a proof-of-concept computational fluid dynamics (CFD) study designed to identify atherosclerotic changes in intracranial aneurysms. We selected 3 patients with multiple unruptured aneurysms including at least one with atherosclerotic changes and investigated whether an image-based CFD study could provide useful information for discriminating the atherosclerotic aneurysms. Patient-specific geometries were constructed from three-dimensional data obtained using rotational angiography. Transient simulations were conducted under patient-specific inlet flow rates measured by phase-contrast magnetic resonance velocimetry. In the postanalyses, we calculated time-averaged wall shear stress (WSS), oscillatory shear index, and relative residence time (RRT). The volume of blood flow entering aneurysms through the neck and the mean velocity of blood flow inside aneurysms were examined. We applied the age-of-fluid method to quantitatively assess the residence of blood inside aneurysms. Atherosclerotic changes coincided with regions exposed to disturbed blood flow, as indicated by low WSS and long RRT. Blood entered aneurysms in phase with inlet flow rates. The mean velocities of blood inside atherosclerotic aneurysms were lower than those inside nonatherosclerotic aneurysms. Blood in atherosclerotic aneurysms was older than that in nonatherosclerotic aneurysms, especially near the wall. This proof-of-concept study demonstrated that CFD analysis provided detailed information on the exchange and residence of blood that is useful for the diagnosis of atherosclerotic changes in intracranial aneurysms.

  151. Intraspinal dissemination of intracranial hemangiopericytoma: Case report and literature review. 査読有り

    Ali HS, Endo T, Endo H, Murakami K, Tominaga T

    Surgical neurology international 7 (Suppl 40) S1016-S1020 2016年

    DOI: 10.4103/2152-7806.195585  

    ISSN:2229-5097

  152. Outcomes of Oculomotor Nerve Palsy Caused by Internal Carotid Artery Aneurysm: Comparison between Microsurgical Clipping and Endovascular Coiling 査読有り

    Masaki Mino, Masahiro Yoshida, Takahiro Morita, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 55 (12) 885-890 2015年12月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.oa.2014-0434  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    The purpose of this study was to compare the clinical outcomes of microsurgical clipping and endovascular coiling in patients with oculomotor nerve palsy (ONP) caused by internal carotid artery (ICA) aneurysm. Among 17 patients with ICA aneurysms presented with ONP, 9 (52.9%) underwent microsurgical clipping and 8 (47.1%) underwent endovascular coiling. Outcomes of functional recovery of ONP were investigated and compared between surgical group and endovascular group. Mean intervals between the onset and treatment were significantly longer in microsurgical group (18.2 days) than in endovascular group (3.5 days). In microsurgical group, complete resolution (CR) of ONP was obtained in 7 of 9 patients (77.8%) and partial resolution (PR) was seen in 2 patients (22.2%). In endovascular group, CR was obtained in 5 of 8 patients (62.5%) and PR was seen in 3 patients (37.5%). The optimal treatment of aneurysm-induced ONP remains controversial; however, present study suggests both procedures are beneficial for achieving functional recovery of ONP. The treatment strategy should be decided primarily considering the general risks of the two procedures, and presence of ONP is not a disadvantageous factor for either procedure.

  153. Experimental model of small subcortical infarcts in mice with long-lasting functional disabilities 査読有り

    Hiroki Uchida, Hiroyuki Sakata, Miki Fujimura, Kuniyasu Niizuma, Yoshihiro Kushida, Mari Dezawa, Teiji Tominaga

    BRAIN RESEARCH 1629 318-328 2015年12月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.brainres.2015.10.039  

    ISSN:0006-8993

    eISSN:1872-6240

    詳細を見る 詳細を閉じる

    Small subcortical infarcts account for 25% of all ischemic strokes. Although once considered to be a small vessel disease with a favorable outcome, recent studies have reported relatively poor long-term prognoses following small subcortical infarcts. Limited pre-clinical modeling has hampered understanding of the etiology and development of treatments for this disease. Therefore, we attempted to develop a new experimental model of small subcortical infarcts in mice to investigate pathophysiological changes in the corticospinal tract and assess long-term behavioral performance. The vasoconstrictor peptide, endothlin-1 (ET-1), in combination with the nitric oxide synthase inhibitor, N(G)-nitro-L-arginine methyl ester (L-NAME), were injected into the internal capsule of mice. Histological and behavioral tests were performed 0-8 weeks after the injection. The ET-1/L-NAME injection resulted in severe neurological deficits that continued for up to 8 weeks. The loss of axons and myelin surrounded by reactive gliosis was identified in the region of the injection, in which the vasoconstriction of microvessels was also observed. Moreover, a tract-tracing study revealed an interruption in axonal flow at the internal capsule. The present model of small subcortical infarcts is unique and novel due to the reproduction of neurological deficits that continue for a long period, up to 8 weeks, as well as the use of mice as experimental animals. The reproducibility, simplicity, and easy adoptability make the present model highly appealing for use in further pre-clinical studies on small subcortical infarcts. (C) 2015 Elsevier B.V. All rights reserved.

  154. Risk factors for meningitis after craniotomy in patients with subarachnoid hemorrhage due to anterior circulation aneurysms rupture 査読有り

    Takashi Inoue, Hiroaki Shimizu, Miki Fujimura, Kenichi Sato, Hidenori Endo, Kuniyasu Niizuma, Hiroyuki Sakata, Teiji Tominaga

    CLINICAL NEUROLOGY AND NEUROSURGERY 139 302-306 2015年12月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.clineuro.2015.10.029  

    ISSN:0303-8467

    eISSN:1872-6968

    詳細を見る 詳細を閉じる

    Objectives: Postoperative meningitis is a serious complication occurring after neurosurgical interventions. However, few investigations have focused specifically on the risk factors that predispose patients to meningitis after major craniotomy. This study identified the risk factors for postoperative meningitis after neurovascular surgery, and investigated the relationship between postoperative meningitis and clinical outcome. Patients and methods: A total of 148 consecutive patients with subarachnoid hemorrhage (SAH) who underwent clipping surgery through a pterional approach within 72 h between January 2007 and September 2011 were retrospectively analyzed. The treatment strategy of our hospital for patients with SAH was based on the findings of digital subtraction angiography in the acute phase. Coil embolization was firstly considered, and clipping through craniotomy if indicated was performed as soon as possible. Prophylactic antibiotics were administered before beginning craniotomy and for at least 3 days after. Hydrocortisone was used to prevent hyponatremia if allowed by the medical condition of the patient. Intrathecal administration of nicardipine hydrochloride was given if required for vasospasm treatment. Meningitis was clinically diagnosed from the blood samplings and cerebrospinal fluid (CSF) examinations. Data were collected from the electronic and paper charts. The status of modified Rankin scale (mRS) 0-2 at discharge was defined as favorable outcome. Results: A total of 14 patients (9.5%) had meningitis during this study period. Symptomatic vasospasm was detected in 33 patients (22.3%), and 12 patients (8.1%) had permanent neurological deficits caused by vasospasm. Overall, 109 patients (73.6%) had favorable outcome. The longer duration of drainage placement, presence of CSF leakage, and intrathecal administration of vasodilatory agent showed significantly higher incidence of postoperative meningitis in univariate analysis (p = 0.0093, 0.0017, and 0.0090, respectively). The proportion of favorable outcome patients at discharge (mRS 0-2) was significantly lower in patients with postoperative meningitis (35.7%) than in patients without it (77.6%) (p = 0.0004). The duration of in-hospital stay was significantly longer in patients with postoperative meningitis (median 58.5, range 28-115 days) than in patients without it (median 38.5, range 19-149 days) (p &lt; 0.001). Multivariate logistic regression analysis showed that only presence of CSF leakage was associated with postoperative meningitis (p = 0.0299). Conclusion: Meningitis after surgery is still a serious complication that requires preventative intervention. The clinical outcome of patients with postoperative meningitis after neurovascular surgery is not still satisfactory. (C) 2015 Elsevier B.V. All rights reserved.

  155. Resection of focal cortical dysplasia located in the upper pre-central gyrus 査読有り

    Samer Serag Eldin, Masaki Iwasaki, Yoshiyuki Nishio, Kazutaka Jin, Nobukazu Nakasato, Teiji Tominaga

    EPILEPTIC DISORDERS 17 (4) 479-484 2015年12月

    出版者・発行元:JOHN LIBBEY EUROTEXT LTD

    DOI: 10.1684/epd.2015.0771  

    ISSN:1294-9361

    eISSN:1950-6945

    詳細を見る 詳細を閉じる

    The primary motor cortex of the oro-facial level can be removed without permanent deficits, because of the bilateral representation of the innate functions. In contrast, resective surgery of the hand motor cortex or higher levels presents more challenges. We treated two adult patients with intractable epilepsy caused by small focal cortical dysplasia in the pre-central gyrus located between the foot and hand primary motor cortices. Focal cortical resection was guided by cortical EEG and intra-operative motor evoked potential, resulting in seizure freedom without neurological deficits in both cases. These cases illustrate that resective surgery can be safely performed in the primary motor cortex even dorsal to the oro-facial level, as long as the critical regions of the hand and foot motor cortices remain intact. Accurate delineation of the anatomical lesion and functional areas using intra-operative neurophysiological monitoring is crucial for successful outcome of the surgery.

  156. Pulsed Laser-induced Liquid Jet System for Treatment of Sellar and Parasellar Tumors: Safety Evaluation 査読有り

    Atsuhiro Nakagawa, Yoshikazu Ogawa, Kosaku Amano, Yudo Ishii, Shigeshi Tahara, Kentaro Horiguchi, Takakazu Kawamata, Shigetoshi Yano, Tatsuhiko Arafune, Toshikatsu Washio, Jun-ichi Kuratsu, Naokatsu Saeki, Yoshikazu Okada, Akira Teramoto, Teiji Tominaga

    JOURNAL OF NEUROLOGICAL SURGERY PART A-CENTRAL EUROPEAN NEUROSURGERY 76 (6) 473-482 2015年11月

    出版者・発行元:THIEME MEDICAL PUBL INC

    DOI: 10.1055/s-0034-1396436  

    ISSN:2193-6315

    eISSN:2193-6323

    詳細を見る 詳細を閉じる

    ObjectiveThe pulsed laser-induced liquid jet (LILJ) system is an emerging surgical instrument intended to assist both maximal removal of the lesion and functional maintenance through preservation of fine vessels and minimal damage to the surrounding tissue. The system ejects the minimum required amount of pulsed water through a handy bayonet-shaped catheter. We have already shown a significant increase in removal rate, in addition to a noteworthy reduction of intraoperative blood loss and procedure time in the treatment of large pituitary and skull base tumors in a single-institution series. The present study evaluated the safety of the system in multiple institutions. MethodsThe study included 46 patients, 29 men and 17 women (mean age: 59.1 years) who underwent microsurgical/endoscopic resection of lesions in or in the vicinity of the pituitary fossa through the transsphenoidal approach between October 2011 and June 2012 at six institutions. The histologic diagnoses were pituitary adenoma (31 cases), meningioma (4), craniopharyngioma (3), cavernous angioma (2), and Rathke cyst cleft (1). Lesion volume ranged from 2.0 to 30.4 cm(3) (mean: 3.7 cm(3)). Cavernous sinus invasion was observed in 11 cases and suprasellar extension in 29 cases. ResultsPreservation of intralesional arteries (diameter: 150 mu m) was achieved in all situations in&gt;80% of cases. Intended surgical steps were achieved except for some restrictions in motion due to the use of an optical quartz fiber. No complications occurred directly related to the use of the device. ConclusionsThe LILJ system can be used for safe removal of lesions in or in the vicinity of the pituitary fossa.

  157. CD40/CD40L expression correlates with the survival of patients with glioblastomas and an augmentation in CD40 signaling enhances the efficacy of vaccinations against glioma models 査読有り

    Masashi Chonan, Ryuta Saito, Takuhiro Shoji, Ichiyo Shibahara, Masayuki Kanamori, Yukihiko Sonoda, Mika Watanabe, Toshiaki Kikuchi, Naoto Ishii, Teiji Tominaga

    NEURO-ONCOLOGY 17 (11) 1453-1462 2015年11月

    出版者・発行元:OXFORD UNIV PRESS INC

    DOI: 10.1093/neuonc/nov090  

    ISSN:1522-8517

    eISSN:1523-5866

    詳細を見る 詳細を閉じる

    The prognosis of glioblastoma (GBM) remains poor; therefore, effective therapeutic strategies need to be developed. CD40 is a costimulatory molecule whose agonistic antibody has been shown to activate antitumor effects. Recently, CD40 has been extensively targeted for immunotherapeutic purposes. Expressions of CD40/CD40L mRNAs were examined in 86 cases of World Health Organization grade IV GBM and 36 cases of grade III gliomas and correlated with outcomes. CD40 signaling was employed to augment the efficacy of immunotherapy against gliomas. The efficacy of FGK45, an agonistic antibody for CD40, was examined by adding it to a tumor lysate-based subcutaneous vaccination against a GL261 glioma model and an NSCL61 glioma-initiating cell-like cell tumor model. We demonstrated for the first time using quantitative PCR that grade III gliomas express higher levels of CD40/CD40L than does grade IV GBM. The higher expression of CD40/CD40L was associated with good prognoses in patients with GBM. Addition of FGK45 to the subcutaneous tumor cell lysate-based vaccination significantly prolonged survival in both tumor models. However, the efficacy was modest in NSCL61-model mice. Therefore, we established combination immunotherapeutic strategies using FGK45 and OX86, an agonistic antibody for OX40. Combination immunotherapy significantly prolonged survival with synergistic effects. Apoptosis increased and proliferation decreased in tumors treated with combination immunotherapy. The high expression of CD40/CD40L can be used as a biomarker for better prognoses in patients with gliomas. Immunotherapy using FGK45 significantly prolonged survival and represents a potential therapeutic strategy for gliomas including glioma-initiating cells.

  158. Shunt placement after cyst fenestration for middle cranial fossa arachnoid cysts in children 査読有り

    Tomomi Kimiwada, Toshiaki Hayashi, Ayumi Narisawa, Reizo Shirane, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-PEDIATRICS 16 (5) 533-539 2015年11月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2015.3.PEDS14573  

    ISSN:1933-0707

    eISSN:1933-0715

    詳細を見る 詳細を閉じる

    OBJECT Some pediatric patients with middle cranial fossa arachnoid cysts present with symptoms of increased intracranial pressure (ICP) and require shunt placement after a cyst fenestration. However, factors concerning increased ICP after fenestration followed by shunt placement have not been elucidated. This study evaluated factors that are associated with shunt placement following cyst fenestration in pediatric patients with middle cranial fossa arachnoid cysts. METHODS Twenty-six pediatric patients with middle cranial fossa arachnoid cysts who were surgically treated at a single institution between 2004 and 2013 were retrospectively identified. The surgical indications for middle cranial fossa arachnoid cysts were as follows: 1) arachnoid cysts associated with symptoms such as headache and abnormally enlarging head circumference; 2) progressively expanding arachnoid cysts; and 3) large arachnoid cysts such as Galassi Type III. A cyst fenestration was performed as a first-line treatment, and shunt placement was required if symptoms associated with increased ICP were found following fenestration. The risk factors evaluated included age; sex, presenting symptoms, the presence of head enlargement, progressive cyst expansion, and subdural hematoma/hygroma. RESULTS Four patients (15.4%) required shunt placement after cyst fenestration. Younger age, abnormal head enlargement, and progressive cyst expansion before fenestration were significantly associated with the need for shunt placement following fenestration. Arachnoid cysts decreased in size in 22 patients (84.6%) after fenestration and/or shunt placement. The presence of symptoms was not associated with postoperative cyst size in this study. CONCLUSIONS In this study, younger age, abnormal head enlargement, and progressive cyst expansion were risk factors for shunt placement after cyst fenestration in pediatric patients with middle cranial fossa arachnoid cysts. It is important to consider that cyst fenestration may not be effective because of a latent derangement of CSF circulation in patients with these risk factors.

  159. Interdigitated craniotomy: a simple technique to fix a bone flap with only a single plate 査読有り

    Noboru Takahashi, Kazunori Fujiwara, Keiichi Saito, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 123 (4) 1055-1058 2015年10月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2014.10.JNS141034  

    ISSN:0022-3085

    eISSN:1933-0693

    詳細を見る 詳細を閉じる

    In pterional craniotomy, fixation plates cause artifacts on postoperative radiological images; furthermore, they often disfigure the scalp in hairless areas. The authors describe a simple technique to fix a cranial bone flap with only a single plate underneath the temporalis muscle in an area with hair, rather than using a plate in a hairless area. The key to this technique is to cut the anterior site of the bone flap at alternate angles on the cut surface. Interdigitation between the bone flap and skull enables single-plate fixation in the area with hair, which reduces artifacts on postoperative radiological images and provides excellent postoperative cosmetic results.

  160. Diffuse large B cell lymphoma of the cranial vault: two case reports 査読有り

    Ryosuke Tashiro, Masayuki Kanamori, Hiroyoshi Suzuki, Akihiro Utsunomiya, Kuniaki Meguro, Hiroshi Uenohara, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 32 (4) 275-280 2015年10月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1007/s10014-015-0225-5  

    ISSN:1433-7398

    eISSN:1861-387X

    詳細を見る 詳細を閉じる

    Malignant lymphoma of the cranial vault is a rare entity and the tumor growth patterns are not well understood. Here we report two cases of malignant lymphoma involving the scalp and epidural space with slight changes in the intervening skull. A 63-year-old woman presented with a scalp mass in her right frontal area. Computed tomography (CT) and magnetic resonance (MR) imaging demonstrated mass lesions in the scalp and epidural space with slight osteolytic changes in the intervening skull. She underwent resection of the lesions. A 53-year-old man presented with a mass in his right frontal area. CT and MR imaging showed mass lesions in the scalp and epidural space without changes in the skull. He underwent resection of the lesions. The histopathological diagnosis was diffuse large B cell lymphoma in both cases. Microscopic examination of the intervening skull found that the bone marrow was diffusely replaced by lymphoma cells, and lymphoma cells extended to the extra- or intra-cranial space along the emissary veins without destruction of the cortical or trabecular bone. These histopathological findings explain the radiological findings and provide the clues to elucidate the mechanism of extension of cranial vault lymphoma.

  161. Cerebral Blood Flow after Acute Bypass with Parent Artery Trapping in Patients with Ruptured Supraclinoid Internal Carotid Artery Aneurysms 査読有り

    Hidenori Endo, Miki Fujimura, Hiroaki Shimizu, Takashi Inoue, Kenichi Sato, Kuniyasu Niizuma, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 24 (10) 2358-2368 2015年10月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2015.06.028  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Background: Bypass with parent artery trapping is an alternative treatment method for ruptured internal carotid artery (ICA) aneurysms when clipping or coiling is contraindicated. However, the efficacy and safety of this strategy during the acute stage of subarachnoid hemorrhage (SAH) is undetermined. Methods: A retrospective review of 955 consecutive patients presenting SAH between 2006 and 2014 identified 17 patients with ruptured ICA aneurysms treated by bypass with parent artery trapping within 72 hours after the bleeding (bypass group). The 26 cases with ruptured posterior communicating artery aneurysms treated with clipping during the same period were defined as a control group (clipping group). Postoperative cerebral blood flow (CBF) was evaluated by single photon emission computed tomography (SPECT). We analyzed the postoperative hemodynamic status, surgical complications, and the clinical outcomes. Results: Postoperative rebleeding did not occur in any of the cases. CBF in the first postoperative week in the bypass group was lower than that in the clipping group (P = .0165). This CBF decrease improved in the second postoperative week and did not differ from that of the clipping group. The incidence of acute ischemic complications was significantly higher in the bypass group (P = .0284), but the incidence of delayed cerebral ischemia did not differ between the 2 groups. The incidence of favorable outcomes at 6 months was 82.4% in the bypass group and 81% in the clipping group. Conclusions: Although the transient CBF decrease with acute ischemic complications should be noted, acute bypass with parent artery trapping is safe and effective for unclippable/uncoilable ruptured ICA aneurysms.

  162. Prognostic factors of craniopharyngioma with special reference to autocrine/paracrine signaling: underestimated implication of growth hormone receptor 査読有り

    Yoshikazu Ogawa, Mika Watanabe, Teiji Tominaga

    ACTA NEUROCHIRURGICA 157 (10) 1731-1740 2015年10月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-015-2519-0  

    ISSN:0001-6268

    eISSN:0942-0940

    詳細を見る 詳細を閉じる

    Craniopharyngioma is a slow-growing tumor classified as benign, but tight adhesion and significant local infiltration to the vital structures are common. In spite of improvement of modern microsurgery techniques and precise anatomical understanding not few cases of this tumor recur, and long-term tumor control and maintenance of quality of life are sometimes difficult. However, very little is known about the effects of the molecular characters of craniopharyngioma on the prognosis. Ninety eight cases of craniopharyngioma surgically treated at the Department of Neurosurgery, Tohoku University Hospital and Kohnan Hospital from April 1996 to May 2014, 45 males and 53 females aged from 2 to 80 years (mean, 40.84 years) were retrospectively reviewed, and postoperative outcomes and the possible involvement of the autocrine/paracrine mechanism were investigated. The patients were followed up at intervals of 6 months to assess tumor recurrence, and clinical outcomes were correlated with the findings of immunohistochemical examinations used growth hormone receptor (GHR) and downstream hormones. The follow-up period ranged from 3 to 209 months. Hormone expression was examined in 88 patients, of which 46 specimens (52.3 %) showed high expression of GHR. The GHR high expression group had a significantly shorter duration of postoperative stable disease compared with the low expression group (logrank test, p = 0.007). Simultaneous high expression of growth hormone (GH) and GHR was found in 33 specimens (37.5 %), and the high expression group had a significantly shorter duration of postoperative stable disease compared with the low expression group (logrank test, p = 0.011). No other hormones showed statistically significant differences in outcomes. High expression of GHR is associated with shorter duration of postoperative stable disease in patients with craniopharyngioma. If the surgical specimens were craniopharyngiomas with high GHR expression, GH supplementation would be introduced quite prudently.

  163. Temporal profile of the vascular anatomy evaluated by 9.4-tesla magnetic resonance angiography and histological analysis in mice with the R4859K mutation of RNF213, the susceptibility gene for moyamoya disease 査読有り

    Atsushi Kanoke, Miki Fujimura, Kuniyasu Niizuma, Akira Ito, Hiroyuki Sakata, Mika Sato-Maeda, Yuiko Morita-Fujimura, Shigeo Kure, Teiji Tominaga

    BRAIN RESEARCH 1624 497-505 2015年10月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.brainres.2015.07.039  

    ISSN:0006-8993

    eISSN:1872-6240

    詳細を見る 詳細を閉じる

    Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disease with an unknown etiology. Recent genome-wide and locus-specific association studies identified the RNF213 gene (RNF213) as an important susceptibility gene of MMD among East Asian populations; however, the mechanism by which an abnormality in RNF213 leads to MMD has not yet been elucidated. Therefore, we herein generated Rnf213-knock-in mice (RNF213-KI) expressing a missense mutation in mouse Rnf213, p. R4828K, on Exon 61, corresponding to human RNF213, p. R4859K, on Exon 60, in MMD patients, and investigated whether they developed MMD. We assessed the temporal profile of intracranial arteries by 9.4-T magnetic resonance angiography (MRA) continuously in the same mouse up to 64 weeks of age. The ratios of the outer diameter of the internal carotid artery (ICA)/basilar artery (BA) and middle cerebral artery (MCA)/BA were evaluated histopathologically. The common carotid arteries (CCA) were sectioned and arterial wall thickness/thinness was evaluated by Elastica-Masson staining before and after CCA ligation, which selectively induced vascular hyperplasia. The results obtained showed that RNF213-KI grew normally, with no significant difference being observed in MBA findings or the anatomy of the circle of Willis between homozygous RNF213-KI and wild-type (Wt) littermates. Furthermore, no significant difference was noted in the diameter of the intracranial vasculature (ICA/BA; p= 0.82, MCA/BA; p =0.27) or in vascular remodeling after CCA ligation. Therefore, RNF213-KI did not spontaneously develop MMD. Multiple secondary insults such as environmental factors may contribute to the onset of MMD in addition to genetic factors. (c) 2015 Elsevier B.V. All rights reserved.

  164. Craniopharyngiomas Presenting with Nonobstructive Hydrocephalus: Underlying Influence of Subarachnoidal Hemorrhage. Two Case Reports 査読有り

    Tomohiro Kawaguchi, Yoshikazu Ogawa, Mika Watanabe, Teiji Tominaga

    JOURNAL OF NEUROLOGICAL SURGERY PART A-CENTRAL EUROPEAN NEUROSURGERY 76 (5) 418-423 2015年9月

    出版者・発行元:THIEME MEDICAL PUBL INC

    DOI: 10.1055/s-0034-1382784  

    ISSN:2193-6315

    eISSN:2193-6323

    詳細を見る 詳細を閉じる

    Nonobstructive hydrocephalus in craniopharyngioma patients is rare, and the etiology is not known. We report two cases of patients with craniopharyngioma who presented with nonobstructive hydrocephalus. Repeated subarachnoidal hemorrhage (SAH) was considered as the underlying mechanism of hydrocephalus development. The first case was a 67-year-old woman presenting with deteriorated consciousness. Head computed tomography (CT) and magnetic resonance (MR) imaging demonstrated a solid suprasellar tumor with subarachnoidal and intraventricular hematoma with ventricle dilatation but no cerebrospinal fluid (CSF) obstruction. The extended transsphenoidal approach achieved gross total removal. Because of persistent ventricle dilatation, ventriculoperitoneal shunt was required. The second case was a 35-year-old woman presenting with persistent headache. Head CT and MR imaging demonstrated a solid suprasellar tumor with ventricular dilatation but no CSF obstruction. The extended transsphenoidal approach achieved gross total removal. The postoperative course was uneventful, and a ventriculoperitoneal shunt was not required. In both cases, histologic examination of the tumors revealed squamous-papillary type craniopharyngioma with remarkable inflammatory cell infiltrations in the perivascular space. CSF cytology revealed hemosiderin-laden phagocytes, indicative of previous SAH causing CSF malabsorption. These cases suggested that surgery should be indicated for patients with craniopharyngiomas with nonobstructive hydrocephalus, even if the tumors are not associated with neurologic and/or endocrinologic deficits.

  165. Sellar and parasellar tumor removal without discontinuing antithrombotic therapy 査読有り

    Yoshikazu Ogawa, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 123 (3) 794-798 2015年9月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2014.9.JNS141088  

    ISSN:0022-3085

    eISSN:1933-0693

    詳細を見る 詳細を閉じる

    OBJECT Treatment with dual antiplatelet agents associated with coronary stenting procedures and long-term anticoagulant therapy is increasingly common, but the treatment carries risks during surgical procedures. Evidence-based recommendations have proposed discontinuation of antithrombotic treatment or introduction of bridging therapy in some procedures less invasive and with lower risk of bleeding. However, neurosurgical procedures without discontinuation of antithrombotic treatment and perioperative management have received little investigation. METHODS Between October 2008 and January 2014, 15 consecutive patients (11 males and 4 females; age range 51-75 years [mean 68.2 years]), with sellar and parasellar tumors were treated through the transsphenoidal approach without discontinuation of antithrombotic therapy. Clinical data were compared with another 15 patients, who underwent transsphenoidal surgeries without preoperative antithrombotic therapy. RESULTS Gross-total removal of the tumor or total aspiration of the content of Rathke's cleft cyst was achieved in 13 patients, and subtotal removal was achieved in 1 patient with a small remnant in the cavernous sinus. No difference was found in intraoperative bleeding between the antithrombotic agent group and the control group (mean 255 ml vs 215 ml, Mann-Whitney U-test, p = 0.547), and no patient required transfusion. No difference was found in operation time between the antithrombotic agent group and the control group (167.8 minutes vs 150.0 minutes, Mann-Whitney U-test, p = 0.262). All patients were discharged on postoperative Day 12 without neurological deficits. CONCLUSIONS The present study suggests that discontinuation of antithrombotic therapy may be unnecessary before the typical transsphenoidal surgery. Large randomized clinical trials at multiple centers are needed to confirm these findings.

  166. Occult dual pathology in mesial temporal lobe epilepsy 査読有り

    Shin-ichiro Osawa, Masaki Iwasaki, Hiroyoshi Suzuki, Nobukazu Nakasato, Teiji Tominaga

    NEUROLOGICAL SCIENCES 36 (9) 1743-1745 2015年9月

    出版者・発行元:SPRINGER-VERLAG ITALIA SRL

    DOI: 10.1007/s10072-015-2268-0  

    ISSN:1590-1874

    eISSN:1590-3478

  167. Use of actuator-driven pulsed water jet in brain and spinal cord cavernous malformations resection 査読有り

    Toshiki Endo, Yoko Takahashi, Atsuhiro Nakagawa, Kuniyasu Niizuma, Miki Fujimura, Teiji Tominaga

    Clinical Neurosurgery 11 394-403 2015年9月1日

    出版者・発行元:Lippincott Williams and Wilkins

    DOI: 10.1227/NEU.0000000000000867  

    ISSN:0148-396X 0069-4827

    詳細を見る 詳細を閉じる

    Background: A piezo actuator-driven pulsed water jet (ADPJ) system is a novel surgical instrument that enables dissection of tissue without thermal damage. It can potentially resect intra-axial lesions while preserving neurological function. OBJECTIVE: To report our first experience of applying an ADPJ system to brain and spinal cord cavernous malformations. METHODS: Four patients (2 women and 2 men, mean age 44.5 years) with brain (n = 3) and spinal cord (n = 1) cavernous malformations were enrolled in the study. All surgeries were performed with the aid of the ADPJ system. Postoperative neurological function and radiological findings were evaluated. RESULTS: The ADPJ system was useful in dissecting boundaries between the lesion and surrounding brain/spinal cord tissues. The pulsed water jet provided a clear surgical view and helped surgeons follow the margins. Water jet dissection peeled off the brain and spinal cord tissues from the lesion wall. Surrounding gliotic tissue was preserved. As a consequence, the cavernous malformations were successfully removed. Postoperative magnetic resonance imaging confirmed total removal of lesions in all cases. Preoperative neurological symptoms completely resolved in 2 patients. The others experienced partial recovery. No patients developed new postoperative neurological deficits facial palsy temporarily worsened in 1 patient who underwent a suprafacial colliculus approach for the brainstem lesion. CONCLUSION: The ADPJ provided a clear surgical field and enabled surgeons to dissect boundaries between lesions and surrounding brain and spinal cord gliotic tissue. The ADPJ system is a feasible option for cavernous malformation surgery, enabling successful tumor removal and preservation of neurological function.

  168. Endovascular parent artery occlusion for distal giant aneurysm of the posterior cerebral artery 査読有り

    Hiroki Uchida, Teiji Tominaga, Masahiro Yoshida, Masaki Mino

    Neurological Surgery 43 (9) 849-854 2015年9月1日

    出版者・発行元:Igaku-Shoin Ltd

    DOI: 10.11477/mf.1436203132  

    ISSN:1882-1251 0301-2603

  169. High-grade Cerebral Arteriovenous Malformation Treated with Targeted Embolization of a Ruptured Site: Wall Enhancement of an Intranidal Aneurysm as a Sign of Ruptured Site 査読有り

    Shunsuke Omodaka, Hidenori Endo, Miki Fujimura, Kuniyasu Niizuma, Kenichi Sato, Yasushi Matsumoto, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 55 (10) 813-817 2015年9月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.cr.2015-0052  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Partial targeted embolization of the ruptured site of cerebral arteriovenous malformations (AVMs) is considered effective to prevent rebleeding. The site of rupture is usually determined by morphological features, such as an intranidal aneurysm or a venous varix; however, the site can be difficult to identify in high-grade AVM with complicated angioarchitecture. The authors present a case of a 36-year-old woman with high-grade AVM presented with repeated hemorrhage. Cerebral angiography showed intranidal aneurysm, which was considered the ruptured site. The T-1-weighted imaging with gadolinium enhancement demonstrated linear enhancement along the outer surface of the thickened wall of the intranidal aneurysm, which could be supplementary information to identify the ruptured site. Obliteration of the intranidal aneurysm was successfully achieved by emergent targeted embolization using N-butyl cyanoacrylate. The patient recovered and regained an independent status. The patient underwent volume-staged radiosurgery and experienced no further hemorrhage during the 26 months follow-up. Targeted embolization of the ruptured site is considered effective to prevent rebleeding in high-grade cerebral AVMs. Wall enhancement of the intranidal aneurysm, in addition to the structural characteristics, could be helpful in identifying the site of rupture embedded in the complicated angioarchitecture.

  170. Significance of Cerebral Blood Flow Analysis in the Acute Stage after Revascularization Surgery for Moyamoya Disease 査読有り

    Miki Fujimura, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 55 (10) 775-781 2015年9月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.ra.2015-0063  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Moyamoya disease is a chronic, occlusive cerebrovascular disease with unknown etiology characterized by steno-occlusive changes at the terminal portion of the internal carotid artery, either bilaterally or unilaterally, and an abnormal vascular network at the base of the brain. Surgical revascularization such as extracranial-intracranial (EC-IC) bypass is the preferred procedure for moyamoya disease. Despite the favorable long-term outcome, cerebral infarction and hyperperfusion syndrome are potential complications of this procedure, which can lead to neurological deterioration in the acute stage. In light of the similar clinical presentations between perioperative ischemia and hyperperfusion, it is essential to attempt a prompt cerebral blood flow (CBF) measurement in the acute stage after EC-IC bypass for moyamoya disease to differentiate these distinct pathologies, because the management of cerebral ischemia and hyperperfusion is contradictory to each other. Routine CBF analysis by single-photon emission computed tomography and/or magnetic resonance imaging not only facilitated a safer perioperative management but also provided important information about dynamic pathology of the hemodynamic conversion in the acute stage after revascularization surgery for moyamoya disease. We represent the current status of CBF analysis during the perioperative period of revascularization surgery for moyamoya disease, and sought to discuss its significance and efficacy to avoid surgical complications.

  171. Outflow Occlusion with Occipital Artery-Posterior Inferior Cerebellar Artery Bypass for Growing Vertebral Artery Fusiform Aneurysm with Ischemic Onset: A Case Report 査読有り

    Ryuzaburo Kochi, Hidenori Endo, Miki Fujimura, Kenichi Sato, Shin-ichiro Sugiyama, Shin-ichiro Osawa, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 24 (8) E223-E226 2015年8月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.020  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Surgical treatments should be considered for vertebral artery fusiform aneurysms, which become symptomatic due to cerebral ischemia or mass effect. Ischemic complication is one of the major problems after surgical or endovascular trapping, which is associated with unfavorable outcomes. The authors present a case with growing vertebral artery (VA) fusiform aneurysm with ischemic onset successfully treated with outflow occlusion with occipital artery-posterior inferior cerebellar artery (OA-PICA) bypass. A 50-year-old woman presented with left PICA territory infarction. Left vertebral angiography (VAG) showed occlusion of the left VA at the proximal V4 segment. Right VAG revealed that the distal part of the left V4 segment with fusiform aneurysmal dilatation was reconstituted through vertebrobasilar junction, and the left PICA was the outlet of the blood flow from the fusiform aneurysm. Although the patient was treated conservatively, enlargement of the left VA fusiform aneurysm was observed 8 months after the initial presentation. Considering the potential risks for future stroke or bleeding, we performed clip occlusion of the origin of the left PICA, which could achieve outflow occlusion of the fusiform aneurysm with preservation of the perforators arising around the aneurysm. We created OA-PICA anastomosis for revascularization of the distal PICA. The postoperative course was uneventful, and the postoperative right VAG revealed occlusion of the fusiform aneurysm. Outflow occlusion instead of trapping is an effective surgical option for VA fusiform aneurysm to achieve obliterate the aneurysm with preservation of the perforator at the blind end.

  172. Therapeutic Clip Occlusion of the Anterior Choroidal Artery Involved with Partially Thrombosed Fusiform Aneurysm: A Case Report 査読有り

    Sherif Rashad, Hidenori Endo, Ahmed Elsayed Sultan, Hiroaki Shimizu, Miki Fujimura, Kenichi Sato, Yasushi Matsumoto, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 24 (8) E227-E230 2015年8月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.024  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Background: We describe a rare case with partially thrombosed fusiform anterior choroidal artery (AchA) aneurysm successfully treated with therapeutic occlusion of the AchA. Clinical presentation: A 58-year-old man presented with transient mild hemiparesis of the right side. Magnetic resonance imaging (MRI) showed an ischemic lesion in the posterior limb of the left internal capsule. Digital subtraction angiography (DSA) revealed a left internal carotid artery saccular aneurysm (14.5-mm diameter) arising from the supraclinoid segment. The left AchA was not detected in the initial DSA, and MRI showed the aneurysm to be partially thrombosed. The second DSA performed 2 weeks after the onset showed recanalization of the thrombosed portion of the aneurysm with the left AchA apparently arising from its tip. The aneurysm was diagnosed as a partially thrombosed fusiform AchA aneurysm. Results: Open surgery was performed and a titanium clip was applied to the base of the fusiform aneurysm under motor evoked potential monitoring, which remained unchanged after clipping. Occlusion of the aneurysm was confirmed by Doppler ultrasound and intraoperative fluorescence angiography. Furthermore, Doppler ultrasound and fluorescence angiography showed that the blood flow supplying the pyramidal tract was reconstituted by the retrograde collateral flow from the choroidal segment. The aneurysm was completely obliterated in postoperative DSA, which demonstrated retrograde filling of the AchA through the posterior circulation. The patient manifested transient weakness of the right side postoperatively, which was completely recovered after short-term rehabilitation. Conclusions: This case illustrates the unique clinical course of a rare partially thrombosed fusiform AchA aneurysm, successfully treated with therapeutic clip occlusion of the AchA under the multimodal monitoring.

  173. Human chorionic gonadotropin is expressed virtually in all intracranial germ cell tumors 査読有り

    Hirokazu Takami, Shintaro Fukushima, Kohei Fukuoka, Tomonari Suzuki, Takaaki Yanagisawa, Yuko Matsushita, Taishi Nakamura, Hideyuki Arita, Akitake Mukasa, Nobuhito Saito, Masayuki Kanamori, Toshihiro Kumabe, Teiji Tominaga, Keiichi Kobayashi, Motoo Nagane, Toshihiko Iuchi, Kaoru Tamura, Taketoshi Maehara, Kazuhiko Sugiyama, Mitsutoshi Nakada, Yonehiro Kanemura, Masahiro Nonaka, Kiyotaka Yokogami, Hideo Takeshima, Yoshitaka Narita, Soichiro Shibui, Yoichi Nakazato, Ryo Nishikawa, Koichi Ichimura, Masao Matsutani

    JOURNAL OF NEURO-ONCOLOGY 124 (1) 23-32 2015年8月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s11060-015-1809-y  

    ISSN:0167-594X

    eISSN:1573-7373

    詳細を見る 詳細を閉じる

    Human chorionic gonadotropin (hCG) production has been utilized as a diagnostic marker for germinoma with syncytiotrophoblastic giant cells (STGC) and choriocarcinoma. Elevated hCG in germinoma is considered to predict less favorable prognosis, and an intensive treatment strategy may accordingly be applied. However, there is some evidence that any germinoma may produce hCG to varying extent. We investigated mRNA expression of the hCG beta subunit (hCG beta) using real time quantitative polymerase chain reaction in 94 germ cell tumors (GCTs). Most (93.3 %) GCTs showed higher expression levels compared with that of normal brain tissue (1.09 x 10(0)-1.40 x 10(5) fold). The expression was the highest in GCTs which harbor choriocarcinoma or STGC components. The expression level of hCG beta in germinoma was highly variable (1.09 x 10(0)-5.88 x 10(4) fold) in linear but not bimodal distribution. hCG concentrations in serum and CSF correlated with gene expression, especially when GCTs with single histological component were analyzed separately. The expression was not significantly associated with recurrence in pure germinoma. These results suggest that the serum/CSF hCG levels may need to be interpreted with caution as most GCTs appear to have the capacity of producing hCG irrespective of their histology. The clinical significance of ubiquitous hCG expression in GCTs needs further investigation.

  174. Ruptured Cerebral Microaneurysm Diagnosed by 3-Dimensional Fast Spin-Echo T1 Imaging with Variable Flip Angles 査読有り

    Hidenori Endo, Kuniyasu Niizuma, Miki Fujimura, Kenichi Sato, Takashi Inoue, Shin-ichiro Osawa, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 24 (8) E231-E235 2015年8月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.031  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Cerebral microaneurysms, which are 2 mm or small in size, are a rare cause of subarachnoid hemorrhage (SAH). The authors present 2 cases with ruptured microaneurysms, in which 3-dimensional (3D) fast spin-echo T1 imaging with variable flip angles (CUBE T1) using gadolinium-diethylenetriaminepentaacetic acid (Gd) enhancement was useful in diagnosing the microaneurysms as the source of bleeding. Case 1 was a 61-year-old woman who had an SAH localized to the left Sylvian fissure. A small bulge (1.4 mm) at the bifurcation of left middle cerebral artery (MCA), which was detected by 3D angiography, was well enhanced by CUBE T1 with Gd enhancement. The patient was successfully treated by trapping of the lower division of the left M2 segment with superficial temporal artery-M3 bypass. The intraoperative findings indicated that the microaneurysm at the bifurcation of the left MCA was the ruptured site. Case 2 was a 41-year-old man who had a diffuse SAH. A small bulge (1.5 mm) at the inferolateral wall of the left internal carotid artery (ICA), which was detected by 3D angiography, was well enhanced by CUBE T1 with Gd enhancement. The patient was treated by trapping of the left ICA with external carotid artery-saphenous vein graft-M2 bypass without complications. The intraoperative findings indicated that the microaneurysm at the inferolateral wall of the left ICA was the ruptured site. CUBE T1 with Gd enhancement was useful as an adjunctive tool for the diagnosis of ruptured cerebral microaneurysms. This sequence might enable neurosurgeons to perform curative surgery with certainty for ruptured microaneurysms.

  175. Consistent delayed unilateral neuronal death after modified transient focal cerebral ischemia in mice that mimics neuronal injury after transient global cerebral ischemia 査読有り

    Yasuo Nishijima, Kuniyasu Niizuma, Miki Fujimura, Yosuke Akamatsu, Hiroaki Shimizu, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 123 (1) 243-253 2015年7月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2014.9.JNS14778  

    ISSN:0022-3085

    eISSN:1933-0693

    詳細を見る 詳細を閉じる

    OBJECT Numerous studies have attempted to reveal the pathophysiology of ischemic neuronal injury using a representative transient global cerebral ischemia (tGCI) model in rodents; however, most of them have used gerbil or rat models. Recent advances in transgene and gene-knockout technology have enabled the precise molecular mechanisms of ischemic brain injury to be investigated. Because the predominant species for the study of genetic mutations is the mouse, a representative mouse model of tGCI is of particular importance. However, simple mouse models of tGC1 are less reproducible; therefore, a more complex process or longer duration of ischemia, which causes a high mortality rate, has been used in previous tGCI models in mice. In this study, the authors aimed to overcome these problems and attempted to produce consistent unilateral delayed hippocampal CA1 neuronal death in mice. METHODS C57BL/6 mice were subjected to short-term unilateral cerebral ischemia using a 4-mm silicone-coated intraluminal suture to obstruct the origin of the posterior cerebral artery (PCA), and regional cerebral blood flow (rCBF) of the PCA territory was measured using laser speckle flowmetry. The mice were randomly assigned to groups of different ischemic durations and histologically evaluated at different time points after ischemia. The survival rate and neurological score of the group that experienced 15 minutes of ischemia were also evaluated. RESULTS Consistent neuronal death was observed in the medial CA1 subregion 4 days after 15 minutes of ischemia in the group of mice with a reduction in rCBF of &lt; 65% in the PCA territory during ischemia. Morphologically degenerated cells were mostly positive for terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate nick-end labeling and cleaved caspase 3 staining 4 days after ischemia. The survival rates of the mice 24 hours (n = 24), 4 days (n = 15), and 7 days (n = 7) after being subjected to 15 minutes of ischemia were 95.8%, 100%, and 100%, respectively, and the mice had slight motor deficits. CONCLUSIONS The authors established a model of delayed unilateral hippocampal neuronal death in C57BL16 Mice by inducing ischemia in the PCA territory using an intraluminal suture method and established inclusion criteria for PCA-territory rCBF monitored by laser speckle flowmetry. This model may be useful for investigating the precise molecular mechanisms of ischemic brain injury.

  176. Local Vasogenic Edema without Cerebral Hyperperfusion after Direct Revascularization Surgery for Moyamoya Disease 査読有り

    Hiroyuki Sakata, Miki Fujimura, Shunji Mugikura, Kenichi Sato, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 24 (7) E179-E184 2015年7月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.050  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Superficial temporal artery-middle cerebral artery anastomosis is generally used as the standard surgical treatment for moyamoya disease to prevent cerebral ischemic attacks. Although the main potential complications associated with this treatment are cerebral hyperperfusion and ischemia, the adverse impacts of revascularization surgery remain unclear. Of the 142 consecutive surgeries for moyamoya disease at our hospital from 2008, we herein presented 2 cases of adult-onset moyamoya disease that manifested local vasogenic edema at the site of anastomosis without cerebral hyperperfusion; 1 in a 31-year-old woman presented with transient ischemic attack and the other in a 22-year-old man manifested as minor completed stroke. Both patients underwent superficial temporal artery-middle cerebral artery anastomosis, resulting in the formation of a reversible high-signal-intensity lesion at the site of anastomosis on T2-weighted images along with an increase in apparent diffusion coefficient values, whereas diffusion-weighted images showed no changes. Neither hyperperfusion nor hypoperfusion, as assessed by single-photon emission computed tomography with N-isopropyl[123I]-p-iodoamphetamine, was observed postoperatively. In light of the increased risk of the further progression of vasogenic edema to intracerebral hemorrhage, these patients were treated with prophylactic blood pressure lowering and the intravenous infusion of a free radical scavenger. They did not have any further cerebrovascular events during the follow-up period. Regional vasogenic edema without cerebral hyperperfusion, possibly due to cerebral ischemia/reperfusion injury, may be another novel entity that needs to be considered as a potential complication after extracranial-intracranial bypass for moyamoya disease. Strict postoperative management should be used to avoid hemorrhagic transformation. (C) 2015 by National Stroke Association

  177. Prediction model for 3-year rupture risk of unruptured cerebral aneurysms in Japanese patients 査読有り

    Shinjiro Tominari, Akio Morita, Toshihiro Ishibashi, Tomosato Yamazaki, Hiroyuki Takao, Yuichi Murayama, Makoto Sonobe, Masahiro Yonekura, Nobuhito Saito, Yoshiaki Shiokawa, Isao Date, Teiji Tominaga, Kazuhiko Nozaki, Kiyohiro Houkin, Susumu Miyamoto, Takaaki Kirino, Kazuo Hashi, Takeo Nakayama

    ANNALS OF NEUROLOGY 77 (6) 1050-1059 2015年6月

    出版者・発行元:WILEY

    DOI: 10.1002/ana.24400  

    ISSN:0364-5134

    eISSN:1531-8249

    詳細を見る 詳細を閉じる

    ObjectiveTo build a prediction model that estimates the 3-year rupture risk of unruptured saccular cerebral aneurysms. MethodsSurvival analysis was done using each aneurysm as the unit for analysis. Derivation data were from the Unruptured Cerebral Aneurysm Study (UCAS) in Japan. It consists of patients with unruptured cerebral aneurysms enrolled between 2000 and 2004 at neurosurgical departments at tertiary care hospitals in Japan. The model was presented as a scoring system, and aneurysms were classified into 4 risk grades by predicted 3-year rupture risk: I,&lt;1%; II, 1 to 3%; III, 3 to 9%, and IV, &gt;9%. The discrimination property and calibration plot of the model were evaluated with external validation data. They were a combination of 3 Japanese cohort studies: UCAS II, the Small Unruptured Intracranial Aneurysm Verification study, and the study at Jikei University School of Medicine. ResultsThe derivation data include 6,606 unruptured cerebral aneurysms in 5,651 patients. During the 11,482 aneurysm-year follow-up period, 107 ruptures were observed. The predictors chosen for the scoring system were patient age, sex, and hypertension, along with aneurysm size, location, and the presence of a daughter sac. The 3-year risk of rupture ranged from &lt;1% to &gt;15% depending on the individual characteristics of patients and aneurysms. External validation indicated good discrimination and calibration properties. InterpretationA simple scoring system that only needs easily available patient and aneurysmal information was constructed. This can be used in clinical decision making regarding management of unruptured cerebral aneurysms. Ann Neurol 2015;77:1050-1059

  178. Required knowledge for stroke specialists (11) management of moyamoya disease 査読有り

    Miki Fujimura, Teiji Tominaga

    Neurological Surgery 43 (6) 557-565 2015年6月1日

    出版者・発行元:Igaku-Shoin Ltd

    DOI: 10.11477/mf.1436203073  

    ISSN:1882-1251 0301-2603

  179. Targeting of Apoptotic Cells Using Functionalized Fe₂O₃ Nanoparticles. 査読有り

    Mekawy M, Saito A, Shimizu H, Tominaga T

    Nanomaterials (Basel, Switzerland) 5 (2) 874-884 2015年5月26日

    出版者・発行元:None

    DOI: 10.3390/nano5020874  

    ISSN:2079-4991

  180. Current Status of Revascularization Surgery for Moyamoya Disease: Special Consideration for Its 'Internal Carotid-External Carotid (IC-EC) Conversion' as the Physiological Reorganization System 査読有り

    Miki Fujimura, Teiji Tominaga

    TOHOKU JOURNAL OF EXPERIMENTAL MEDICINE 236 (1) 45-53 2015年5月

    出版者・発行元:TOHOKU UNIV MEDICAL PRESS

    DOI: 10.1620/tjem.236.45  

    ISSN:0040-8727

    eISSN:1349-3329

    詳細を見る 詳細を閉じる

    Moyamoya disease is a chronic cerebrovascular disease with unknown etiology, which is characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network formation at the base of the brain. Moyamoya disease is known to have unique and dynamic nature to convert the vascular supply for the brain from internal carotid (IC) system to the external carotid (EC) system, as indicated by Suzuki's angiographic staging established in 1969. Insufficiency of this 'IC-EC conversion system' may result in cerebral ischemia, as well as in intracranial hemorrhage from inadequate collateral vascular network, both of which represent the clinical presentation of moyamoya disease. Therefore, surgical revascularization by extracranial-intracranial bypass is the preferred procedure for moyamoya disease to complement 'IC-EC conversion' and thus to avoid cerebral infarction and/or intracranial hemorrhage. Long-term outcome of revascularization surgery for moyamoya disease is favorable, but rapid increase in cerebral blood flow on the affected hemisphere could temporarily cause unfavorable phenomenon such as cerebral hyperperfusion syndrome. We would review the current status of revascularization surgery for moyamoya disease based on its basic pathology, and sought to discuss the significance of measuring cerebral blood flow in the acute stage and intensive perioperative management. (C) 2015 Tohoku University Medical Press

  181. Activation of the NRF2 pathway and its impact on the prognosis of anaplastic glioma patients 査読有り

    Masayuki Kanamori, Tsuyoshi Higa, Yukihiko Sonoda, Shohei Murakami, Mina Dodo, Hiroshi Kitamura, Keiko Taguchi, Tatsuhiro Shibata, Mika Watanabe, Hiroyoshi Suzuki, Ichiyo Shibahara, Ryuta Saito, Yoji Yamashita, Toshihiro Kumabe, Masayuki Yamamoto, Hozumi Motohashi, Teiji Tominaga

    NEURO-ONCOLOGY 17 (4) 555-565 2015年4月

    出版者・発行元:OXFORD UNIV PRESS INC

    DOI: 10.1093/neuonc/nou282  

    ISSN:1522-8517

    eISSN:1523-5866

    詳細を見る 詳細を閉じる

    Background. Nuclear factor erythroid 2-related factor 2 (NRF2) plays pivotal roles in cytoprotection. We aimed at clarifying the contribution of the NRF2 pathway to malignant glioma pathology. Methods. NRF2 target gene expression and its association with prognosis were examined in 95 anaplastic gliomas with or without isocitrate dehydrogenase (IDH) 1/2 gene mutations and 52 glioblastomas. To explore mechanisms for the altered activity of the NRF2 pathway, we examined somatic mutations and expressions of the NRF2 gene and those encoding NRF2 regulators, Kelch-like ECH-associated protein 1 (KEAP1) and p62/SQSTSM. To clarify the functional interaction between IDH1 mutations and the NRF2 pathway, we introduced a mutant IDH1 to T98 glioblastoma-derived cells and examined the NRF2 activity in these cells. Results. NRF2 target genes were elevated in 13.7% and 32.7% of anaplastic gliomas and glioblastomas, respectively. Upregulation of NRF2 target genes correlated with poor prognosis in anaplastic gliomas but not in glioblastomas. Neither somatic mutations of NRF2/KEAP1 nor dysregulated expression of KEAP1/p62 explained the increased expression of NRF2 target genes. In most cases of anaplastic glioma with mutated IDH1/2, NRF2 and its target genes were downregulated. This was reproducible in IDH1 R132H-expressing T98 cells. In minor cases of IDH1/2-mutant anaplastic gliomas with increased expression of NRF2 target genes, the clinical outcomes were significantly poor. Conclusions. The NRF2 activity is increased in a significant proportion of malignant gliomas in general but decreased in the majority of IDH1/2-mutant anaplastic gliomas. It is plausible that the NRF2 pathway plays an important role in tumor progression of anaplastic gliomas with IDH1/2 mutations.

  182. Association between molecular alterations and tumor location and MRI characteristics in anaplastic gliomas 査読有り

    Yukihiko Sonoda, Ichiyoo Shibahara, Tomohiro Kawaguchi, Ryuta Saito, Masayuki Kanamori, Mika Watanabe, Hiroyoshi Suzuki, Toshihiro Kumabe, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 32 (2) 99-104 2015年4月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1007/s10014-014-0211-3  

    ISSN:1433-7398

    eISSN:1861-387X

    詳細を見る 詳細を閉じる

    The aim of this study was to determine if molecular alterations are associated with tumor location and radiological characteristics in anaplastic gliomas. We performed a retrospective analysis of 122 anaplastic gliomas for molecular alterations (IDH1/2 mutations, TP53 mutations, and 1p19q co-deletion) to compare MRI features (location and image characteristics). We observed that IDH mutation is strongly associated with frontal location (P = 0.001). However, 13 tumors not located in the cerebral cortex were IDH intact tumors (P &lt; 0.0001). While IDH mutation and TP53 mutation are significantly associated with AA (p &lt; 0.0001), IDH mutation and 1p19q co-deletion were significantly associated with AO/AOA (p &lt; 0.0001). No tumors with IDH mutation and 1p19q co-deletion infiltrated the temporal lobe (P = 0.003). The tumors with 1p19q co-deletion and histologically diagnosed as AO/AOA were associated with contrast enhancement on MR images (p = 0.007, p = 0.002, respectively) and those with TP53 mutation had a weak association with sharp tumor borders (p = 0.043). MRI features might be useful to predict molecular profiles in anaplastic gliomas.

  183. Water Supply Facility Damage and Water Resource Operation at Disaster Base Hospitals in Miyagi Prefecture in the Wake of the Great East Japan Earthquake 査読有り

    Takashi Matsumura, Shizuka Osaki, Daisuke Kudo, Hajime Furukawa, Atsuhiro Nakagawa, Yoshiko Abe, Satoshi Yamanouchi, Shinichi Egawa, Teiji Tominaga, Shigeki Kushimoto

    PREHOSPITAL AND DISASTER MEDICINE 30 (2) 193-198 2015年4月

    出版者・発行元:CAMBRIDGE UNIV PRESS

    DOI: 10.1017/S1049023X15000084  

    ISSN:1049-023X

    eISSN:1945-1938

    詳細を見る 詳細を閉じる

    Introduction: The aim of this study was to shed light on damage to water supply facilities and the state of water resource operation at disaster base hospitals in Miyagi Prefecture (Japan) in the wake of the Great East Japan Earthquake (2011), in order to identify issues concerning the operational continuity of hospitals in the event of a disaster. Methods: In addition to interview and written questionnaire surveys to 14 disaster base hospitals in Miyagi Prefecture, a number of key elements relating to the damage done to water supply facilities and the operation of water resources were identified from the chronological record of events following the Great East Japan Earthquake. Results: Nine of the 14 hospitals experienced cuts to their water supplies, with a median value of three days (range=one to 20 days) for service recovery time. The hospitals that could utilize well water during the time that water supply was interrupted were able to obtain water in quantities similar to their normal volumes. Hospitals that could not use well water during the period of interruption, and hospitals whose water supply facilities were damaged, experienced significant disruption to dialysis, sterilization equipment, meal services, sanitation, and outpatient care services, though the extent of disruption varied considerably among hospitals. None of the hospitals had determined the amount of water used for different purposes during normal service or formulated a plan for allocation of limited water in the event of a disaster. Conclusion: The present survey showed that it is possible to minimize the disruption and reduction of hospital functions in the event of a disaster by proper maintenance of water supply facilities and by ensuring alternative water resources, such as well water. It is also clear that it is desirable to conclude water supply agreements and formulate strategic water allocation plans in preparation for the eventuality of a long-term interruption to water services.

  184. Rosette-forming Glioneuronal Tumor: Rare Case Presented with Spontaneous Disappearance of Contrast Enhancement. 査読有り

    Shinya Haryu, Ryuta Saito, Masayuki Kanamori, Yukihiko Sonoda, Toshihiro Kumabe, Mika Watanabe, Faruk Tonga, Teiji Tominaga

    NMC case report journal 2 (2) 65-67 2015年4月

    DOI: 10.2176/nmccrj.2014-0077  

    詳細を見る 詳細を閉じる

    This report presents rosette-forming glioneuronal tumor (RGNT) of the tectum in a 24-year-old woman in whom spontaneous disappearance of contrast enhancement (CE) on magnetic resonance (MR) imaging was observed during 9-year follow-up period before therapeutic intervention. MR imaging obtained 9 years ago when she first visited local hospital with headaches showed a mass of the brain stem with CE. Follow-up MR imaging showed disappearance of CE without tumor growth. Nine years later, she was admitted to our hospital with headache and nausea, due to obstructive hydrocephalus. She underwent endoscopic third ventriculostomy (ETV) and tumor biopsy. Histological study revealed RGNT. To our knowledge, this is the first report presenting that the RGNT may show spontaneous disappearance of CE without tumor growth. It is unclear what this phenomenon means, however, knowledge of this phenomenon may be helpful for correct diagnosis and for follow up of RGNT.

  185. A significant increase in intraoperative flash visual evoked potential amplitude during craniopharyngioma surgery-case report 査読有り

    Tomohiro Kawaguchi, Yoshikazu Ogawa, Satoru Fujiwara, Teiji Tominaga

    Neurological Surgery 43 (4) 323-329 2015年4月1日

    出版者・発行元:Igaku-Shoin Ltd

    DOI: 10.11477/mf.1436203015  

    ISSN:1882-1251 0301-2603

    詳細を見る 詳細を閉じる

    The flash visual evoked potential (VEP) is a useful diagnostic modality for visual preservation during surgery. Decreased VEP amplitude is recognized to indicate visual deterioration however, whether intraoperative VEP can detect visual improvement remains unclear. We describe a craniopharyngioma case with a significant increase in VEP amplitude during surgery. A 67-year-old woman presented with progressive gait disturbance and impaired consciousness. Head magnetic resonance imaging demonstrated a sellar-suprasellar tumor compressing the optic chiasm upward with significant ventricular dilation. Her Glasgow Coma Scale was E3V3M5. Visual fields and acuity could not be examined because of impaired consciousness, and she could not see/recognize objects on a table. Preoperative VEP showed reproducible waveforms. Tumor removal by the extended transsphenoidal approach was performed with VEP monitoring. Increased VEP amplitude was observed after dural incision and persisted until the surgery ended. Postoperative VEP waveforms were also reproducible, but visual fields/acuity could not be examined because of cognitive dysfunction. Useful visual function was restored, and she became independent in daily life. The histological diagnosis was craniopharyngioma. The patient underwent ventriculo-peritoneal shunting for hydrocephalus 16 days after tumor removal. The postoperative course was uneventful and she was transferred to another hospital for rehabilitation. Intraoperative VEP may indicate visual improvement during surgery, which is a useful objective assessment for visual function in patients with impaired consciousness and cognitive dysfunction.

  186. [A case of atherothrombotic embolization developing with slowly progressive symptoms and requiring differential diagnosis from metastatic tumor recurrence]. 査読有り

    Sho Umegaki, Ryuta Saito, Yosuke Akamatsu, Hiroyuki Sakata, Ken-Ichi Sato, Miki Fujimura, Yukihiko Sonoda, Teiji Tominaga

    No shinkei geka. Neurological surgery 43 (4) 339-43 2015年4月

    DOI: 10.11477/mf.1436203017  

    ISSN:0301-2603

    詳細を見る 詳細を閉じる

    We report a case of atherothrombotic embolization that developed with slowly progressive symptoms and required differential diagnosis from metastatic tumor recurrence. A 64-year-old man with a history of lung cancer and metastatic brain tumor was carefully followed at our outpatient department for tumor recurrence. Five years after surgery for brain metastasis and whole brain radiation therapy, he had no recurrence and systemic disease was well controlled. At a routine follow up in October 2013, he complained of slight right arm dysesthesia. Follow up brain magnetic resonance (MR) imaging revealed no lesion. Two months later, he developed right hemiparesthesia and gait disturbance. Spinal MR imaging was unremarkable. However, at a routine follow up in January 2014, multiple enhancements were detected near the resection cavity and regions delineating the sulci. At first, this was diagnosed as tumor recurrence. However, 3 days later, additional MR imaging detected new multiple small infarctions after worsening right hemiparesis and dysarthria. With the diagnosis of embolic stroke, we searched for an embolic source. Cardiogenic embolization and carotid bifurcation stenosis studies were negative, but severe stenosis and thrombosis were detected near the left common carotid artery origin. This site was in the field of radiation the patient received as treatment for primary lung cancer.

  187. Required knowledge for stroke specialists (9) asymptomatic cerebrovascular diseases 査読有り

    Kuniyasu Niizuma, Teiji Tominaga

    Neurological Surgery 43 (4) 357-368 2015年4月1日

    出版者・発行元:Igaku-Shoin Ltd

    DOI: 10.11477/mf.1436203022  

    ISSN:1882-1251 0301-2603

  188. Intraventricular Hemorrhage on Initial Computed Tomography as Marker of Diffuse Axonal Injury after Traumatic Brain Injury 査読有り

    Daddy Mata-Mbemba, Shunji Mugikura, Atsuhiro Nakagawa, Takaki Murata, Yumiko Kato, Yasuko Tatewaki, Li Li, Kei Takase, Kiyoshi Ishii, Shigeki Kushimoto, Teiji Tominaga, Shoki Takahashi

    JOURNAL OF NEUROTRAUMA 32 (5) 359-365 2015年3月

    出版者・発行元:MARY ANN LIEBERT, INC

    DOI: 10.1089/neu.2014.3453  

    ISSN:0897-7151

    eISSN:1557-9042

    詳細を見る 詳細を閉じる

    Intraventricular hemorrhage (IVH) on initial computed tomography (CT) was reported to predict lesions of diffuse axonal injury (DAI) in the corpus callosum (CC) on subsequent magnetic resonance imaging (MRI). We aimed to examine the relationship between initial CT findings and DAI lesions detected on MRI as well as the relationship between the severity of IVH (IVH score) and severity of DAI (DAI staging). A consecutive 140 patients with traumatic brain injury (TBI) who underwent MRI within 30 days after onset were revisited. We reviewed their initial CT for the following six findings: Status of basal cistern, status of mid-line shift, epidural hematoma, IVH, subarachnoid hemorrhage, and volume of hemorrhagic mass and IVH score were assigned in each patient. Based on MRI findings, patients were divided into DAI and non-DAI groups and were assigned a DAI staging. Then, to confirm that the IVH on initial CT predicts DAI lesions on MRI, we used multi-variate analysis of the six CT findings, including IVH, and examined the relationship between IVH score and DAI staging. The IVH detected on CT was the only predictor of DAI (p=0.0139). The IVH score and DAI staging showed significant positive correlation (p&lt;0.0003). IVH score in DAI stage 3 (with DAI involving the brain stem; p=0.0025) or stage 2 (with DAI involving CC; p=0.0042) was significantly higher than that of DAI stage 0 (no DAI lesions). In conclusion, IVH on initial CT is the only marker of DAI on subsequent MRI, specifically severe DAI (stage 2 or 3).

  189. Exclusively epidural spinal metameric arteriovenous shunts: case report and literature review 査読有り

    Alaa Elkordy, Toshiki Endo, Kenichi Sato, Yukihiko Sonoda, Akira Takahashi, Teiji Tominaga

    SPINE JOURNAL 15 (3) E15-E22 2015年3月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.spinee.2014.11.022  

    ISSN:1529-9430

    eISSN:1878-1632

    詳細を見る 詳細を閉じる

    BACKGROUND CONTEXT: Spinal arteriovenous metameric syndrome (SAMS) is a subgroup of spinal arteriovenous malformations (AVMs). Most SAMS cases have intra- and extradural AVMs and suffer from hematomyelia, subarachnoid hemorrhage, or venous congestive myelopathy. PURPOSE: To present a rare case of SAMS in which spinal AVMs were exclusively epidural. We reviewed previous literature and evaluated the feasibility of a treatment strategy using endovascular interventions, followed by surgical obliteration. STUDY DESIGN: A case report and literature review of SAMS. METHODS: We report a case of a 15-year-old boy suffering from SAMS in which epidural venous ectasia because of extradural AVMs caused spinal cord compression. RESULTS: The patient was successfully treated with multiple sessions of transarterial embolization followed by open surgery. After the treatment, his neurologic deficits resolved. Postoperative angiography confirmed complete obliteration of extradural AVMs. CONCLUSIONS: Although exclusively epidural spinal AVM is an uncommon type of SAMS, combined endovascular and surgical interventions can be an effective treatment for AVMs to achieve better radiologic outcomes and complete resolution of patient symptoms. (C) 2015 Elsevier Inc. All rights reserved.

  190. Diagnosis of Moyamoya Disease: International Standard and Regional Differences 査読有り

    Miki Fujimura, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 55 (3) 189-193 2015年3月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmcsa.2014-0307  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Moyamoya disease is a chronic, occlusive cerebrovascular disease with unknown etiology characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. These diagnostic criteria of the moyamoya disease, stated by the Research Committee on Spontaneous Occlusion of the Circle of Willis (moyamoya disease) in Japan, are well established and generally accepted as the definition of this rare entity. On the contrary to the diagnosis of definitive moyamoya disease, there is some confusion in the terminology and understanding of quasi-moyamoya disease; moyamoya disease in association with various disease entities, such as atherosclerosis, autoimmune diseases, Down syndrome, etc. Although the clinical management is not affected by these semantic distinctions, terminological confusion may interfere with the international collaboration of the clinical investigation of these rare conditions. In this article, we sought to review the international standard and regional differences in the diagnosis of moyamoya disease and quasi-moyamoya disease.

  191. Impaired Leptomeningeal Collateral Flow Contributes to the Poor Outcome following Experimental Stroke in the Type 2 Diabetic Mice 査読有り

    Yosuke Akamatsu, Yasuo Nishijima, Chih Cheng Lee, Shih Yen Yang, Lei Shi, Lin An, Ruikang K. Wang, Teiji Tominaga, Jialing Liu

    JOURNAL OF NEUROSCIENCE 35 (9) 3851-3864 2015年3月

    出版者・発行元:SOC NEUROSCIENCE

    DOI: 10.1523/JNEUROSCI.3838-14.2015  

    ISSN:0270-6474

    詳細を見る 詳細を閉じる

    Collateral status is an independent predictor of stroke outcome. However, the spatiotemporal manner in which collateral flow maintains cerebral perfusion during cerebral ischemia is poorly understood. Diabetes exacerbates ischemic brain damage, although the impact of diabetes on collateral dynamics remains to be established. Using Doppler optical coherent tomography, a robust recruitment of leptomeningeal collateral flow was detected immediately after middle cerebral artery ( MCA) occlusion in C57BL/6 mice, and it continued to grow over the course of 1 week. In contrast, an impairment of collateral recruitment was evident in the Type 2 diabetic db/db mice, which coincided with a worse stroke outcome compared with their normoglycemic counterpart db/+, despite their equally well-collateralized leptomeningeal anastomoses. Similar to the wild-type mice, both db/+ and db/db mice underwent collateral growth 7 d after MCA stroke, although db/db mice still exhibited significantly reduced retrograde flow into the MCA territory chronically. Acutely induced hyperglycemia in the db/+ mice did not impair collateral flow after stroke, suggesting that the state of hyperglycemia alone was not sufficient to impact collateral flow. Human albumin was efficacious in improving collateral flow and outcome after stroke in the db/db mice, enabling perfusion to proximal MCA territory that was usually not reached by retrograde flow from anterior cerebral artery without treatment. Our results suggest that the impaired collateral status contributes to the exacerbated ischemic injury in mice with Type 2 diabetes, and modulation of collateral flow has beneficial effects on stroke outcome among these subjects.

  192. Clinical features of intracerebral hemorrhage under antithrombotic therapy in the warfarin era 査読有り

    Misaki Kohama, Masahiro Yoshida, Masaki Mino, Teiji Tominaga

    Neurological Surgery 43 (3) 199-205 2015年3月1日

    出版者・発行元:Igaku-Shoin Ltd

    DOI: 10.11477/mf.1436202987  

    ISSN:1882-1251 0301-2603

    詳細を見る 詳細を閉じる

    We investigated the clinical characteristics and prognosis of intracerebral hemorrhage (ICH) under antithrombotic therapy. We retrospectively reviewed the medical records of 463 patients admitted to our hospital due to ICH during 3-year periiod between January 2010 and December 2012. The ICH patients were classified into 4 groups: patients with anticoagulant therapy (AC, n = 36). antiplatelet therapy (AP, n = 65), anticoagulant and antiplatelet therapies (AC+AP, n = 18), and no antiplatelet or anticoagulant therapy (NT, n=344). There were no significant differences between the groups in terms of gender, hematoma location, and initial hematoma size. Age and previous history of ischemic cerebral disease or ischemic coronary disease were significantly higher in the AC. AP, and AC+AP groups than in the NT group. The number of patients who had received previous treatment for hypertension was higher in the AC, AP, and AC+AP groups, and systolic blood pressure at admission was lower in the AC and AC+AP groups than in the NT group. Hematoma enlargement occurred more frequently in the AC and AC+AP groups. The AC, AP and AC+AP groups showed worse prognosis and higher mortality than the NT group. Anticoagulant therapy can be a risk factor for hematoma enlargement, and anticoagulant and/or antiplatelet therapy can be a risk factor of poor outcome.

  193. A case of akin moyamoya disease associated with type-I diabetes mellitus managed by extracranial-intracranial bypass 査読有り

    Yosuke Akamatsu, Miki Fujimura, Hiroyuki Sakata, Hidenori Endo, Ryo Itabashi, Teiji Tominaga

    Neurological Surgery 43 (3) 227-233 2015年3月1日

    出版者・発行元:Igaku-Shoin Ltd

    DOI: 10.11477/mf.1436202991  

    ISSN:1882-1251 0301-2603

    詳細を見る 詳細を閉じる

    Moyamoya disease is characterized by idiopathic steno-occlusion at the terminal portion of the internal carotid artery with concomitant abnormal vascular networks that can lead to transient ischemic attacks and hemorrhagic stroke with symptoms of headache, confusion, dizziness, ataxia, seizure, and cognitive and personality changes. Because these symptoms also occur in patients with type 1 diabetes mellitus (T1DM), patients with both diseases might go unnoticed and without the less common diagnosis of akin moyamoya disease, accurate diagnosis and treatment could be delayed. Here, we report the case of a 32-year-old woman with past history of T1 DM for 26 years presenting with right amaurosis, which was diagnosed as akin moyamoya disease even though she had suffered right incomplete hemiparesis 2 years ago. She underwent superficial temporal artery-middle cerebral artery anastomosis with pial synangiosis in the left hemisphere without complication. She had no cerebrovascular events postoperatively. Although akin moyamoya disease associated with T1 DM is rare in Japan, we recommend that clinicians consider the coexistence of both diseases when evaluating patients with T1DM who have neurologic signs or symptoms and not overlook the possibility of cerebrovascular diseases, such as akin moyamoya disease.

  194. Quantitative analysis of early postoperative cerebral blood flow contributes to the prediction and diagnosis of cerebral hyperperfusion syndrome after revascularization surgery for moyamoya disease 査読有り

    Miki Fujimura, Kuniyasu Niizuma, Hidenori Endo, Kenichi Sato, Takashi Inoue, Hiroaki Shimizu, Teiji Tominaga

    NEUROLOGICAL RESEARCH 37 (2) 131-138 2015年2月

    出版者・発行元:MANEY PUBLISHING

    DOI: 10.1179/1743132814Y.0000000432  

    ISSN:0161-6412

    eISSN:1743-1328

    詳細を見る 詳細を閉じる

    Objective: Cerebral hyperperfusion syndrome (HPS) is a potential complication of extracranial-intracranial (EC-IC) bypass for moyamoya disease; however, the pathological threshold of the early cerebral blood flow (CBF) increases after EC-IC bypass has yet to be determined. The purpose of this study is to evaluate the predictive and diagnostic values of early quantitative CBF analysis for the detection of HPS after EC-IC bypass for moyamoya disease. Methods: We quantitatively evaluated regional CBF at the site of the anastomosis in 23 patients with moyamoya disease aged between 18 and 66 years (mean, 39.6) before and 1 day after superficial temporal artery-middle cerebral artery anastomosis by an auto-radiographic method using N-isopropyl-p-[I-123] iodoamphetamine single-photon emission computed tomography. Results: Regional CBF 1 day after surgery was significantly higher in patients with HPS (n = 5; mean, 54.6 ml/100 g/minutes) than in patients without HPS (n = 18; mean, 40.5 ml/100 g/minutes) (P = 0.038). The postoperative/preoperative CBF ratio was significantly higher in patients with HPS (1.84) than in patients without HPS (1.34) (P = 0.044). Multivariate analyses showed that the regional CBF value 1 day after surgery (P = 0.036) and operating on the left hemisphere (P = 0.026) significantly correlated with HPS. All patients with HPS developed symptoms and/or intracerebral hemorrhage more than 2 days after EC-IC bypass. Receiver operating characteristic analysis indicated that the cutoff value of pathological postoperative CBF increase was 46.1 ml/100 g/minutes (sensitivity = 80%, specificity = 77.8%, AUC value = 0.81). Conclusion: Quantitative analysis of early postoperative CBF is useful for predicting and diagnosing HPS after revascularization surgery for moyamoya disease.

  195. OX40 ligand expressed in glioblastoma modulates adaptive immunity depending on the microenvironment: a clue for successful immunotherapy 査読有り

    Ichiyo Shibahara, Ryuta Saito, Rong Zhang, Masashi Chonan, Takuhiro Shoji, Masayuki Kanamori, Yukihiko Sonoda, Toshihiro Kumabe, Masahiko Kanehira, Toshiaki Kikuchi, Takanori So, Takashi Watanabe, Hiroaki Takahashi, Erina Iwabuchi, Yuetsu Tanaka, Yukiko Shibahara, Hironobu Sasano, Naoto Ishii, Teiji Tominaga

    MOLECULAR CANCER 14 41 2015年2月

    出版者・発行元:BIOMED CENTRAL LTD

    DOI: 10.1186/s12943-015-0307-3  

    ISSN:1476-4598

    詳細を見る 詳細を閉じる

    Background: Glioblastoma is the most malignant human brain tumor and has a dismal prognosis; however, some patients show long-term survival. The interaction between the costimulatory molecule OX40 and its ligand OX40L generates key signals for T-cell activation. The augmentation of this interaction enhances antitumor immunity. In this present study, we explored whether OX40 signaling is responsible for antitumor adaptive immunity against glioblastoma and also established therapeutic antiglioma vaccination therapy. Methods: Tumor specimens were obtained from patients with primary glioblastoma (n = 110) and grade III glioma (n = 34). Quantitative polymerase chain reaction (PCR), flow cytometry, and immunohistochemistry were used to analyze OX40L expression in human glioblastoma specimens. Functional consequences of OX40 signaling were studied using glioblastoma cell lines, mouse models of glioma, and T cells isolated from human subjects and mice. Cytokine production assay with mouse regulatory T cells was conducted under hypoxic conditions (1.5% O-2). Results: OX40L mRNA was expressed in glioblastoma specimens and higher levels were associated with prolonged progression-free survival of patients with glioblastoma, who had undergone gross total resection. In this regard, OX40L protein was expressed in A172 human glioblastoma cells and its expression was induced under hypoxia, which mimics the microenvironment of glioblastoma. Notably, human CD4 T cells were activated when cocultured in anti-CD3-coated plates with A172 cells expressing OX40L, as judged by the increased production of interferon-y. To confirm the survival advantage of OX40L expression, we then used mouse glioma models. Mice bearing glioma cells forced to express OX40L did not die during the observed period after intracranial transplantation, whereas all mice bearing glioma cells lacking OX40L died. Such a survival benefit of OX40L was not detected in nude mice with an impaired immune system. Moreover, compared with systemic intraperitoneal injection, the subcutaneous injection of the OX40 agonist antibody together with glioma cell lysates elicited stronger antitumor immunity and prolonged the survival of mice bearing glioma or glioma-initiating cell-like cells. Finally, OX40 triggering activated regulatory T cells cultured under hypoxia led to the induction of the immunosuppressive cytokine IL10. Conclusion: Glioblastoma directs immunostimulation or immunosuppression through OX40 signaling, depending on its microenvironment.

  196. Malignant clinical features of anaplastic gliomas without IDH mutation 査読有り

    Ichiyo Shibahara, Yukihiko Sonoda, Takuhiro Shoji, Masayuki Kanamori, Ryuta Saito, Tomoo Inoue, Tomohiro Kawaguchi, Yoji Yamashita, Takashi Watanabe, Toshihiro Kumabe, Mika Watanabe, Hiroyoshi Suzuki, Teiji Tominaga

    NEURO-ONCOLOGY 17 (1) 136-144 2015年1月

    出版者・発行元:OXFORD UNIV PRESS INC

    DOI: 10.1093/neuonc/nou112  

    ISSN:1522-8517

    eISSN:1523-5866

    詳細を見る 詳細を閉じる

    Background. Diagnosis of WHO grade III anaplastic gliomas does not always correspond to its clinical outcome because of the isocitrate dehydrogenase (IDH) gene status. Anaplastic gliomas without IDH mutation result in a poor prognosis, similar to grade IV glioblastomas. However, the malignant features of anaplastic gliomas without IDH mutation are not well understood. The aim of this study was to examine anaplastic gliomas, in particular those without IDH mutation, with regard to their malignant features, recurrence patterns, and association with glioma stem cells. Methods. We retrospectively analyzed 86 cases of WHO grade III anaplastic gliomas. Data regarding patient characteristics, recurrence pattern, and prognosis were obtained from medical records. We examined molecular alterations such as IDH mutation, 1p19q loss, TP53 mutation, MGMT promoter methylation, Ki67 labeling index, and CD133, SOX2, and NESTIN expression. Results. Of the 86 patients with anaplastic gliomas, 58 carried IDH mutation, and 40 experienced recurrence. The first recurrence was local in 25 patients and distant in 15. Patients without IDH mutation exhibited significantly higher CD133 and SOX2 expression (P = .025 and .020, respectively) and more frequent distant recurrence than those with IDH mutation (P = .022). Conclusions. Patients with anaplastic gliomas without IDH mutation experienced distant recurrence and exhibited glioma stem cell markers, indicating that this subset may share some malignant characteristics with glioblastomas.

  197. Enhanced post-ischemic angiogenesis in mice lacking RNF213; a susceptibility gene for moyamoya disease 査読有り

    Akira Ito, Miki Fujimura, Kuniyasu Niizuma, Atsushi Kanoke, Hiroyuki Sakata, Yuiko Morita-Fujimura, Atsuo Kikuchi, Shigeo Kure, Teiji Tominaga

    BRAIN RESEARCH 1594 310-320 2015年1月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.brainres.2014.11.014  

    ISSN:0006-8993

    eISSN:1872-6240

    詳細を見る 詳細を閉じる

    Moyamoya disease (MMD) is a chronic occlusive cerebrovascular disease with unknown etiology that is characterized by the development of abnormal vascular networks at the base of the brain. Recent genome-wide studies identified RNF213 as an important MMD susceptibility gene. However, the exact mechanism by which the RNF213 abnormality leads to MMD remains unknown. Thus, we sought to clarify the role of RNF213 in angiogenesis under ischemic conditions using conventional RNF213 knockout mice. We assessed the infarction volume, cerebral edema, and vascular density in the ischemic brain after transient middle cerebral artery occlusion (tMCAO). To further evaluate systemic angiogenesis following chronic ischemia, we investigated blood flow recovery using laser speckle flowmetry, the severity of ambulatory impairments, and vascular density in the hind-limb after permanent femoral artery ligation. Results were compared between homozygous RNF213 knockout mice (RNF213 -/-) and wild-type littermates (Wt). No significant differences were observed in infarction volume or the formation of edema following tMCAO, or in vascular density 28 days after tMCAO between RNF213 -/- and Wt. Blood flow recovery was significantly improved in RNF213 -/- from 3 to 28 days after femoral artery ligation, and angiogenesis as shown by vascular density in the hind-limb was significantly enhanced in RNF213 -/- at 28 days. The amelioration of ambulatory impairments was also evident in RNF213 -/-. Angiogenesis was enhanced in mice lacking RNF213 after chronic hind-limb ischemia, which suggested the potential role of the RNF213 abnormality in the development of pathological vascular networks in chronic ischemia. (C) 2014 Elsevier B.V. All rights reserved.

  198. Audit Trail Management System in Community Health Care Information Network 査読有り

    Naoki Nakamura, Masaharu Nakayama, Jun Nakaya, Teiji Tominaga, Takuo Suganuma, Norio Shiratori

    Studies in Health Technology and Informatics 216 1080 2015年

    出版者・発行元:IOS Press

    DOI: 10.3233/978-1-61499-564-7-1080  

    ISSN:1879-8365 0926-9630

    eISSN:1879-8365

    詳細を見る 詳細を閉じる

    After the Great East Japan Earthquake we constructed a community health care information network system. Focusing on the authentication server and portal server capable of SAML&amp ID-WSF, we proposed an audit trail management system to look over audit events in a comprehensive manner. Through implementation and experimentation, we verified the effectiveness of our proposed audit trail management system.

  199. Interhemispheric Vertical Hemispherotomy: A Single Center Experience 査読有り

    Masaki Iwasaki, Mitsugu Uematsu, Shin-ichiro Osawa, Yoshiteru Shimoda, Kazutaka Jin, Nobukazu Nakasato, Teiji Tominaga

    PEDIATRIC NEUROSURGERY 50 (5) 295-300 2015年

    出版者・発行元:KARGER

    DOI: 10.1159/000437145  

    ISSN:1016-2291

    eISSN:1423-0305

    詳細を見る 詳細を閉じる

    Purpose: Hemispheric epileptogenic lesions such as hemimegalencephaly often manifest as intractable epilepsy in early infancy. Hemispherotomy is the treatment of choice for controlling intractable hemispheric epilepsy. Less invasive procedures are desirable for surgery on infants with low body weight. This study compared our experience with interhemispheric vertical hemispherotomy (IVH) and peri-insular lateral hemispherotomy (PIH). Methods: Thirteen consecutive patients underwent hemispherotomy for treatment of intractable epilepsy in our institution between 2001 and 2012. The etiology of epilepsy included hemimegalencephaly in 7 patients and cortical dysplasia in 3. PIH was performed on the first 5 patients and IVH on the last 8 patients. In the latter procedure, complete section of the corpus callosum was first performed via the interhemispheric approach. After removing part of the cingulate gyrus, section of the descending fibers was performed anterolaterally to the thalamus. Clinical characteristics, duration of operation and amount of blood transfusion were compared between the PIH and IVH groups. Results: There was no difference in age at surgery, body weight and age of epilepsy onset between the two groups. No surgery-related death was observed. No patients required shunt operation. One patient who underwent IVH required reoperation for incomplete disconnection. The amount of intraoperative blood transfusion was smaller and the total duration of operation was shorter in the IVH group than in the PIH group. Conclusion: The interhemispheric approach minimizes cortical resection and may be less invasive than PIH. IVH is advantageous for treating infants with low body weight. (C) 2015 S. Karger AG, Basel

  200. Electro-and magneto-encephalographic spike source localization of small focal cortical dysplasia in the dorsal peri-rolandic region 査読有り

    Hisashi Itabashi, Kazutaka Jin, Masaki Iwasaki, Eiichi Okumura, Akitake Kanno, Kazuhiro Kato, Teiji Tominaga, Ryuta Kawashima, Nobukazu Nakasato

    CLINICAL NEUROPHYSIOLOGY 125 (12) 2358-2363 2014年12月

    出版者・発行元:ELSEVIER IRELAND LTD

    DOI: 10.1016/j.clinph.2014.02.028  

    ISSN:1388-2457

    eISSN:1872-8952

    詳細を見る 詳細を閉じる

    Objective: Small focal cortical dysplasia (FCD) may be ambiguous or overlooked on magnetic resonance (MR) imaging. Source localization of EEG and magnetoencephalography (MEG) spikes was evaluated to confirm the diagnosis of small FCD. Methods: This study included 6 epilepsy patients with a single small lesion on MR imaging suggesting FCD within a single gyrus among 181 consecutive epilepsy patients admitted to our epilepsy monitoring unit over 27 months. Stereotypical interictal spikes were detected on simultaneous EEG and MEG recordings and the onset-related source of averaged spikes was estimated. Results: All 6 patients had unique clinical characteristics as follows: leg sensori-motor seizures in 5 patients and eye version in 1 patient; a small MR imaging lesion suggesting FCD in the dorsal perirolandic region, which had been overlooked until our evaluation; and both EEG and MEG dipoles were estimated adjacent to the MR imaging lesion. Conclusions: Source localization of EEG and MEG spikes can confirm the diagnosis of FCD based on a single small MR imaging lesion, which was overlooked by previous examination of MR images. Significance: Examination of MR images should be based on spike source localization as well as seizure semiology to identify subtle MR imaging abnormalities. (C) 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  201. Intracerebral cystic rhabdoid papillary meningioma in an 11-year-old patient 査読有り

    Wenting Jia, Yukihiko Sonoda, Ryuta Saito, Toshiki Endo, Mika Watanabe, Teiji Tominaga

    CHILDS NERVOUS SYSTEM 30 (12) 2151-2155 2014年12月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00381-014-2470-z  

    ISSN:0256-7040

    eISSN:1433-0350

    詳細を見る 詳細を閉じる

    Introduction Rhabdoid papillary meningioma is a rare meningioma variant categorized as WHO grade III. We report an 11-year-old girl with an intracerebral rhabdoid papillary meningioma. Materials and methods An 11-year-old girl presented to our hospital with a short history of severe headache and vomiting. MRI revealed a left frontal intracerebral cystic lesion with rim enhancement. The tumor, including the cyst wall, was totally removed. Since the histological diagnosis was rhabdoid papillary meningioma, she was treated with postoperative radiotherapy. She is currently undergoing routine follow-up without any symptoms of recurrence. Conclusion We discuss the clinical picture of this patient with reference to the published literature on this uncommon diagnosis.

  202. Spontaneous Alteration from Rathke's Cleft Cyst to Craniopharyngioma-Possible Involvement of Transformation Between These Pathologies 査読有り

    Yoshikazu Ogawa, Mika Watanabe, Teiji Tominaga

    ENDOCRINE PATHOLOGY 25 (4) 422-426 2014年12月

    出版者・発行元:HUMANA PRESS INC

    DOI: 10.1007/s12022-014-9328-5  

    ISSN:1046-3976

    eISSN:1559-0097

    詳細を見る 詳細を閉じる

    Both Rathke's cleft cyst and craniopharyngioma are considered to arise from the remnants of Rathke's diverticulum despite the quite different histological characteristics. These two lesions may consist of a disease spectrum extending from Rathke's cleft cyst to craniopharyngioma. However, in spite of increasing evidence of these intermediate histologies, very few cases of the actual transformation from Rathke's cleft cyst to craniopharyngioma have been reported in the same patient. A 47-year-old man suffered from recurrent visual dysfunction. Aspiration and partial cystectomy was performed to a suprasellar massive cystic lesion. The histological diagnosis was Rathke's cleft cyst with a small component of squamous metaplasia. Seven months later, the cyst was re-expanded. The cyst wall was irregularly thickened. Re-operation was performed, and the thickened anterior wall was widely removed. Postoperative histological examination showed multiplication of stratified squamous epithelia forming a papillary arrangement. Ki-67 staining showed positive cells randomly distributed not only in the basal layer but also in various epithelial layers, with a labeling index of more than 20 %. The histological diagnosis was squamous papillary type of craniopharyngioma with high potential of proliferation. Subsequent immunohistochemical examinations showed positive reaction to cytokeratin 8 only in the initial epithelium and negative in the latter epithelium. The present case was thought as an actual evidence of the proposed link between Rathke's cleft cyst and craniopharyngioma. Cytokeratin 8 could be the important examination to differentiate Rathke's cleft cyst from craniopharyngioma.

  203. Increased vascular MMP-9 in mice lacking RNF213: moyamoya disease susceptibility gene 査読有り

    Shinya Sonobe, Miki Fujimura, Kuniyasu Niizuma, Taku Fujimura, Sadanori Furudate, Yasuo Nishijima, Shigeo Kure, Teiji Tominaga

    NEUROREPORT 25 (18) 1442-1446 2014年12月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1097/WNR.0000000000000289  

    ISSN:0959-4965

    eISSN:1473-558X

    詳細を見る 詳細を閉じる

    Moyamoya disease (MMD) is a chronic occlusive cerebrovascular disease with unknown etiology. Recent genetic studies have identified RNF213 as an important susceptibility gene for MMD. To evaluate the role of RNF213 in vascular remodeling, RNF213 knockout mice (RNF213-/-) and their wild-type littermates (WT) were subjected to common carotid artery ligation to induce vascular hyperplasia. We examined the vascular expression of matrix metalloproteinase (MMP)-9, known to be increased in MMD. MMP-9 expression was significantly higher in RNF213-/- mice than in wild-type mice 1 and 7 days after common carotid artery ligation. The vascular wall was significantly thinner in RNF213-/- mice at 14 days. The increased vascular expression of MMP-9 and subsequent vascular wall thinning in RNF213-/-mice could reflect the early characteristic of MMD, consistent with the recently proposed constrictive remodeling theory. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

  204. Radiology Diagnostic Devices Under Emergency Electric Power at Disaster Base Hospitals During the Acute Phase of the Great East Japan Earthquake: Results of a Survey of All Disaster Base Hospitals in Miyagi Prefecture 査読有り

    Shota Maezawa, Daisuke Kudo, Hajime Furukawa, Atsuhiro Nakagawa, Satoshi Yamanouchi, Takashi Matsumura, Shinichi Egawa, Teiji Tominaga, Shigeki Kushimoto

    DISASTER MEDICINE AND PUBLIC HEALTH PREPAREDNESS 8 (6) 548-552 2014年12月

    出版者・発行元:CAMBRIDGE UNIV PRESS

    DOI: 10.1017/dmp.2014.134  

    ISSN:1935-7893

    eISSN:1938-744X

    詳細を見る 詳細を閉じる

    Objective: This study aimed to clarify the management of emergency electric power and the operation of radiology diagnostic devices after the Great East Japan Earthquake. Methods: Timing of electricity restoration, actual emergency electric power generation, and whether radiology diagnostic devices were operational and the reason if not were investigated through a questionnaire submitted to all 14 disaster base hospitals in Miyagi Prefecture in February and March 2013. Results: Commercial electricity supply resumed within 3 days after the earthquake at 13 of 14 hospitals. Actual emergency electric power generation was lower than pre-disaster estimates at most of the hospitals. Only 4 of 11 hospitals were able to generate 60% of the power normally consumed. Under emergency electric power, conventional X-ray and computed tomography (CT) scanners worked in 9 of 14 (64%) and 8 of 14 (57%) hospitals, respectively. The main reason conventional X-ray and CT scanners did not operate was that hospitals had not planned to use these devices under emergency electric power. Only 2 of the 14 hospitals had a pre-disaster plan to allocate emergency electric power, and all devices operated at these 2 hospitals. Conclusions: Pre-disaster plans to allocate emergency electric power are required for disaster base hospitals to effectively operate radiology diagnostic devices after a disaster.

  205. Novel pulsed water jet system permits off-clamp partial nephrectomy in swine 査読有り

    Shinichi Yamashita, Yoshihiro Kamiyama, Atsuhiro Nakagawa, Yasuhiro Kaiho, Teiji Tominaga, Yoichi Arai

    INTERNATIONAL JOURNAL OF UROLOGY 21 (11) 1181-1182 2014年11月

    出版者・発行元:WILEY-BLACKWELL

    DOI: 10.1111/iju.12538  

    ISSN:0919-8172

    eISSN:1442-2042

  206. Practical surgical indicators to identify candidates for radical resection of insulo-opercular gliomas 査読有り

    Tomohiro Kawaguchi, Toshihiro Kumabe, Ryuta Saito, Masayuki Kanamori, Masaki Iwasaki, Yon Yamashita, Yukihiko Sonoda, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 121 (5) 1124-1132 2014年11月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2014.7.JNS13899  

    ISSN:0022-3085

    eISSN:1933-0693

    詳細を見る 詳細を閉じる

    Object. Maximum resection of gliomas with minimum surgical complications usually leads to optimum outcomes for patients. Radical resection of insulo-opercular gliomas is still challenging, and selection of ideal patients can reduce risk and obtain better outcomes. Methods. This retrospective study included 83 consecutively treated patients with newly diagnosed gliomas located at the insulo-opercular region and extending to the sylvian fissure around the primary motor and somatosensory cortices. The authors selected 4 characteristics as surgical indicators: clear tumor boundaries, negative enhancement, intact lenticulostriate arteries, and intact superior extremity of the central insular sulcus. Results. Univariate analysis showed that tumors with clear boundaries were associated with higher rates of gross-total resection than were tumors with ambiguous boundaries (75.7% vs 19.6%). Tumors with negative enhancement compared with enhanced tumors were associated with lower frequency of tumor progression (32.0% vs 81.8%, respectively) and lower rates of surgical complications (14.0% vs 45.5%, respectively). Tumors with intact lenticulostriate arteries were associated with higher rates of gross-total resection than were tumors with involved lenticulostriate arteries (67.3% vs 11.8%, respectively). Tumors with intact superior extremity of the central insular sulcus were associated with higher rates of gross-total resection (57.4% vs 20.7%, respectively) and lower rates of surgical complications (18.5% vs 41.4%, respectively) than were tumors with involved anatomical structures. Multivariate analysis showed that clear tumor boundaries were independently associated with gross-total resection (p &lt; 0.001). Negative enhancement was found to be independently associated with surgical complications (p = 0.005), overall survival times (p &lt;0.001), and progression-free survival times (p = 0.004). Independent associations were also found between intact lenticulostriate arteries and gross-total resection (p &lt; 0.001), between intact lenticulostriate arteries and progression-free survival times (p = 0.026), and between intact superior extremity of the central insular sulcus and gross-total resection (p = 0.043). Among patients in whom all 4 indicators were present, prognosis was good (5-year survival rate 93.3%), resection rate was maximal (gross-total resection 100%), and surgical complication rate was minimal (6.7%). Also among these patients, overall rates of survival (p = 0.003) and progression-free survival (p = 0.005) were significantly higher than among patients in whom fewer indicators were present. Conclusions. The authors propose 4 simple indicators that can be used to identify ideal candidates for radical resection of insulo-opercular gliomas, improve the outcomes, and promote maximum resection without introducing neurological complications. The indicators are clear tumor boundaries, negative enhancement, intact lenticulostriate arteries, and intact superior extremity of the central insular sulcus.

  207. Usefulness of Laser Speckle Flowgraphy for the Assessment of Ocular Blood Flow in Extracranial-Intracranial Bypass 査読有り

    Shunsuke Omodaka, Hidenori Endo, Hiroshi Doi, Hiroaki Shimizu, Miki Fujimura, Naoko Aizawa, Toru Nakazawa, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 23 (10) E445-E448 2014年11月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2014.06.021  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Laser speckle flowgraphy (LSFG) is a noninvasive technique that can measure relative blood flow velocity in the optic fundus. The authors present a case of symptomatic internal carotid artery occlusion treated with superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in which an improvement of ocular circulation was confirmed by LSFG. A 47-year-old man presented with a 1-month history of repeated left blurred vision and motor weakness of the right leg. Diffusion-weighted magnetic resonance imaging revealed a small infarction in the left frontal lobe. Carotid angiography revealed that the left internal carotid artery was occluded at the C4 portion. Single-photon emission computed tomography indicated that the cerebral blood flow in the left MCA territory was markedly impaired. Ophthalmologic examination revealed ischemic change of the left optic fundi, and LSFG revealed decreased blood flow around the left optic disc. Left STA-MCA bypass was successfully performed. Both ischemic ocular symptoms and the ischemic symptoms of the right leg were completely recovered after surgery. Postoperative ophthalmologic examination revealed improvement of both ischemic changes of the left optic fundi. Moreover, LSFG revealed improvement of the blood flow around the left optic disc. LSFG can be a promising clinical tool for the assessment of ocular circulation before and after bypass surgery for occlusive cerebrovascular disease.

  208. [Usefulness of pulsed water jet in dissecting sphenoid ridge meningioma while preserving arteries]. 査読有り

    Toshiki Endo, Atsuhiro Nakagawa, Miki Fujimura, Yukihiko Sonoda, Hiroaki Shimizu, Teiji Tominaga

    No shinkei geka. Neurological surgery 42 (11) 1019-25 2014年11月

    DOI: 10.11477/mf.1436200025  

    ISSN:0301-2603

    詳細を見る 詳細を閉じる

    We report the utility of a pulsed water jet device in meningioma surgery. The presented case is that of a 61-year-old woman with left visual disturbance. MRI demonstrated heterogeneously enhanced mass with intratumoral hemorrhage, indicating sphenoid ridge meningioma on her left side. The tumor invaded the cavernous sinus and left optic canal, engulfing the internal carotid artery in the carotid cistern and encased middle cerebral arteries. During the operation, the pulsed water jet device was useful for dissecting the tumor away from the arteries since it was safe in light of preserving parent arteries. The jet did not cause any vascular injury and did not induce vasospasm as shown by postoperative symptomatology and MRIs. With the aid of pulsed water jet, we could achieve total resection of the tumor except for the piece within the cavernous sinus. The patient had no new neurological deficits after the operation. We consider the pulsed water jet as a useful device, especially when the need to dissect meningioma from parent arteries exists. The jet can help neurosurgeons simultaneously achieve tumor resection and preservation of blood vessels.

  209. Surgical Management of Traumatic Acute Subdural Hematoma in Adults: A Review 査読有り

    Hiroshi Karibe, Toshiaki Hayashi, Takayuki Hirano, Motonobu Kameyama, Atsuhiro Nakagawa, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 54 (11) 887-894 2014年11月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.ra.2014-0204  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Traumatic acute subdural hematoma (ASDH) is a major clinical entity in traumatic brain injury (TBI). It acts as a space occupying lesion to increase intracranial pressure, and is often complicated by co-existing lesions, and is modified by cerebral blood flow (CBF) changes, coagulopathy, and delayed hematomas. Because of its complicated pathophysiology, the mortality of ASDH is still remaining high. In this review article, its epidemiology, pathophyiology, surgical treatment, and salvage ability are described. With regard to epidemiology, as the population ages, growing number of elderly patients with ASDH, especially patients with prehospital anticoagulant and antiplatelets, increase. Concerning pathophysiology, in addition to well-known initial intracranial hypertension and subsequent ischemia, delayed hyperemia/hyperperfusion, or delayed hematoma is being recognized frequently in recent years. However, optimal treatments for these delayed phenomenons have not been established yet. With regard to surgical procedures, all of craniotomy, decompressive craniectomy, and initial trephination strategies seem to be effective, but superiority of each procedure have not been established yet. Since Glasgow Coma Scale (GCS) scores, age, papillary reaction, and computed tomographic findings are strongly correlated to outcome, each factor has been investigated as an indicator of salvage ability. None of them, however, has been defined as such one. In future studies, epidemiological changes as population ages, management of delayed pathophysiology, superiority of each surgical procedures, and salvage ability should be addressed.

  210. Experimental Application of Piezoelectric Actuator-Driven Pulsed Water Jets in Retinal Vascular Surgery 査読有り

    Hiroshi Kunikata, Yuji Tanaka, Naoko Aizawa, Atsuhiro Nakagawa, Teiji Tominaga, Toru Nakazawa

    TRANSLATIONAL VISION SCIENCE & TECHNOLOGY 3 (6) 10 2014年11月

    出版者・発行元:ASSOC RESEARCH VISION OPHTHALMOLOGY INC

    DOI: 10.1167/tvst.3.6.10  

    ISSN:2164-2591

    詳細を見る 詳細を閉じる

    Purpose: To report on the effectiveness and safety of an ophthalmic piezoelectric actuator-driven pulsed water jet (ADPJ) system adapted for intraocular use. Methods: First, we determined the highest ADPJ flow rate that did not cause an unsafe rise in intraoperative intraocular pressure (IOP) in rabbits (n = 4). Next, we determined the most effective ADPJ frequency (in hertz) at that flow rate. Finally, we visualized the ADPJ stream, measured its pressure, and determined the minimum voltage and distance between the ADPJ needle and retinal veins to induce intravenous displacement of the blood column (DBC) through massage of the outer retinal vessels (n = 3) while not causing retinal tearing or hemorrhage. Results: We found that a 0.05 mL/min ADPJ flow rate caused IOP to rise above 40 mm Hg after 1 minute, but that at 0.025 mL/min, IOP stayed below 40 mm Hg even after 3 minutes. Moreover, we found that a 0.025 mL/min ADPJ stream was stable at a pulse frequency of 10 Hz and that at this flow rate/frequency the ADPJ pressure was closely correlated with the applied voltage (P&lt; 0.001, r(2) = 0.9991). The minimum voltage and distance to achieve intravenous DBC without causing retinal tearing or hemorrhage were 40 V and 0.5 mm, respectively. Conclusions: With an appropriate flow rate and surgical time, ADPJ successfully induced massage of the retinal vessels and intravenous DBC while maintaining safe IOP and not causing retinal complications. Translational Relevance: The ADPJ system has promise as a safe and minimally invasive instrument for the intraocular surgical treatment of human retinal vascular diseases.

  211. Efficacy of Superficial Temporal Artery-Middle Cerebral Artery Double Anastomoses in a Patient with Rapidly Progressive Moyamoya Disease: Case Report 査読有り

    Michiko Yokosawa, Toshiaki Hayashi, Reizo Shirane, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 54 (10) 836-840 2014年10月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.cr.2013-0139  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Moyamoya disease can be associated with a rapidly progressive course in young patients. This report describes a patient with moyamoya disease who experienced rapid disease progression, resulting in cerebral infarction and a wide area of diminished cerebral perfusion. Double superficial temporal artery (STA)-middle cerebral artery (MCA) anastomoses were utilized to immediately increase cerebral perfusion in the affected area. This case involved a 5-year-old girl who had been diagnosed with moyamoya disease and had undergone STA-MCA anastomosis with indirect bypass in the right hemisphere at the age of 3. At the time of presentation, magnetic resonance (MR) imaging showed cerebral infarction at the left frontal lobe, and MR angiography showed rapidly progressive narrowing of the left MCA that had not been present 3 months prior. N-isopropyl-p-[I123] iodoamphetamine single-photon emission computed tomography (IMP-SPECT) showed markedly decreased uptake in the left hemisphere. She underwent emergent STA-MCA double anastomoses with indirect bypass on the left side. IMP-SPECT showed marked increase in uptake in the left hemisphere. The anterior cerebral artery (ACA) territory adjacent to the cerebral infarction also showed increased uptake on the SPECT. Postoperatively, there were no clinical or radiographic indications of ischemic or hemorrhagic complications. Double anastomoses are effective in quickly and significantly increasing blood flow. The postoperative course in this case was uneventful. Double anastomoses are a surgical option for patients with moyamoya disease who show rapid disease progression, even in those in the acute phase of cerebral infarction.

  212. Conformational Change in Transfer RNA Is an Early Indicator of Acute Cellular Damage 査読有り

    Eikan Mishima, Chisako Inoue, Daisuke Saigusa, Ryusuke Inoue, Koki Ito, Yusuke Suzuki, Daisuke Jinno, Yuri Tsukui, Yosuke Akamatsu, Masatake Araki, Kimi Araki, Ritsuko Shimizu, Haruka Shinke, Takehiro Suzuki, Yoichi Takeuchi, Hisato Shima, Yasutoshi Akiyama, Takafumi Toyohara, Chitose Suzuki, Yoshikatu Saiki, Teiji Tominaga, Shigehito Miyagi, Naoki Kawagisihi, Tomoyoshi Soga, Takayoshi Ohkubo, Kenichi Yamamura, Yutaka Imai, Satohiro Masuda, Venkata Sabbisetti, Takaharu Ichimura, David B. Mount, Joseph V. Bonventre, Sadayoshi Ito, Yoshihisa Tomioka, Kunihiko Itoh, Takaaki Abe

    JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY 25 (10) 2316-2326 2014年10月

    出版者・発行元:AMER SOC NEPHROLOGY

    DOI: 10.1681/ASN.2013091001  

    ISSN:1046-6673

    eISSN:1533-3450

    詳細を見る 詳細を閉じる

    Tissue damage by oxidative stress is a key pathogenic mechanism in various diseases, including AKI and CKD. Thus, early detection of oxidative tissue damage is important. Using a tRNA-specific modified nucleoside 1-methyladenosine (m1A) antibody, we show that oxidative stress induces a direct conformational change in tRNA structure that promotes subsequent tRNA fragmentation and occurs much earlier than DNA damage. In various models of tissue damage (ischemic reperfusion, toxic injury, and irradiation), the levels of circulating tRNA derivatives increased rapidly. In humans, the levels of circulating tRNA derivatives also increased under conditions of acute renal ischemia, even before levels of other known tissue damage markers increased. Notably, the level of circulating free m1A correlated with mortality in the general population (n=1033) over a mean follow-up of 6.7 years. Compared with healthy controls, patients with CKD had higher levels of circulating free m1A, which were reduced by treatment with pitavastatin (2 mg/d; n=29). Therefore, tRNA damage reflects early oxidative stress damage, and detection of tRNA damage may be a useful tool for identifying organ damage and forming a clinical prognosis.

  213. Cavernous malformation of the optic pathway mimicking optic glioma: a case report 査読有り

    Yui Mano, Toshihiro Kumabe, Ryuta Saito, Mika Watanabe, Teiji Tominaga

    CHILDS NERVOUS SYSTEM 30 (10) 1753-1758 2014年10月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00381-014-2465-9  

    ISSN:0256-7040

    eISSN:1433-0350

    詳細を見る 詳細を閉じる

    Optic pathway cavernous malformations (CMs) are extremely rare, accounting for less than 1 % of all intracranial CMs. We report a case of optic pathway CM mimicking optic glioma because the initial magnetic resonance (MR) images did not disclose hemorrhagic findings such as popcorn-like lesion or hemosiderin ring. A 20-year-old woman presented with subacute left visual acuity loss and visual field defect and was referred to our hospital. Initial MR imaging findings were suggestive of optic glioma. Second MR imaging demonstrated hemorrhagic findings, but the hemorrhage was considered to be intratumoral hemorrhage from left optic pilocytic astrocytoma. She underwent radiochemotherapy and intravenous administration of corticosteroids but her symptoms deteriorated. Third and fourth MR imaging revealed enlargement of the hematoma. Therefore, the radiation therapy was interrupted at a delivered dose of 16.2 Gy, and craniotomy was performed to preserve residual right visual field. The lesion was totally removed and the histological diagnosis was CM. Her right visual field was preserved, but not improved. The present case and previous cases suggest that optic pathway CMs sometimes do not initially manifest with signs of hemorrhage, so CMs should be included in the differential diagnosis of optic pathway lesions. Histological confirmation with preparation for total resection should be considered for rapidly progressive cases even if the neuroimaging findings are compatible with optic glioma.

  214. Outcome and mid-term prognosis after maximum and radical removal of craniopharyngiomas with the priority to the extended transsphenoidal approach-A single center experience 査読有り

    Yoshikazu Ogawa, Tomohiro Kawaguchi, Teiji Tominaga

    CLINICAL NEUROLOGY AND NEUROSURGERY 125 41-46 2014年10月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.clineuro.2014.07.014  

    ISSN:0303-8467

    eISSN:1872-6968

    詳細を見る 詳細を閉じる

    Objective: The transsphenoidal approach has been increasingly used for the surgical treatment of craniophaiyngiomas with/without sellar enlargement. However, the optimum indications for the extended transsphenoidal approach with opening of the posterior ethmoidal sinus in addition to opening of the sellar floor are still controversial. Methods: Forty-two patients with craniopharyngiomas treated by the extended transsphenoidal approach were retrospectively studied from a series of 993 cases of pituitary surgeries between April 2004 and September 2013. Removal rate, visual function, endocrinological changes, and mid-term prognosis were investigated. Results: Gross total removal was achieved in 31 of 42 patients (73.8%) overall, in 24 of 27 patients (88.9%) undergoing initial treatment, and in 7 of 15 patients (46.7%) undergoing re-treatment after previous transcranial tumor removal and/or radiation therapy. The major cause of abandonment of surgery in the re-treatment group was tight adhesion and/or encasement of the perforating arteries. The rate of total removal showed a significant difference between initial treatment and re-treatment groups (logrank test, p &lt; 0.001). Only one patient suffered tumor recurrence after total removal, but the others remained disease-free during the follow-up period. Postoperative visual acuity was improved in 20 of 40 patients evaluated, remained steady in 20, and deteriorated in none, indicating good ophthalmological outcomes in all 40 patients. The pituitary stalk was intentionally sectioned in 18 of 42 patients, and 9 of the 18 patients could discontinue usage of antidiuretic hormone in the follow-up period. All patients were discharged without neurological deficits, except for two patients with preoperative dysfunction of the mammillary bodies, and all maintained independence in daily life with hormonal supplementation. No other complications including cerebrospinal fluid leakage were experienced in the follow-up period. Conclusions: Maximum and radical removal through the extended transsphenoidal approach achieved high rate of total removal and good visual outcomes. However, re-treatment still presents challenges. (C) 2014 Elsevier B.V. All rights reserved.

  215. Hypothermia in Victims of the Great East Japan Earthquake: A Survey in Miyagi Prefecture 査読有り

    Hajime Furukawa, Daisuke Kudo, Atsuhiro Nakagawa, Takashi Matsumura, Yoshiko Abe, Ryota Konishi, Satoshi Yamanouchi, Satoru Ishibashi, Masakazu Kobayashi, Norio Narita, Toshikatsu Washio, Tatsuhiko Arafune, Teiji Tominaga, Shigeki Kushimoto

    DISASTER MEDICINE AND PUBLIC HEALTH PREPAREDNESS 8 (5) 379-389 2014年10月

    出版者・発行元:CAMBRIDGE UNIV PRESS

    DOI: 10.1017/dmp.2014.70  

    ISSN:1935-7893

    eISSN:1938-744X

    詳細を見る 詳細を閉じる

    Objective: A survey was conducted to describe the characteristics of patients treated for hypothermia after the Great East Japan Earthquake. Methods: Written questionnaires were distributed to 72 emergency medical hospitals in Miyagi Prefecture. Data were requested regarding inpatients with a temperature less than 36 degrees C admitted within 72 hours after the earthquake. The availability of functional heating systems and the time required to restore heating after the earthquake were also documented. Results: A total of 91 inpatients from 13 hospitals were identified. Tsunami victims comprised 73% of the patients with hypothermia. Within 24 hours of the earthquake, 66 patients were admitted. Most patients with a temperature of 32 degrees C or higher were treated with passive external rewarming with blankets. Discharge without sequelae was reported for 83.3% of patients admitted within 24 hours of the earthquake and 44.0% of those admitted from 24 to 72 hours after the earthquake. Heating systems were restored within 3 days of the earthquake at 43% of the hospitals. Conclusions: Hypothermia in patients hospitalized within 72 hours of the earthquake was primarily due to cold-water exposure during the tsunami. Many patients were successfully treated in spite of the post-earthquake disruption of regional social infrastructure.

  216. Development of Moyamoya Disease in Pregnancy and Puerperium: Case Report 査読有り

    Yosuke Akamatsu, Miki Fujimura, Hiroshi Uenohara, Hiroaki Shimizu, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 54 (10) 824-826 2014年10月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.cr.2014-0071  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Progressive moyamoya disease in pregnancy and puerperium has not been reported previously. Here, we present a 39-year-old woman who had been found to have moderate stenosis of right middle cerebral artery (MCA) 4 years prior to her pregnancy, finally suffering minor completed stroke due to progressive moyamoya disease at the early postpartum period. Three days after cesarean section without any complication, she developed cerebral infraction at right hemisphere, when magnetic resonance angiography indicated apparent progression of the proximal MCA stenosis. Catheter angiography demonstrated nearly occlusion of the right terminal internal carotid artery (ICA) and the development of an abnormal vascular network at the base of the brain as well as MCA stenosis, indicating a definitive diagnosis of moyamoya disease with unilateral involvement. The patient underwent superficial temporal artery-middle cerebral artery anastomosis 1 month after the onset of stroke, and she did not manifest as further neurological events during the follow-up period of 2 years. Moyamoya disease could newly develop in pregnancy and puerperium, which should be noted as a pitfall of the management of moyamoya disease with pregnancy.

  217. Maximum Preservation of the Media in Carotid Endarterectomy 査読有り

    Kuniyasu Niizuma, Hiroaki Shimizu, Takashi Inoue, Mika Watanabe, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 54 (10) 812-818 2014年10月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.tn.2014-0202  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Carotid endarterectomy (CEA) is intended to remove atheromatous plaque by dissecting a plane between the intima and the media (circular medial fibers), but this may not be the optimal dissection plane. The present technique is based on identifying the plane that divides the media from the plaque, so preserving the media on the adventitia as much as possible. This plane is more difficult to find and follow than the easy-to-dissect plane usually located between the media and the adventitia, because the plaque invades the media and so the dividing plane is located within the media. In this prospective observational study, CEA was performed in 22 patients to histologically examine the excised plaques and small samples of the whole arterial wall, and evaluate the clinical outcomes. Plaque had invaded the luminal part of the media in the whole arterial wall sample of 80% of cases. Thin medial layers covering &gt; 80% of the surface of the plaque were found in 16 of 22 plaques (73%). Some atheromatous component was sometimes left in the preserved media, rather than completely removed with the media. No morbidity or mortality had occurred by discharge. Only 1 small ipsilateral infarction (4.5%) and no restenosis of greater than 50% were detected during the mean follow-up period of 7 years. Since the plaque usually invades the media, the optimum dissection plane may be located within the media, dividing it into two layers. The presence of some remnant atheromatous components in the preserved media was not associated with surgical complications or restenosis.

  218. Cervical Perimedullary Arteriovenous Shunts: A Study of 22 Consecutive Cases With a Focus on Angioarchitecture and Surgical Approaches 査読有り

    Toshiki Endo, Hiroaki Shimizu, Kenichi Sato, Kuniyasu Niizuma, Ryushi Kondo, Yasushi Matsumoto, Akira Takahashi, Teiji Tominaga

    NEUROSURGERY 75 (3) 238-248 2014年9月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1227/NEU.0000000000000401  

    ISSN:0148-396X

    eISSN:1524-4040

    詳細を見る 詳細を閉じる

    BACKGROUND: Reports of cervical perimedullary arteriovenous shunt (PMAVS) are limited, and treatment strategies have not been established. OBJECTIVE: To describe angioarchitecture and optimal treatment strategies for cervical PMAVS. METHODS: We treated 22 patients with cervical PMAVS between 2000 and 2012 (8 women and 14 men; age, 9-80 years). According to the classification, our patients included type IVa (4 patients), type IVb (16 patients), and type IVc (2 patients). Seventeen patients presented with subarachnoid hemorrhage. RESULTS: A total of 41 shunting points were localized in 22 patients, of which 34 points were located ventral or ventrolateral to the spinal cord. The anterior spinal artery (ASA) contributed to the shunts in 16 patients. Aneurysm formation was identified in 8 patients. Endovascular treatment was attempted in 3 patients, resulting in complete obliteration in 1 patient (type IVc). Overall, 21 patients underwent open surgery. An anterior approach with corpectomy was elected for 2 patients; the other 19 patients underwent the posterior approaches using indocyanine green videoangiography, intraoperative angiography, endoscopy (8 patients), and neuromonitoring. Twenty patients were rated as having a good recovery at 6 months after surgery. No recurrence was observed in any patients during the follow-up (mean, 59.7 months). CONCLUSION: Shunting points of the cervical PMAVS were predominantly located ventral or ventrolateral to the spinal cord and were often fed by the ASA. Even for ventral lesions, posterior exposure assisted with neuromonitoring and endoscopy, and intraoperative angiography provided a view sufficient to understand the relationships between the shunts and the ASA and contributed to good surgical outcomes.

  219. A Case of Bilateral Giant Internal Carotid Artery Aneurysms at the Cavernous Portion Managed by 2-stage Extracranial-Intracranial Bypass with Parent Artery Occlusion: Consideration for Bypass Selection and Timing of Surgeries 査読有り

    Miki Fujimura, Kenichi Sato, Naoto Kimura, Takashi Inoue, Hiroaki Shimizu, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 23 (8) E393-E398 2014年9月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2014.02.020  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Bilateral giant internal carotid artery (ICA) aneurysms at the cavernous portion with bilateral cranial nerve symptoms are extremely rare. Extracranial-intracranial (EC-IC) bypass with parent artery occlusion (PAO) is one of the preferred procedures for giant ICA aneurysm at the cavernous portion with cranial nerve palsy; however, optimal bypass selection and the timing of surgery are controversial, particularly in bilateral cases. A 28-year-old woman developed left third nerve palsy with giant ICA aneurysms at the bilateral cavernous portion. Because only the left aneurysm was symptomatic, she initially underwent left EC-IC bypass using a saphenous vein graft with PAO without complications, which relieved her symptoms. However, she developed right third/fifth nerve palsy 10 months later, at which time magnetic resonance (MR) imaging and MR angiography revealed an enlarged right ICA aneurysm and shrunken left ICA aneurysm. Balloon test occlusion of the right ICA identified sufficient ischemic tolerance; therefore, she underwent right superficial temporal artery-middle cerebral artery bypass with PAO. Both bypasses were confirmed by MR angiography to be patent after surgery. Cranial nerve palsy gradually improved postoperatively, and single-photon emission computed tomography confirmed static cerebral hemodynamics. In conclusion, high-flow EC-IC bypass with PAO is recommended in the first stage of surgery on a unilaterally symptomatic side to minimize postoperative hemodynamic stress to the contralateral aneurysm. Once the contralateral side becomes symptomatic, second stage EC-IC bypass with PAO, either low-flow or high-flow bypass, is recommended based on the results of balloon test occlusion.

  220. Efficacy of extracranial-intracranial bypass for progressive middle cerebral artery occlusion associated with active Sjögren's syndrome: case report. 査読有り

    Sakata H, Fujimura M, Sato K, Shimizu H, Tominaga T

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 23 (8) E399-E402 2014年9月

    出版者・発行元:None

    DOI: 10.1016/j.jstrokecerebrovasdis.2014.02.022  

    ISSN:1052-3057

    eISSN:1532-8511

  221. Diagnostic pitfalls of hyperprolactinemia: The importance of sequential pituitary imaging 査読有り

    Tomohiro Kawaguchi, Yoshikazu Ogawa, Teiji Tominaga

    BMC Research Notes 7 (1) 555 2014年8月20日

    出版者・発行元:BioMed Central Ltd.

    DOI: 10.1186/1756-0500-7-555  

    ISSN:1756-0500

    詳細を見る 詳細を閉じる

    Background: The purpose of this study is to confirm whether the serum prolactin cut-off value is definitive to distinguish prolactinoma and non-functioning pituitary adenoma with hyperprolactinemia. We retrospectively reviewed patients with non-functioning pituitary adenoma, including gonadotroph cell adenoma, null cell adenoma and prolactinoma who were surgically treated at Kohnan hospital between June 2005 and March 2012. The patients without endocrinological/neurological symptom and with the tumor larger than 40 mm in diameter were excluded. According to previously reported cut-off value of serum prolactin, mild hyperprolactinemia, which is considered non-definitive (border zone) concentration between prolactinoma and non-functioning pituitary adenoma, were defined as 90 - 200 ng/ml. Ninety-five prolactinoma patients and 212 patients with non-functioning pituitary adenoma were analyzed. The serum prolactin concentration, tumor size, and clinical characteristics were statistically compared. Results: Receiver operating characteristic (ROC) curve analysis was performed, indicating that cut-off value of serum prolactin concentration to distinguish between non-functioning pituitary adenoma and prolactinoma was 38.6 ng/ml. Although it was statistically good accuracy (the area under the curve 0.96, sensitivity 0.99 and specificity 0.81), the result did not fit the clinical situation as many false-positive cases (40 of 212, 18.9%) were included. Among them, mild hyperprolactinemia were shown in 9 (4.2%) and 53 (55.8%) non-functioning pituitary adenoma and prolactinoma, respectively. Four of 9 border zone patients with non-functioning pituitary adenoma were initially treated with dopamine agonists. Sequential head magnetic resonance imaging revealed no tumor shrinkage in all of them despite serum prolactin concentration was decreased. Surgery was chosen for them 24.6 months in average after the introduction of medication. Conclusions: Non-negligible number of patients with non-functioning pituitary adenoma presented unexpectedly high concentration of prolactin, fraught with a potential risk of misdiagnosis. While this equivocal population is not the majority, the prolactin cut-off value is not safely applicable. Especially for the patients with border zone prolactin concentration, meticulous follow up with sequential pituitary imaging is important.

  222. SMTP-7, a new thrombolytic agent, decreases hemorrhagic transformation after transient middle cerebral artery occlusion under warfarin anticoagulation in mice 査読有り

    Akira Ito, Kuniyasu Niizuma, Hiroaki Shimizu, Miki Fujimura, Keiji Hasumi, Teiji Tominaga

    BRAIN RESEARCH 1578 38-48 2014年8月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.brainres.2014.07.004  

    ISSN:0006-8993

    eISSN:1872-6240

    詳細を見る 詳細を閉じる

    Stachybotrys microspora triprenyl phenol-7 (SMTP-7) is a new thrombolytic agent that exhibits anti-inflammatory effects. We previously demonstrated that the hemorrhagic transformation was fewer with SMTP-7 than with recombinant tissue plasminogen activator (rt-PA) following ischemia-reperfusion in animal models. We hypothesized that SMTP-7 may decrease hemorrhagic transformation after ischemia-reperfusion under the warfarin-treated condition. Transient middle cerebral artery occlusion (MCAO) was induced for 3 h using an intraluminal suture in warfarin-treated mice to produce hemorrhagic transformation. Warfarin was administered orally for a 24-h feeding period before MCAO through bottled drinking water (5 mg in 375 ml tap water), resulting in a mean INR of 5.6 +/- 0.2. Mice were treated with vehicle, rt-PA, or SMTP-7 5 h before reperfusion. Twenty percent of vehicle-treated and 50.0% of rt-PA-treated mice died 24 h after reperfusion, while all SMTP-7-treated mice survived. Hemorrhagic severity in SMTP-7-treated mice was significantly lower than that in rt-PA-treated mice. Neurological deficit was significantly lower in SMTP-7-treated mice than vehicle- and rt-PA-treated mice. These results indicate that SMTP-7 decreases mortality, hemorrhagic transformation, and neurological deficits, and can be a safe thrombolytic agent following MCAO under the warfarin-treated condition. (C) 2014 Elsevier B.V. All rights reserved.

  223. Moyamoya syndrome associated with Basal meningioma successfully treated by the modified transsphenoidal approach: case report. 査読有り

    Ogawa Y, Fujimura M, Tominaga T

    Journal of neurological surgery reports 75 (1) e77-80 2014年8月

    DOI: 10.1055/s-0033-1363504  

    ISSN:2193-6358

  224. RBPJ is disrupted in a case of proximal 4p deletion syndrome with epilepsy 査読有り

    Tojo Nakayama, Hirotomo Saitsu, Wakaba Endo, Atsuo Kikuchi, Mitsugu Uematsu, Kazuhiro Haginoya, Naomi Hino-fukuyo, Tomoko Kobayashi, Masaki Iwasaki, Teiji Tominaga, Shigeo Kure, Naomichi Matsumoto

    BRAIN & DEVELOPMENT 36 (6) 532-536 2014年6月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.braindev.2013.07.009  

    ISSN:0387-7604

    eISSN:1872-7131

    詳細を見る 詳細を閉じる

    Proximal 4p deletion syndrome is characterized clinically by mental retardation, minor dysmorphic facial features, and is occasionally complicated with epilepsy. More than 20 cases of proximal 4p deletion syndrome have been reported, but the causative gene(s) remain elusive. We describe here a 2-year-old female patient with a common manifestation of proximal 4p deletion syndrome and infantile epileptic encephalopathy possessing a de novo balanced translocation t(4;13)(p15.2;q12.13). The patient was diagnosed as infantile spasms at 9 months of age. She presented with dysmorphic facial features and global developmental delay, compatible with proximal 4p deletion syndrome. Using fluorescence in situ hybridization, we determined the translocation breakpoint at 4p15.2 to be within RBPJ. RBPJ is a transcription factor in the Notch/RBPJ signaling pathway, playing a crucial role in the developing human brain, and particularly telencephalon development. Our findings, combined with those of previous studies, strongly suggest that RBPJ is causative for proximal 4p deletion syndrome and epilepsy in this case. (C) 2013 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  225. Mutually exclusive mutations of KIT and RAS are associated with KIT mRNA expression and chromosomal instability in primary intracranial pure germinomas 査読有り

    Shintaro Fukushima, Ayaka Otsuka, Tomonari Suzuki, Takaaki Yanagisawa, Kazuhiko Mishima, Akitake Mukasa, Nobuhito Saito, Toshihiro Kumabe, Masayuki Kanamori, Teiji Tominaga, Yoshitaka Narita, Soichiro Shibui, Mamoru Kato, Tatsuhiro Shibata, Masao Matsutani, Ryo Nishikawa, Koichi Ichimura

    ACTA NEUROPATHOLOGICA 127 (6) 911-925 2014年6月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00401-014-1247-5  

    ISSN:0001-6322

    eISSN:1432-0533

    詳細を見る 詳細を閉じる

    Intracranial germ cell tumors (iGCTs) are the second most common brain tumors among children under 15 in Japan. The pathogenesis of iGCTs is largely unexplored. Although a subset of iGCTs is known to have KIT mutation, its impact on the biology and patients' survival has not been established. In this study, we investigated genes involved in the KIT signaling pathway. 65 iGCTs (30 pure germinomas, 14 teratomas, 18 mixed GCTs, 2 yolk sac tumors, 1 choriocarcinoma) were screened for mutation of KIT, KRAS, NRAS, HRAS, BRAF, PDGFRA, and IDH1 by direct sequencing. KIT expression was examined by immunohistochemistry and quantitative PCR. Chromosomal status was analyzed by array-comparative genomic hybridization (aCGH). Somatic mutations were detected only in KIT and RAS, which were frequently observed in pure germinomas (60.0 %), but rare in non-germinomatous GCTs (NGGCTs) (8.6 %). All KIT/RAS mutations were mutually exclusive. Regardless of the mutation status or mRNA expression, the KIT protein was expressed in all germinomas, while only in 54.3 % of NGGCTs. Amplification of KIT was found in one pure germinoma by aCGH. In pure germinomas, high expression of KIT mRNA was associated with the presence of KIT/RAS alterations and severe chromosomal instability. Our results indicate that alterations of the KIT signaling pathway play an important role in the development of germinomas. Pure germinomas may develop through two distinct pathogeneses: one with KIT/RAS alterations, elevated KIT mRNA expression and severe chromosomal instability, and the other through yet an unidentified mechanism without any of the above abnormalities.

  226. Development of a de novo arteriovenous malformation after bilateral revascularization surgery in a child with moyamoya disease Case report 査読有り

    Miki Fujimura, Naoto Kimura, Masayuki Ezura, Kuniyasu Niizuma, Hiroshi Uenohara, Tem Tominaga

    JOURNAL OF NEUROSURGERY-PEDIATRICS 13 (6) 647-649 2014年6月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2014.3.PEDS13610  

    ISSN:1933-0707

    eISSN:1933-0715

    詳細を見る 詳細を閉じる

    The development of a de novo arteriovenous malformation (AVM) in patients with moyamoya disease is extremely rare. A 14-year-old girl developed an AVM in the right occipital lobe during the 4-year postoperative period following successful bilateral revascularization surgeries. She suffered a transient ischemic attack with hemodynamic compromise of the bilateral hemispheres at the age of 10 years. Results of an initial examination by 1.5-T MRI and MR angiography satisfied the diagnostic criteria of moyamoya disease but failed to detect any vascular malformation. Bilateral direct and indirect revascularization surgeries in the anterior circulation relieved her symptoms, and she underwent MRI and MR angiography follow-up every year after surgery. Serial T2-weighted MRI revealed the gradual appearance of flow voids in the right occipital lobe during the follow-up period. Magnetic resonance angiography ultimately indicated the development of an AVM 4 years after these surgeries when catheter angiography confirmed the diagnosis of an AVM in the right occipital lobe. The AVM remained asymptomatic, and the patient remained free of cerebrovascular events during the time she was observed by the authors. Acquired AVM in moyamoya disease is extremely rare, with only 3 pediatric cases including the present case being reported in the literature. The development of a de novo AVM in a postoperative patient with moyamoya disease appears to be unique, and this case may provide insight into the dynamic pathology of AVMs.

  227. Rapid and sensitive intraoperative detection of mutations in the isocitrate dehydrogenase 1 and 2 genes during surgery for glioma Laboratory investigation 査読有り

    Masayuki Kanamori, Atsuo Kikuchi, Mika Watanabe, Ichiyo Shibahara, Ryuta Saito, Yoji Yamashita, Yukihiko Sonoda, Toshihiro Kumabe, Shigeo Kure, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 120 (6) 1288-1297 2014年6月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2014.3.JNS131505  

    ISSN:0022-3085

    eISSN:1933-0693

    詳細を見る 詳細を閉じる

    Object. Intraoperative diagnosis is important in determining the strategies during surgery for glioma. Because the mutations in the isocitrate dehydrogenase 1 and 2 (IDH1 and IDH2) genes have diagnostic, prognostic, and predictive values, the authors assessed the feasibility and significance of a simplified method for the intraoperative detection of IDH1 and IDH2 gene mutations. Methods. Rapid DNA extraction, amplification with conventional polymerase chain reaction (PCR) or co-amplification at lower denaturation temperature PCR (COLD-PCR), and fluorescence melting curve analysis with adjacent hybridization probes were performed for the intraoperative detection of IDH1 and IDH2 mutations in 18 cases of suspected nonneoplastic lesions and low- and high-grade gliomas and in 3 cases of radiation necrosis. Results. DNA extraction for detection of the mutation took 60-65 minutes. The results of this assay showed complete correlation with that of Sanger sequencing. The sensitivity for detection of mutations in a background of wild-type genes was 12.5% and 2.5% in conventional PCR and COLD-PCR, respectively. The diagnosis of glioma was established in 3 of 5 cases in which definitive diagnosis was not obtained using frozen sections, and information was obtained for the discrimination of glioblastoma or glioblastoma with an oligodendroglioma component from anaplastic glioma or secondary glioblastoma. This assay also detected a small fraction of tumor cells with IDH1 mutation in radiation necrosis. Conclusions. These methods provide important information for establishing the differential diagnosis between low-grade glioma and nonneoplastic lesions and the diagnosis for subtypes of high-grade glioma. Although tumor cells in radiation necrosis were detected with a high sensitivity, further investigation is necessary for clinical application in surgery for recurrent glioma.

  228. Recurrent Extracranial Internal Carotid Artery Vasospasm Diagnosed by Serial Magnetic Resonance Angiography and Superselective Transarterial Injection of a Calcium Channel Blocker 査読有り

    Yoshiteru Shimoda, Miki Fujimura, Naoto Kimura, Masayuki Ezura, Hiroshi Uenohara, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 23 (5) E383-E387 2014年5月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.050  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Recurrent vasospasm of the extracranial internal carotid artery (ICA) is extremely rare, and optimal management is unclear. A 25-year-old woman developed transient dysarthria and left-sided hemiparesis. Initial magnetic resonance (MR) imaging showed spotty acute infarction in the right temporal lobe, and MR angiography revealed right ICA occlusion. ICA occlusion was spontaneously resolved within 6 days of its onset, whereas transient left ICA narrowing was evident at 12 days. Because recurrent occlusion of the right ICA occurred at 14 days when the contralateral ICA was still narrowed, we attempted a local intra-arterial injection of a calcium channel blocker based on the diagnosis of recurrent extracranial ICA vasospasm. The local injection of 1 mg of nicardipine partially dilated the affected ICA, which confirmed the diagnosis of vasospasm. After the introduction of oral medication with benidipine hydrochloride, bilateral ICA vasospasm was completely resolved 23 days after its onset, as shown by MR angiography. In conclusion, we recommend intensive radiologic follow-up at the acute stage and therapeutic catheter angiography when the bilateral lesion is evident because bilateral occlusion of the ICA could lead to a catastrophic condition.

  229. Effects of Extracranial-Intracranial Bypass for Patients With Hemorrhagic Moyamoya Disease Results of the Japan Adult Moyamoya Trial 査読有り

    Susumu Miyamoto, Takashi Yoshimoto, Nobuo Hashimoto, Yasushi Okada, Ichiro Tsuji, Teiji Tominaga, Jyoji Nakagawara, Jun C. Takahashi

    STROKE 45 (5) 1415-1421 2014年5月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1161/STROKEAHA.113.004386  

    ISSN:0039-2499

    eISSN:1524-4628

    詳細を見る 詳細を閉じる

    Background and Purpose About one half of those who develop adult-onset moyamoya disease experience intracranial hemorrhage. Despite the extremely high frequency of rebleeding attacks and poor prognosis, measures to prevent rebleeding have not been established. The purpose of this study is to determine whether extracranial-intracranial bypass can reduce incidence of rebleeding and improve patient prognosis. Methods This study was a multicentered, prospective, randomized, controlled trial conducted by 22 institutes in Japan. Adult patients with moyamoya disease who had experienced intracranial hemorrhage within the preceding year were given either conservative care or bilateral extracranial-intracranial direct bypass and were observed for 5 years. Primary and secondary end points were defined as all adverse events and rebleeding attacks, respectively. Results Eighty patients were enrolled (surgical, 42; nonsurgical, 38). Adverse events causing significant morbidity were observed in 6 patients in the surgical group (14.3%) and 13 patients in the nonsurgical group (34.2%). Kaplan-Meier survival analysis revealed significant differences between the 2 groups (3.2%/y versus 8.2%/y; P=0.048). The hazard ratio of the surgical group calculated by Cox regression analysis was 0.391 (95% confidence interval, 0.148-1.029). Rebleeding attacks were observed in 5 patients in the surgical group (11.9%) and 12 in the nonsurgical group (31.6%), significantly different in the Kaplan-Meier survival analysis (2.7%/y versus 7.6%/y; P=0.042). The hazard ratio of the surgical group was 0.355 (95% confidence interval, 0.125-1.009). Conclusions Although statistically marginal, Kaplan-Meier analysis revealed the significant difference between surgical and nonsurgical group, suggesting the preventive effect of direct bypass against rebleeding. Clinical Trial Registration URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: C000000166.

  230. Genetics and Biomarkers of Moyamoya Disease: Significance of RNF213 as a Susceptibility Gene 査読有り

    Miki Fujimura, Shinya Sonobe, Yasuo Nishijima, Kuniyasu Niizuma, Hiroyuki Sakata, Shigeo Kure, Teiji Tominaga

    JOURNAL OF STROKE 16 (2) 65-72 2014年5月

    出版者・発行元:KOREAN STROKE SOC

    DOI: 10.5853/jos.2014.16.2.65  

    ISSN:2287-6391

    eISSN:2287-6405

    詳細を見る 詳細を閉じる

    Moyamoya disease is characterized by a progressive stenosis at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. Although its etiology is still unknown, recent genome-wide and locus-specific association studies identified RNF213 as an important susceptibility gene of moyamoya disease among East Asian population. A polymorphism in c.14576G &gt; A in RNF213 was identified in 95% of familial patients with moyamoya disease and 79% of sporadic cases, and patients having this polymorphism were found to have significantly earlier disease onset and a more severe form of moyamoya disease, such as the presentation of cerebral infarction and posterior cerebral artery stenosis. The exact mechanism by which the RNF213 abnormality relates to moyamoya disease remains unknown, while recent reports using genetically engineered mice lacking RNF213 by homologous recombination provide new insight for the pathogenesis of this rare entity. Regarding biomarkers of moyamoya disease, moyamoya disease is characterized by an increased expression of angiogenic factors and pro-inflammatory molecules such as vascular endothelial growth factors and matrix metalloproteinase-9, which may partly explain its clinical manifestations of the pathologic angiogenesis, spontaneous hemorrhage, and higher incidence of cerebral hyperperfusion after revascularization surgery. More recently, blockade of these pro-inflammatory molecules during perioperative period is attempted to reduce the potential risk of surgical complication including cerebral hyperperfusion syndrome. In this review article, we focus on the genetics and biomarkers of moyamoya disease, and sought to discuss their clinical implication.

  231. Transformation of adult cerebellar pilocytic astrocytoma to glioblastoma 査読有り

    Takashi Sasaki, Ryuta Saito, Toshihiro Kumabe, Masayuki Kanamori, Yukihiko Sonoda, Mika Watanabe, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 31 (2) 108-112 2014年4月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1007/s10014-013-0154-0  

    ISSN:1433-7398

    eISSN:1861-387X

    詳細を見る 詳細を閉じる

    A 54-year-old woman with a past history of uterine cancer developed a tumor in her right cerebellum. Magnetic resonance imaging with contrast enhancement revealed a mass composed of two components, inside and outside, although both components resided in the same high-intensity area on T2-weighted imaging. Surgical resection removed the bulk of the tumor. Pathological examination revealed two distinct pathological features of the tumor-the inner major component had the features of glioblastoma whereas outer minor component had those of pilocytic astrocytoma (PA). These two components occurred with intercalating transitional areas. No genetic differences, including BRAF alteration or IDH mutations, were detected in either component. Activation of Akt, which is reported to be associated with clinically aggressive and anaplastic PA was found in the PA component of this tumor. The transitional area also stained positive, suggesting the continuity of both components. Consequently, the glioblastoma in this case was likely to have developed as a result of malignant transformation of PA. This case provides additional support for the concept of anaplastic transformation of PA.

  232. Preservation of the Long Insular Artery to Prevent Postoperative Motor Deficits after Resection of Insulo-opercular Glioma: Technical Case Reports 査読有り

    Masaki Iwasaki, Toshihiro Kumabe, Ryuta Saito, Masayuki Kanamori, Yoji Yamashita, Yukihiko Sonoda, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 54 (4) 321-326 2014年4月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.cr2012-0361  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Resection of insulo-opercular gliomas carries the risk of postoperative hemiparesis caused by ischemia of the corona radiata resulting from injury to the long insular arteries. However, intraoperative identification of these perforating arteries is challenging. We attempted intra-operative motor evoked potential (MEP) monitoring under temporary occlusion of the suspected long insular artery arising from the opercular portion of middle cerebral artery in two patients with insulo-opercular gliomas. Temporary occlusion of the artery caused decrease in MEP amplitude, which recovered after release in one patient, who had no postoperative motor deficits or ischemic lesion in the corona radiata. Temporary occlusion of the artery caused no changes in MEP amplitude, so that the artery was sacrificed for tumor removal in the other patient, who had no motor deficits but ischemic lesion was present in the corona radiata in the territory of the long insular artery sparing the descending motor pathway. These cases show that great care should be taken during surgical manipulations near the posterior part of the superior limiting sulcus to preserve the perforating branches to the corona radiata, and temporary occlusion of the branches under MEP monitoring is useful to identify the arteries supplying the pyramidal tract.

  233. A Multicenter Phase I/II Study of the BCNU Implant (Gliadel<sup>®</sup> Wafer) for Japanese Patients with Malignant Gliomas. 査読有り

    Aoki T, Nishikawa R, Sugiyama K, Nonoguchi N, Kawabata N, Mishima K, Adachi JI, Kurisu K, Yamasaki F, Tominaga T, Kumabe T, Ueki K, Higuchi F, Yamamoto T, Ishikawa E, Takeshima H, Yamashita S, Arita K, Hirano H, Yamada S, Matsutani M

    Neurologia medico-chirurgica 54 (4) 290-301 2014年4月

    出版者・発行元:None

    DOI: 10.2176/nmc.oa2013-0112  

    ISSN:0470-8105

    eISSN:1349-8029

  234. The Association of Subventricular Zone Involvement at Recurrence with Survival after Repeat Surgery in Patients with Recurrent Glioblastoma 査読有り

    Yukihiko Sonoda, Ryuta Saito, Masayuki Kanamori, Toshihiro Kumabe, Hiroshi Uenohara, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 54 (4) 302-309 2014年4月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.oa.2013-0226  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Surgical resection is identified as an important prognostic factor for survival in patients undergoing initial resection of glioblastoma (GBM). However, in patients with tumor recurrence, the benefits of repeat surgery remain unclear. Recent reports have stated that the association between initial surgery for GBM and subventricular zone (SVZ) influences survival. The current study examined the relationship of SVZ involvement in recurrent GBM to survival time after reoperation. We conducted a retrospective review of 61 consecutive patients who had undergone repeat surgery for recurrent GBM at our institution between 1997 and 2010. Survival after repeat surgery were compared between patients with (n = 29) and without (n = 32) SVZ involvement at recurrence using univariate analysis with known prognostic factors, including sex, age, Karnofsky Performance Status (KPS) score at recurrence, recurrent tumor size, initial SVZ involvement, and adjuvant therapy after repeat surgery, as variables. All 26 SVZ-positive tumors at initial diagnosis recurred as SVZ-positive tumors, while 32 of 35 SVZ-negative tumors at initial diagnosis remained SVZ-negative at recurrence; the remaining three were SVZ-positive at recurrence. Survival after repeat surgery was decreased in patients with recurrent GBM involving the SVZ at recurrence (p = 0.022). No other prognostic factors for survival after repeat surgery were identified in this study. This finding may have prognostic and therapeutic significance.

  235. A multicenter phase I/II study of the BCNU implant (Gliadel(®) Wafer) for Japanese patients with malignant gliomas. 査読有り

    Aoki T, Nishikawa R, Sugiyama K, Nonoguchi N, Kawabata N, Mishima K, Adachi J, Kurisu K, Yamasaki F, Tominaga T, Kumabe T, Ueki K, Higuchi F, Yamamoto T, Ishikawa E, Takeshima H, Yamashita S, Arita K, Hirano H, Yamada S, Matsutani M, N, study group

    Neurologia medico-chirurgica 54 (4) 290-301 2014年4月

    出版者・発行元:None

    DOI: 10.2176/nmc.oa2013-0112  

    ISSN:0470-8105

    eISSN:1349-8029

  236. Spinal dural arteriovenous shunt presenting with intramedullary hemorrhage 査読有り

    Ayumi Narisawa, Toshiki Endo, Kenichi Sato, Mika Watanabe, Akira Takahashi, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-SPINE 20 (3) 322-326 2014年3月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2013.12.SPINE12163  

    ISSN:1547-5654

    eISSN:1547-5646

    詳細を見る 詳細を閉じる

    The authors report on a 49-year-old man with a thoracic spinal dural arteriovenous shunt (dAVS) in which rupture of a varix caused intramedullary hemorrhage. In the literature, patients with a thoracic dAVS predominantly present with congestive myelopathy; however, the patient featured in this report presented without increased deep tendon reflexes or muscle weakness, but instead with intermittent stabbing chest pain and paresthesia. Magnetic resonance images and angiograms demonstrated tortuous enlargement and the formation of a varix-like structure of the draining veins, features compatible with those of high-flow angiopathy. Recognition of this phenomenon is important in thoracic dAVS because intramedullary hemorrhage dramatically degrades outcome. A high index of clinical suspicion can prevent a similar case of thoracic dAVS from progressing to intramedullary hemorrhage.

  237. Temporal profile of the vascular anatomy evaluated by 9.4-T magnetic resonance angiography and histopathological analysis in mice lacking RNF213: A susceptibility gene for moyamoya disease 査読有り

    Shinya Sonobe, Miki Fujimura, Kuniyasu Niizuma, Yasuo Nishijima, Akira Ito, Hiroaki Shimizu, Atsuo Kikuchi, Natsuko Arai-Ichinoi, Shigeo Kure, Teiji Tominaga

    BRAIN RESEARCH 1552 64-71 2014年3月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.brainres.2014.01.011  

    ISSN:0006-8993

    eISSN:1872-6240

    詳細を見る 詳細を閉じる

    Moyamoya disease (MMD) is a chronic occlusive cerebrovascular disease with unknown etiology. Recent genome-wide and locus-specific association studies identified RNF213 as an important MMD susceptibility gene. However, the exact mechanism by which an abnormality in RNF213 leads to MMD is unknown. To evaluate the role of RNF213 in the etiology of MMD, we generated RNF213-deficient mice (RNF213 -/-) by deleting exon 32 of RNF213 by the Cre-lox system, and investigated whether they developed MMD. The temporal profile of cervical/intracranial arteries was evaluated by 9.4-T magnetic resonance angiography (MRA). The anatomy of the circle of Willis was analyzed by a transcardiac injection of carbon black dye. The common carotid arteries (CCA) were sectioned and the arterial wall thickness/thinness was evaluated by Elastica-Masson staining before and after CCA ligation, which selectively induced vascular hyperplasia. As a result, RNF213 -/- grew normally, and no significant difference was observed in MRA findings, the anatomy of the circle of Willis, or vascular wall thickness/thinness between RNF -/- and wild-type littermates (Wt.) under normal conditions until 64 weeks of age. However, Elastica-Masson staining demonstrated that both the intima and medial layer were significantly thinner after CCA ligation in RNF213 -/- than in Wt. after 14 days (P &lt;0.01). In conclusion, mice lacking the RNF213 gene did not spontaneously develop MMD, indicating that a functional loss of RNF213 did not sufficiently induce MMD. Suppression of vascular remodeling in RNF213 -/- requires further examination to clarify the role of RNF213. (c) 2014 Elsevier B.V. All rights reserved.

  238. Cytogenetic Prognostication Within Medulloblastoma Subgroups 査読有り

    David J. H. Shih, Paul A. Northcott, Marc Remke, Andrey Korshunov, Vijay Ramaswamy, Marcel Kool, Betty Luu, Yuan Yao, Xin Wang, Adrian M. Dubuc, Livia Garzia, John Peacock, Stephen C. Mack, Xiaochong Wu, Adi Rolider, A. Sorana Morrissy, Florence M. G. Cavalli, David T. W. Jones, Karel Zitterbart, Claudia C. Faria, Ulrich Schueller, Leos Kren, Toshihiro Kumabe, Teiji Tominaga, Young Shin Ra, Miklos Garami, Peter Hauser, Jennifer A. Chan, Shenandoah Robinson, Laszlo Bognar, Almos Klekner, Ali G. Saad, Linda M. Liau, Steffen Albrecht, Adam Fontebasso, Giuseppe Cinalli, Pasqualino De Antonellis, Massimo Zollo, Michael K. Cooper, Reid C. Thompson, Simon Bailey, Janet C. Lindsey, Concezio Di Rocco, Luca Massimi, Erna M. C. Michiels, Stephen W. Scherer, Joanna J. Phillips, Nalin Gupta, Xing Fan, Karin M. Muraszko, Rajeev Vibhakar, Charles G. Eberhart, Maryam Fouladi, Boleslaw Lach, Shin Jung, Robert J. Wechsler-Reya, Michelle Fevre-Montange, Anne Jouvet, Nada Jabado, Ian F. Pollack, William A. Weiss, Ji-Yeoun Lee, Byung-Kyu Cho, Seung-Ki Kim, Kyu-Chang Wang, Jeffrey R. Leonard, Joshua B. Rubin, Carmen de Torres, Cinzia Lavarino, Jaume Mora, Yoon-Jae Cho, Uri Tabori, James M. Olson, Amar Gajjar, Roger J. Packer, Stefan Rutkowski, Scott L. Pomeroy, Pim J. French, Nanne K. Kloosterhof, Johan M. Kros, Erwin G. Van Meir, Steven C. Clifford, Franck Bourdeaut, Olivier Delattre, Francois F. Doz, Cynthia E. Hawkins, David Malkin, Wieslawa A. Grajkowska, Marta Perek-Polnik, Eric Bouffet, James T. Rutka, Stefan M. Pfister, Michael D. Taylor

    JOURNAL OF CLINICAL ONCOLOGY 32 (9) 886-+ 2014年3月

    出版者・発行元:AMER SOC CLINICAL ONCOLOGY

    DOI: 10.1200/JCO.2013.50.9539  

    ISSN:0732-183X

    eISSN:1527-7755

    詳細を見る 詳細を閉じる

    Purpose Medulloblastoma comprises four distinct molecular subgroups: WNT, SHH, Group 3, and Group 4. Current medulloblastoma protocols stratify patients based on clinical features: patient age, metastatic stage, extent of resection, and histologic variant. Stark prognostic and genetic differences among the four subgroups suggest that subgroup-specific molecular biomarkers could improve patient prognostication. Patients and Methods Molecular biomarkers were identified from a discovery set of 673 medulloblastomas from 43 cities around the world. Combined risk stratification models were designed based on clinical and cytogenetic biomarkers identified by multivariable Cox proportional hazards analyses. Identified biomarkers were tested using fluorescent in situ hybridization (FISH) on a nonoverlapping medulloblastoma tissue microarray (n = 453), with subsequent validation of the risk stratification models. Results Subgroup information improves the predictive accuracy of a multivariable survival model compared with clinical biomarkers alone. Most previously published cytogenetic biomarkers are only prognostic within a single medulloblastoma subgroup. Profiling six FISH biomarkers (GLI2, MYC, chromosome 11 [chr11], chr14, 17p, and 17q) on formalin-fixed paraffin-embedded tissues, we can reliably and reproducibly identify very low-risk and very high-risk patients within SHH, Group 3, and Group 4 medulloblastomas. Conclusion Combining subgroup and cytogenetic biomarkers with established clinical biomarkers substantially improves patient prognostication, even in the context of heterogeneous clinical therapies. The prognostic significance of most molecular biomarkers is restricted to a specific subgroup. We have identified a small panel of cytogenetic biomarkers that reliably identifies very high-risk and very low-risk groups of patients, making it an excellent tool for selecting patients for therapy intensification and therapy de-escalation in future clinical trials.

  239. A Prospective, Multicenter, Randomized Study of the Efficacy of Eicosapentaenoic Acid for Cerebral Vasospasm: The EVAS Study 査読有り

    Hiroshi Yoneda, Satoshi Shirao, Jyoji Nakagawara, Kuniaki Ogasawara, Teiji Tominaga, Michiyasu Suzuki

    WORLD NEUROSURGERY 81 (2) 309-315 2014年2月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.wneu.2012.09.020  

    ISSN:1878-8750

    eISSN:1878-8769

    詳細を見る 詳細を閉じる

    OBJECTIVE: The sphingosylphosphorylcholine-Rho-kinase pathway plays an important role in Ca2+ sensitization of vascular smooth muscle contraction. Eicosapentaenoic acid (EPA) inhibits sphingosylphosphorylcholine -Rho-kinase-activated Ca2+-sensitization in vitro and in subarachnoid hemorrhage (SAH) models in vivo and has also been shown to inhibit the occurrence of cerebral vasospasm (CIV) after the onset of SAH in a prospective, nonrandomized study. The current prospective, multicenter, randomized study was performed to confirm the preventive effects of EPA on CIV in patients with SAH. METHODS: The trial population comprised 162 patients who underwent surgical clipping within 72 hours of the onset of SAH. Of these patients, 81 received 2700 mg/day EPA from the day after surgery until day 30 (EPA group), and 81 did not receive EPA (control group). The primary end point was the occurrence of symptomatic vasospasm (SV) or cerebral infarction caused by CIV. RESULTS: The occurrences of SV (15% vs. 30%; P = 0.022) and CIV (7% vs. 21%; P = 0.012) were lower in the EPA group. Multivariate analysis revealed an adjusted odds ratio of 0.39 (95% confidence interval, 0.17-0.89; P = 0.028) for SV inhibition by EPA and 0.27 (95% confidence interval, 0.09-0.72; P = 0.012) for CIV inhibition. CONCLUSIONS: These results indicate that oral EPA reduces the frequency of SV and CIV after the onset of aneurysmal SAH.

  240. Minocycline Prevents Focal Neurological Deterioration Due to Cerebral Hyperperfusion After Extracranial-Intracranial Bypass for Moyamoya Disease 査読有り

    Miki Fujimura, Kuniyasu Niizuma, Takashi Inoue, Kenichi Sato, Hidenori Endo, Hiroaki Shimizu, Teiji Tominaga

    NEUROSURGERY 74 (2) 163-170 2014年2月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1227/NEU.0000000000000238  

    ISSN:0148-396X

    eISSN:1524-4040

    詳細を見る 詳細を閉じる

    BACKGROUND:Cerebral hyperperfusion (CHP) is a potential complication of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease (MMD), and optimal postoperative management has not yet been established. Minocycline, a neuroprotective antibiotic agent, plays a role in blocking matrix metalloproteinase 9 (MMP-9), which contributes to edema formation and hemorrhagic conversion after cerebral ischemia-reperfusion. Patients with MMD have been shown to have increased serum MMP-9 levels.OBJECTIVE:To examine the effect of minocycline on the prevention of postoperative CHP after STA-MCA anastomosis for MMD.METHODS:N-isopropyl-p-[I-123]iodoamphetamine single-photon emission computed tomography was performed 1 and 7 days after STA-MCA anastomosis on 109 hemispheres in 86 consecutive patients with MMD (ages, 9-69 years; mean, 37.2 years). Postoperative systolic blood pressure was strictly maintained at lower than 130 mm Hg in all 109 surgeries. The most 60 recent hemispheres were managed by the intraoperative and postoperative intravenous administration of minocycline hydrochloride (200 mg/d). The incidence of focal neurological deterioration (FND) due to CHP was then compared with that in 36 patients undergoing 49 surgeries managed without minocycline.RESULTS:FND due to CHP was observed in 4 operated hemispheres in patients treated without minocycline (4/49, 8.16%), and in none in the minocycline-treated group (0/60) (P = .0241). Multivariate analysis revealed that minocycline administration (P &lt; .001), surgery on the left hemisphere (P = .031), and a smaller recipient artery diameter (P &lt; .001) significantly correlated with FND due to CHP.CONCLUSION:The administration of minocycline with strict blood pressure control may represent secure and effective postoperative management to prevent symptomatic CHP after STA-MCA anastomosis for MMD.ABBREVIATIONS:CBF, cerebral blood flowCHP, cerebral hyperperfusionEC-IC, extracranial-intracranialEDMS, encephaloduromyosynangiosisFND, focal neurological deterioration(123)I-IMP-SPECT,N-isopropyl-p-[I-123]iodoamphetamine single-photon emission computed tomographyMCA, middle cerebral arteryMMD, moyamoya diseaseMMP-9, matrix metalloproteinase 9MRA, magnetic resonance angiographySPECT, single-photon emission computed tomographySTA-MCA, superficial temporal artery-middle cerebral artery

  241. A Ruptured Aneurysm Arising at the Leptomeningeal Collateral Circulation from the Extracranial Vertebral Artery to the Posterior Inferior Cerebellar Artery Associated with Bilateral Vertebral Artery Occlusion 査読有り

    Masashi Chonan, Shinjitu Nishimura, Naoto Kimura, Masayuki Ezura, Hiroshi Uenohara, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 23 (2) E135-E139 2014年2月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2013.08.028  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    We report an extremely rare case of a small ruptured aneurysm of the leptomeningeal collateral circulation from the vertebral artery (VA) to the posterior inferior cerebellar artery (PICA); this aneurysm was associated with bilateral VA occlusion. A 72-year-old woman with sudden headache, nausea, and subarachnoid hemorrhage (SAH) was admitted to our hospital. On admission, no evidence of cerebral signs or cranial nerve palsy was found. Computed tomography imaging showed SAH predominantly in the posterior fossa, and digital subtraction angiography revealed bilateral VA occlusion and the left VA aneurysm located proximal to the VA union. In addition, a small aneurysm was observed at the leptomeningeal collateral circulation located between the extracranial left VA and the left PICA. The patient underwent radical surgery on the day of the onset of the symptoms associated with SAH. However, the VA aneurysm was unruptured and surgically trapped. The small aneurysm arising at the leptomeningeal collateral circulation was ruptured during the surgery and was electrocoagulated; the collateral circulation was preserved, and no neurologic deficits were observed. The postoperative course was uneventful. SAH with the occlusion of major vessels should be diagnosed with utmost caution to allow preoperative neurologic and radiological assessments.

  242. Cognard type V intracranial dural arteriovenous shunt: case reports and literature review with special consideration of the pattern of spinal venous drainage. 査読有り

    Haryu S, Endo T, Sato K, Inoue T, Takahashi A, Tominaga T

    Neurosurgery 74 (1) E135-42; discussion E142 2014年1月

    DOI: 10.1227/NEU.0000000000000069  

    ISSN:0148-396X

  243. Angiographic circulation time and cerebral blood flow during balloon test occlusion of the internal carotid artery 査読有り

    Kenichi Sato, Hiroaki Shimizu, Takashi Inoue, Miki Fujimura, Yasushi Matsumoto, Ryushi Kondo, Hidenori Endo, Yukihiko Sonoda, Teiji Tominaga

    JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM 34 (1) 136-143 2014年1月

    出版者・発行元:NATURE PUBLISHING GROUP

    DOI: 10.1038/jcbfm.2013.176  

    ISSN:0271-678X

    eISSN:1559-7016

    詳細を見る 詳細を閉じる

    Angiography-based balloon test occlusion (BTO) has been empirically used to predict tolerance to permanent carotid artery occlusion. We tested the hypothesis that the laterality of the hemispheric circulation time (HCT) of the contrast medium at cerebral angiography would reflect bilateral asymmetry of the cerebral blood flow (CBF) during BTO. Thirty-one consecutive patients who underwent BTO of the internal carotid artery were retrospectively analyzed. HCT was defined as the interval between the time-to-peak in the middle cerebral artery and the cortical veins calculated using time-density curve. The difference in HCT between the occluded and nonoccluded side was calculated at the carotid or dominant vertebral angiograms obtained during BTO. We estimated the correlation between the difference in HCT and bilateral asymmetry of the CBF, which was quantitatively determined by single-photon emission computed tomography. The HCT was 5.3 +/- 1.5 seconds and regional CBF was 41.3 +/- 11.3 mL/100 g per minute in the occluded side, compared with 3.6 +/- 0.9 seconds and 48.4 +/- 14.9 mL/100 g per minute in the nonoccluded side, respectively. The difference in HCT was strongly correlated with the asymmetry ratio of the CBF (r(2) = 0.89, P &lt; 0.0001). Angiographically based measurement of the cerebral circulation time can provide valuable information concerning cerebral hemodynamics.

  244. Treatment outcomes in glioblastoma patients aged 76 years or older: a multicenter retrospective cohort study 査読有り

    Takeo Uzuka, Kenichiro Asano, Toshio Sasajima, Kaori Sakurada, Toshihiro Kumabe, Takaaki Beppu, Masahiro Ichikawa, Chifumi Kitanaka, Hiroshi Aoki, Kiyoshi Saito, Kuniaki Ogasawara, Teiji Tominaga, Kazuo Mizoi, Hiroki Ohkuma, Yukihiko Fujii, Takamasa Kayama

    JOURNAL OF NEURO-ONCOLOGY 116 (2) 299-306 2014年1月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s11060-013-1291-3  

    ISSN:0167-594X

    eISSN:1573-7373

    詳細を見る 詳細を閉じる

    Age is one of the most important prognostic factors in glioblastoma patients, but no standard treatment has been established for elderly patients with this condition. We therefore conducted a retrospective cohort study to evaluate treatment regimens and outcomes in elderly glioblastoma patients. The study population consisted of 79 glioblastoma patients aged a parts per thousand yen76 years (median age 78.0 years; 34 men and 45 women). The median preoperative Karnofsky performance status (KPS) score was 60. Surgical procedures were classified as biopsy (31 patients, 39.2 %), &lt; 95 % resection of the tumor (21 patients, 26.9 %), and a parts per thousand yen95 % resection of the tumor (26 patients, 33.3 %). Sixty-seven patients (81.0 %) received radiotherapy and 45 patients (57.0 %) received chemotherapy. The median overall progression-free survival time was 6.8 months, and the median overall survival time was 9.8 months. Patients aged a parts per thousand yen78 years were significantly less likely to receive radiotherapy (p = 0.004). Patients with a postoperative KPS score of a parts per thousand yen60 were significantly more likely to receive maintenance chemotherapy (p = 0.008). Multivariate analyses identified two independent prognostic factors: postoperative KPS score a parts per thousand yen60 (hazard ratio [HR] = 0.531, 95 % confidence interval [CI] 0.315-0.894, p = 0.017) and temozolomide therapy (HR = 0.442, 95 % CI 0.25-0.784, p &lt; 0.001).The findings of this study suggest that postoperative KPS score is an important prognostic factor for glioblastoma patients aged a parts per thousand yen76 years, and that these patients may benefit from temozolomide therapy.

  245. Early response to chemotherapy as an indicator for the management of germinoma-like tumors of the pineal and/or suprasellar regions 査読有り

    Ryuta Saito, Toshihiro Kumabe, Masayuki Kanamori, Yukihiko Sonoda, Mika Watanabe, Shunji Mugikura, Shoki Takahashi, Teiji Tominaga

    JOURNAL OF CLINICAL NEUROSCIENCE 21 (1) 124-130 2014年1月

    出版者・発行元:ELSEVIER SCI LTD

    DOI: 10.1016/j.jocn.2013.05.014  

    ISSN:0967-5868

    eISSN:1532-2653

    詳細を見る 詳細を閉じる

    Recent advances in diagnostic imaging and experience with germinomas may allow for the differentiation of central nervous system germinomas from other tumors based on clinical information, without histological verification. We retrospectively analyzed clinically diagnosed germinoma-like tumors of the pineal and/or suprasellar regions. This was done to evaluate the efficacy of our strategy of defining germinoma-compatible tumors based on good responses to initial. chemotherapy. The responses to chemotherapy and survival of 34 consecutive patients with germinoma-like tumors who underwent initial treatment from July 2001 to October 2010 were analyzed. The minimum apparent diffusion coefficient (minADC) value and proton magnetic resonance spectroscopy (MRS) were evaluated in recent patients. Twelve patients with histologically verified germinomas and 18 with germinoma-compatible tumors showed early logarithmic decreases in tumor volume in response to initial chemotherapy, typical low minADC values and typical MRS characteristics, including increased choline/creatine ratios, decreased N-acetylasparate/creatine ratios, and large lipid peaks. These patients had good progression-free survival. The other four patients, with histologically verified non-germinomas, showed no response to chemotherapy, and one patient with a pineoblastoma showed a similar minADC value and MRS characteristics to those of patients with germinomas. The response to initial chemotherapy can be used to distinguish germinoma-compatible tumors from non-germinoma in patients with germinoma-like tumors of the pineal and/or suprasellar regions. The evaluation of minADC and proton MRS are useful for distinguishing germinomas from other tumors. However, a subset of non-germinomas may show similar characteristics to germinomas. The benefit of bypassing unnecessary surgical intervention can be achieved, at least in Asian populations with a high incidence of germinomas. (C) 2013 Elsevier Ltd. All rights reserved.

  246. Concentration rather than dose defines the local brain toxicity of agents that are effectively distributed by convection-enhanced delivery 査読有り

    Rong Zhang, Ryuta Saito, Yui Mano, Masayuki Kanamori, Yukihiko Sonoda, Toshihiro Kumabe, Teiji Tominaga

    JOURNAL OF NEUROSCIENCE METHODS 222 131-137 2014年1月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jneumeth.2013.11.004  

    ISSN:0165-0270

    eISSN:1872-678X

    詳細を見る 詳細を閉じる

    Background: Convection-enhanced delivery (CED) has been developed as a potentially effective drug-delivery strategy into the central nervous system. In contrast to systemic intravenous administration, local delivery achieves high concentration and prolonged retention in the local tissue, with increased chance of local toxicity, especially with toxic agents such as chemotherapeutic agents. Therefore, the factors that affect local toxicity should be extensively studied. New method: With the assumption that concentration-oriented evaluation of toxicity is important for local CED, we evaluated the appearance of local toxicity among different agents after delivery with CED and studied if it is dose dependent or concentration dependent. Results: Local toxicity profile of chemotherapeutic agents delivered via CED indicates BCNU was dose-dependent, whereas that of ACNU was concentration-dependent. On the other hand, local toxicity for doxorubicin, which is not distributed effectively by CED, was dose-dependent. Local toxicity for PLD, which is extensively distributed by CED, was concentration-dependent. Comparison with existing method: Traditional evaluation of drug induced toxicity was dose-oriented. This is true for systemic intravascular delivery. However, with local CED, toxicity of several drugs exacerbated in concentration-dependent manner. From our study, local toxicity of drugs that are likely to distribute effectively tended to be concentration-dependent. Conclusion: Concentration rather than dose may be more important for the toxicity of agents that are effectively distributed by CEO. Concentration-oriented evaluation of toxicity is more important for CED. (C) 2013 Elsevier B.V. All rights reserved.

  247. Reliability of telecommunications systems following a major disaster: Survey of secondary and tertiary emergency institutions in miyagi prefecture during the acute phase of the 2011 Great East Japan Earthquake 査読有り

    Daisuke Kudo, Hajime Furukawa, Atsuhiro Nakagawa, Yoshiko Abe, Toshikatsu Washio, Tatsuhiko Arafune, Dai Sato, Satoshi Yamanouchi, Sae Ochi, Teiji Tominaga, Shigeki Kushimoto

    Prehospital and Disaster Medicine 29 (2) 204-208 2014年

    出版者・発行元:Cambridge University Press

    DOI: 10.1017/S1049023X14000119  

    ISSN:1945-1938 1049-023X

    eISSN:1945-1938

    詳細を見る 詳細を閉じる

    Introduction Telecommunication systems are important for sharing information among health institutions to successfully provide medical response following disasters. Hypothesis/Problem The aim of this study was to clarify the problems associated with telecommunication systems in the acute phase of the Great East Japan Earthquake (March 11, 2011). Methods All 72 of the secondary and tertiary emergency hospitals in Miyagi Prefecture were surveyed to evaluate the telecommunication systems in use during the 2011 Great Japan Earthquake, including satellite mobile phones, multi-channel access (MCA) wireless systems, mobile phones, Personal Handy-phone Systems (PHS), fixed-line phones, and the Internet. Hospitals were asked whether the telecommunication systems functioned correctly during the first four days after the earthquake, and, if not, to identify the cause of the malfunction. Each telecommunication system was considered to function correctly if the hospital staff could communicate at least once in every three calls. Results Valid responses were received from 53 hospitals (73.6%). Satellite mobile phones functioned correctly at the highest proportion of the equipped hospitals, 71.4%, even on Day 0. The MCA wireless system functioned correctly at the second highest proportion of the equipped hospitals. The systems functioned correctly at 72.0% on Day 0 and at 64.0% during Day 1 through Day 3. The main cause of malfunction of the MCA wireless systems was damage to the base station or communication lines (66.7%). Ordinary (personal or general communication systems) mobile phones did not function correctly at any hospital until Day 2, and PHS, fixed-line phones, and the Internet did not function correctly at any area hospitals that were severely damaged by the tsunami. Even in mildly damaged areas, these systems functioned correctly at &lt 40% of the hospitals during the first three days. The main causes of malfunction were a lack of electricity (mobile phones, 25.6% the Internet, 54.8%) and damage to the base stations or communication lines (the Internet, 38.1% mobile phones, 56.4%). Conclusion Results suggest that satellite mobile phones and MCA wireless systems are relatively reliable and ordinary systems are less reliable in the acute period of a major disaster. It is important to distribute reliable disaster communication equipment to hospitals and plan for situations in which hospital telecommunications systems do not function.

  248. Post-purchase reassessment and improvement of neuroendoscope holder: Importance of physician-manufacturer communication 査読有り

    Yoshikazu Ogawa, Yusuke Nakata, Teiji Tominaga

    TECHNOLOGY AND HEALTH CARE 22 (2) 297-301 2014年

    出版者・発行元:IOS PRESS

    DOI: 10.3233/THC-140781  

    ISSN:0928-7329

    eISSN:1878-7401

    詳細を見る 詳細を閉じる

    BACKGROUND: Modern medical management requires constant quality improvement of the various instruments used for surgical procedures. Higher quality, less complicated handling, and reduced maintenance are all desirable qualities. However, any improvements in instrumentation require that surgeons must clearly understand the application of the device by adherence to the manufacturer's instructions. The weakness of this one-way information flow depends on the low interest among medical personnel for post-purchase reassessment. OBJECTIVE: Service industries have research departments to investigate the post-purchase behavior of customers, and service recovery is considered essential to retain customers after service failure. All service providers can suffer service failures, and even the best providers may make errors in delivering service. Such an approach has been increasingly adopted in the risk management at medical institutions. METHODS: We report our clinical trials of the post-purchase reassessment and product improvement of surgical instrumentation. Medical personnel reassessed the use of a newly developed endoscope holder based on the manufacturer's manual and made recommendations for possible improvements, which were examined by the manufacturer. RESULTS: Simple but important improvement was achieved for reducing the instability and uncertainty of instrument fixation. CONCLUSION: This bi-directional post-purchase communication between medical personnel and manufacturers can improve risk management in medical institutions.

  249. Hyponatremia caused by siadh following endoscopic third ventriculostomy: A case report 査読有り

    Ryota Shigeeda, Hidenori Endo, Miki Fujimura, Yoshikazu Ogawa, Hiroaki Shimizu, Teiji Tominaga

    Neurological Surgery 42 (4) 335-339 2014年

    出版者・発行元:Igaku-Shoin Ltd

    ISSN:1882-1251 0301-2603

    eISSN:1882-1251

    詳細を見る 詳細を閉じる

    A 25-year-old man complained of disorientation and gait disturbance during the past 2 weeks. The patient had been treated for cerebellar astrocytoma by open surgery thrice, at ages 3, 5, and 11. Ventriculo-peritoneal shunt was performed for postoperative hydrocephalus at the age of 11. Magnetic resonance imaging (MRI) showed enlargement of both lateral ventricles, ballooning of the third ventricle, and obstruction of the aqueduct of Sylvius. The patient was diagnosed with recurrent hydrocephalus due to shunt malfunction, and treated by endoscopic third ventriculostomy (ETV) using a flexible endoscopic system. He was relieved of the symptoms immediately after surgery, and postoperative MRI showed reduced hydrocephalus. However, the symptoms reoccurred 6 days after surgery. Computed tomography did not show recurrence of hydrocephalus. Laboratory tests revealed hyponatremia (117 mEq/L) and low serum osmolality (240 mOsm/kg). The patient gained 2.4 kg over the preoperative body weight. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was considered to be the cause of the hyponatremia, which was successfully treated with 3 days of fluid restriction. The patient was discharged 24 days after surgery. Hyponatremia is a relatively rare complication of ETV. When a patient shows recurrence of hydrocephalus-related symptoms during the early postoperative period after ETV, hyponatremia caused by SIADH should be considered.

  250. Cardiopulmonary complication as a pitfall of the perioperative management of moyamoya syndrome with atherosclerosis: Conflict to counteract with cerebral hyperperfusion 査読有り

    Hiroyuki Sakata, Miki Fujimura, Kenichi Sato, Hiroaki Shimizu, Teiji Tominaga

    Neurological Surgery 42 (8) 737-743 2014年

    出版者・発行元:Igaku-Shoin Ltd

    ISSN:1882-1251 0301-2603

    eISSN:1882-1251

    詳細を見る 詳細を閉じる

    A 42-year-old man with a history of hypertension and obesity presented with transient dysesthesia in his left upper and lower extremities and was found to have moyamoya syndrome associated with atherosclerosis. He underwent superficial temporal artery-middle cerebral artery anastomosis with pial synangiosis in the right hemisphere 1 month after the onset of symptoms. Prophylactic blood pressure lowering (&lt 130 mmHg) as well as minocycline administration was introduced immediately after surgery to prevent symptomatic cerebral hyperperfusion, but he developed pulmonary edema due to congestive heart failure several hours after surgery. We subsequently allowed his systolic blood pressure to be under 140 mmHg, which dramatically improved his cardiopulmonary condition. The neurologic status of the patient was unremarkable, but 123I-IMP-SPECT the day after surgery demonstrated an intense increase in the cerebral blood flow at the site of the anastomosis. Moreover, postoperative magnetic resonance angiography demonstrated the bypass as thick, high signal. Together, these results led us to the diagnosis of cerebral hyperperfusion. The patient did not demonstrate any neurological sign during the entire perioperative period, but CT scan performed 7 days after surgery revealed a delayed intra-cerebral hemorrhage in the right temporal lobe due to the cerebral hyperperfusion. We continued to mildly lower his blood pressure, and neither ischemic nor hemorrhagic events were subsequently observed he was discharged without neurological deficit 2 weeks after surgery. In conclusion, congestive heart failure and pulmonary edema are potential complications of the perioperative management of moyamoya syndrome with atherosclerotic background. Moreover, cardiopulmonary complications should be mentioned as a potential pitfall of the intensive perioperative management of moyamoya disease to counteract with cerebral hyperperfusion.

  251. The Dissection Profile and Mechanism of Tissue-Selective Dissection of the Piezo Actuator-Driven Pulsed Water Jet as a Surgical Instrument: Laboratory Investigation Using Swine Liver 査読有り

    Masato Yamada, Toru Nakano, Chiaki Sato, Atsuhiro Nakagawa, Fumiyoshi Fujishima, Naoki Kawagishi, Chikashi Nakanishi, Tadashi Sakurai, Go Miyata, Teiji Tominaga, Noriaki Ohuchi

    EUROPEAN SURGICAL RESEARCH 53 (1-4) 61-72 2014年

    出版者・発行元:KARGER

    DOI: 10.1159/000365288  

    ISSN:0014-312X

    eISSN:1421-9921

    詳細を見る 詳細を閉じる

    Background/Purpose: The water jet technique dissects tissue while sparing cord-like structures such as blood vessels. The mechanism of such tissue-selective dissection has been unknown. The novel piezo actuator-driven pulsed water jet (ADPJ) system can achieve dissection with remarkably reduced water consumption compared to the conventional water jet; however, the system's characteristics and dissection capabilities on any organ have not been clarified. The purposes of this study were to characterize the physical properties of the novel ADPJ system, evaluate the dissection ability in swine organs, and reveal the mechanism of tissue-selective dissection. Methods: The pulsed water jet system comprised a pump chamber driven by a piezo actuator, a stainless steel tube, and a nozzle. The peak pressure of the pulsed water jet was measured through a sensing hole using a pressure sensor. The pulsed water jet technique was applied on swine liver in order to dissect tissue on a moving table using one-way linear ejection at a constant speed. The dissection depth was measured with light microscopy and evaluated histologically. The physical properties of swine liver were evaluated by breaking strength tests using tabletop universal testing instruments. The liver parenchyma was also cut with three currently available surgical devices to compare the histological findings. Results: The peak pressure of the pulsed water jet positively correlated with the input voltage ( R-2 = 0.9982, p &lt; 0.0001), and this was reflected in the dissection depth. The dissection depth negatively correlated with the breaking strength of the liver parenchyma (R-2 = 0.6694, p &lt; 0.0001). The average breaking strengths of the liver parenchyma, hepatic veins, and Glisson's sheaths were 1.41 +/- 0.45, 8.66 +/- 1.70, and 29.6 +/- 11.0 MPa, respectively. The breaking strength of the liver parenchyma was significantly lower than that of the hepatic veins and Glisson's sheaths. Histological staining confirmed that the liver parenchyma was selectively dissected, preserving the hepatic veins and Glisson's sheaths in contrast to what is commonly observed with electrocautery or ultrasonic instruments. Conclusions: The dissection depth of liver tissue is well controlled by input voltage and is influenced by the moving velocity and the physical properties of the organ. We showed that the device can be used to assure liver resection with tissue selectivity due to tissue-specific physical properties. Although this study uses an excised organ, further in vivo studies are necessary. The present work demonstrates that this device may function as an alternative tool for surgery due to its good controllability of the dissection depth and ability of tissue selectivity. (C) 2014 S. Karger AG, Basel

  252. Autoimmune hypophysitis presenting with intracranial multi-organ involvement: Three case reports and review of the literature 査読有り

    Atsushi Kanoke, Yoshikazu Ogawa, Mika Watanabe, Toshihiro Kumabe, Teiji Tominaga

    BMC Research Notes 6 (1) 560 2013年12月28日

    DOI: 10.1186/1756-0500-6-560  

    ISSN:1756-0500

    詳細を見る 詳細を閉じる

    Background: Autoimmune hypophysitis very rarely spreads to nearby organs outside the pituitary tissue, for unknown reasons, with only 5 reported cases of hypophysitis spreading over the cavernous sinus. Case presentation. Three patients presented with cases of non-infectious hypophysitis spreading outside the pituitary tissue over the cavernous sinus. All three cases were diagnosed with histological confirmation by transsphenoidal surgery, and the patients showed remarkable improvement with postoperative pulse dose steroid therapy, including disappearance of abnormal signal intensities in the bilateral hypothalami on magnetic resonance imaging, resolution of severe stenosis of the internal carotid artery, and normalization of swollen pituitary tissues. Two of 3 cases fulfilled the histological criteria of immunoglobulin G4-related disease, although none of the patients had high serum immunoglobulin G4 level. Conclusion: The true implications of such unusual spreading of hypophysitis to nearby organs are not fully understood, but the mechanism of occurrence might vary according to the timing of inflammation in this unusual mode of spreading. Pulse dose steroid therapy achieved remarkably good outcomes even in the patient with progressive severe stenosis of the internal carotid artery and rapid visual deterioration. © 2013 Kanoke et al. licensee BioMed Central Ltd.

  253. Compression neuropathy caused by cancer metastasis to the optic nerve canal 査読有り

    Hiroshi Tamai, Kazuyuki Ishida, Kensuke Murakami, Norio Narita, Teiji Tominaga, Nobuo Fuse

    BMC Research Notes 6 (1) 546 2013年12月20日

    DOI: 10.1186/1756-0500-6-546  

    ISSN:1756-0500

    詳細を見る 詳細を閉じる

    Background: Cancerous cells are known to metastasize to different ocular structures. This happens especially to the choroid in males with lung cancer and females with breast cancer. However, we observed two cases of cancerous metastasis to the optic canal region. Both cases showed only a progressive decrease in vision without any other remarkable ophthalmological symptoms or abnormalities in the affected eye. Case presentation. Two females, a 60-year-old and a 73-year-old, came to our hospital because of progressive loss of vision. These patients showed no remarkable symptoms or signs in their eyes except visual acuity loss. Several ophthalmoscopic examinations, such as slit lamp microscopy and fundoscopy, showed no abnormal changes in their affected eye but magnetic resonance imaging indicated a massive legion around the optic nerve. Conclusion: It is possible for cancer to metastasize to the optic canal region and the existence of primary tumors should be considered. © 2013 Tamai et al. licensee BioMed Central Ltd.

  254. Surgical Treatment of Spinal Extradural Arteriovenous Fistula With Parenchymal Drainage: Report on 5 Cases 査読有り

    Kuniyasu Niizuma, Toshiki Endo, Kenichi Sato, Shihomi Takada, Takayuki Sugawara, Shigeki Mikawa, Teiji Tominaga

    NEUROSURGERY 73 (2 Suppl Operative) E287-E293 2013年12月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1227/NEU.0000000000000189  

    ISSN:0148-396X

    eISSN:1524-4040

    詳細を見る 詳細を閉じる

    BACKGROUND AND IMPORTANCE: Spinal extradural arteriovenous fistula (SEDAVF) with parenchymal drainage (type A) is a rare clinical entity that causes venous congestive myelopathy. Treatment includes endovascular and open microsurgical interventions. We reviewed the clinical records of patients treated for a type A SEDAVF to evaluate the feasibility of our treatment strategy. CLINICAL PRESENTATION: Between 2004 and 2010, 5 patients with a type A SEDAVF were treated at our institutes (4 men and 1 woman; mean age, 60 years). We performed endovascular transvenous embolization (TVE) when lesions were accessible transvenously; otherwise, microsurgical perimedullary drainer occlusion was performed. Follow-up ranged from 23 to 94 months (mean, 45.8 months). One patient was treated with TVE, and the remaining 4 were treated with microsurgical drainer occlusion. After a simple intradural drainer occlusion, an epidural venous lake was completely thrombosed in 2 patients. In 1 patient, postoperative angiography revealed that a part of the epidural component had persisted; however, the patient has been asymptomatic. In the remaining case with multiple intradural draining veins, sole drainer occlusion was not sufficient. A second surgery was required to meticulously coagulate the venous lake. As a consequence, parenchymal drainers disappeared. Overall, all patients stabilized or improved neurologically and experienced no recurrence. CONCLUSION: To treat a type A SEDAVF, either TVE or microsurgical intradural drainer occlusion can be used for satisfactory long-term results with minimal surgical risks. For a case with multiple intradural draining veins, detachment of the venous lake should be considered.

  255. Signal changes on T2*-weighted magnetic resonance imaging from the acute to chronic phases in patients with subarachnoid hemorrhage 査読有り

    Takashi Inoue, Shihomi Takada, Hiroaki Shimizu, Kuniyasu Niizuma, Miki Fujimura, Kenichi Sato, Hidenori Endo, Teiji Tominaga

    Cerebrovascular Diseases 36 (5-6) 421-429 2013年12月

    DOI: 10.1159/000355897  

    ISSN:1015-9770 1421-9786

    eISSN:1421-9786

    詳細を見る 詳細を閉じる

    Background: Timing of the onset of subarachnoid hemorrhage (SAH) is important for treatment decision-making, especially as some patients visit hospital several weeks after the onset of SAH. T2*-weighted (T2*W) magnetic resonance (MR) imaging is regarded as a sensitive method for the detection of deoxyhemoglobin or hemosiderin deposits. This study investigated the characteristics of the abnormal low intensity changes on T2*W imaging in patients with SAH, how long the abnormal low intensity persisted, and whether the day of onset could be predicted based on the T2*W imaging changes. Methods: The study included patients treated for SAH associated with ruptured cerebral aneurysms, or who had previously suffered such SAH and were followed up at our hospital, between 2006 and 2007. MR imaging was performed using a whole-body 3.0-tesla MR scanner. All patients underwent gradient recalled echo (GRE) and echo planar (EP) T2*W imaging. The strength of the low intensity areas was evaluated as the following 5 grades: grade 0, no abnormal low intensity on both GRE and EP T2*W images grade 1, no abnormal intensity on GRE T2*W images and low intensity on EP T2*W images grade 2, spotty abnormal low intensity on both GRE and EP T2*W images grade 3, medium abnormal low intensity (&lt 5 mm) on both GRE and EP T2*W images, and grade 4, large abnormal low intensity (≥5 mm) on both GRE and EP T2*W images. Results: A total of 50 patients with 74 MR images were included during the study period. Abnormal low intensity on T2*W imaging was observed in all patients. The T2* score gradually decreased from the onset of SAH until day 90, showing a significant negative linear correlation (R2 = 0.25, p = 0.0002). On the other hand, the T2* score did not change after 1 year. The square correlation coefficient between the recorded and calculated days from the onset of SAH was 0.29 (p = 0.0107). The pure error was ±10 days. Conclusion: The T2* score gradually decreased until 90 days from the onset of SAH, but persisted for 16 years after the onset. We could predict the day of onset with pure error ±10 days in patients with SAH within 90 days of onset using our grading system for T2*W images. © 2013 S. Karger AG, Basel.

  256. Successful treatment of suprasellar tumors associated with poor brain blood perfusion by severe intracranial arterial stenosis: Two case reports 査読有り

    Yoshikazu Ogawa, Teiji Tominaga

    BMC Research Notes 6 (1) 499 2013年12月1日

    DOI: 10.1186/1756-0500-6-499  

    ISSN:1756-0500

    詳細を見る 詳細を閉じる

    Abstract. Background: Treatment strategy to prevent perioperative cerebral infarction in patients with asymptomatic severe stenosis of the internal carotid artery is not fully established. Case presentation. Two patients were treated for skull base tumor in the presence of severe stenosis of the internal carotid artery, unilateral in one patient and bilateral in the other patient. Both patients were asymptomatic but had reduced vascular reserve capacity. The extended transsphenoidal approach was planned avoiding the low perfusion pressure region, with only conventional methods of maintaining blood pressure and PaCO§ssub§2§esub§ rather than performing prophylactic vascular reconstruction surgery, and successful tumor removals were achieved without causing further neurological or radiological deficits. Conclusion: If the surgical route is planned to avoid the distribution of stenotic vessels and low perfusion pressure, prophylactic vascular reconstruction surgery would be unnecessary. Although more experiences based on sub-classified etiology for internal carotid artery stenosis are required, various types of operations including intracranial-extracranial vascular surgery might be justified based on this principle. © 2013 Ogawa and Tominaga licensee BioMed Central Ltd.

  257. Efficacy of fusion image for the preoperative assessment of anatomical variation of the anterior choroidal artery 査読有り

    Yasuko Aoki, Hidenori Endo, Kuniyasu Nnzuma, Takashi Inoue, Hiroaki Shimizu, Teiji Tominaga

    Neurological Surgery 41 (12) 1075-1080 2013年12月

    ISSN:0301-2603 1882-1251

    eISSN:1882-1251

    詳細を見る 詳細を閉じる

    We report two cases with internal carotid artery (ICA) aneurysms, in which fusion image effectively indicated the anatomical variations of the antenor choroidal artery (AchoA) Fusion image was obtained using fusion application software (Integrated Registration, Advantage Workstation VS4, GE Healthcare). When the artery passed through the choroidal fissure, it was diagnosed as AchoA Case 1 had an aneurysm at the left ICA Left internal carotid angiography (ICAG) showed that an artery arising from the aneurysmal neck supplied the medial occipital lobe Fusion image showed that this artery had a branch passing through the choroidal fissure, which was diagnosed as hyperplastic AchoA Case 2 had an aneurysm at the supraclinoid segment of the right ICA AchoA or postenor communicating artery (PcomA) were not detected by the right ICAG Fusion image obtained from 3D vertebral angiography (VAG) and MRI showed that the right AchoA arose from the nght PcomA Fusion image obtained from the right ICAG and the left VAG suggested that the aneurysm was located on the ICA where the PcomA regressed. Fusion image is an effective tool for assessing anatomical vanations of AchoA The present method is simple and quick for obtaining a fusion image that can be used in a real-time clinical setting.

  258. Time-varying inter-hemispheric coherence during corpus callosotomy 査読有り

    Eiichi Okumura, Masaki Iwasaki, Rie Sakuraba, Izumi Itabashi, Shin-ichiro Osawa, Kazutaka Jin, Hisashi Itabashi, Kazuhiro Kato, Akitake Kanno, Teiji Tominaga, Nobukazu Nakasato

    CLINICAL NEUROPHYSIOLOGY 124 (11) 2091-2100 2013年11月

    出版者・発行元:ELSEVIER IRELAND LTD

    DOI: 10.1016/j.clinph.2013.05.004  

    ISSN:1388-2457

    eISSN:1872-8952

    詳細を見る 詳細を閉じる

    Objective: Corpus callosotomy limits the bilateral synchrony of epileptic discharges. However, the instantaneous changes in bilateral synchrony during corpus callosotomy are unclear. The present study investigated how and when bilateral synchrony is suppressed in the anterior and then posterior steps of corpus callosotomy. Methods: Intra-operative scalp electroencephalography (EEG) was recorded simultaneously with surgical video for six patients who underwent total corpus callosotomy for medically intractable drop attacks. The time-varying EEG inter-hemispheric coherence was quantified by wavelet transform coherence and trend analysis. Results: The 4-13 Hz coherence decreased after corpus callosotomy in five patients. Significant decrease in coherence was observed only during the posterior step of callosal sectioning in three patients, but throughout both steps in two patients. Conclusions: Decrease in inter-hemispheric coherence is not always correlated with the stages of callosal sectioning. Inter-hemispheric coherence is decreased during the final stage of corpus callosotomy and the effect is maximized after sectioning is completed. Significance: Various patterns of coherence decrease suggest individual variations in the participation of the corpus callosum in the genesis of bilateral synchrony. Time-varying inter-hemispheric EEG coherence is useful to monitor the physiological completeness of corpus callosotomy. (c) 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  259. I-123-IMP-SPECT in a Patient with Cerebral Proliferative Angiopathy: A Case Report 査読有り

    Tomomi Kimiwada, Toshiaki Hayashi, Reizo Shirane, Teiji Tominaga

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 22 (8) 1432-1435 2013年11月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2013.05.038  

    ISSN:1052-3057

    eISSN:1532-8511

    詳細を見る 詳細を閉じる

    Cerebral proliferative angiopathy (CPA) is a new clinical entity demonstrating a diffuse network of densely enhanced vascular abnormalities with intermingled normal brain parenchyma and is distinguishable from classical arteriovenous malformations by specific clinical and imaging markers. However, the pathophysiological nature of this disease is unclear, and there is no consensus on the treatment. We describe cerebral perfusion abnormalities in a patient with CPA by using N-isopropyl-p-[I-123] iodoamphetamine single-photon emission computed tomography (I-123-IMP-SPECT) and perfusion-weighted magnetic resonance imaging. The patient, a 13-year-old boy, had reversible focal neurological deficits unrelated to cerebral hemorrhage. I-123-IMP-SPECT at resting state showed preserved uptake within the vascular lesion, yet lower uptake in the area adjacent to the lesion. In addition, acetazolamide-stressed I-123-IMP-SPECT exhibited severely impaired cerebrovascular reactivity over the affected hemisphere, suggesting that his focal neurological deficits were related to the cerebral ischemia. The perfusion abnormalities on I-123-IMP-SPECT in a CPA patient have never been previously reported. The concept of vascular malformation-related hypoperfusion is discussed.

  260. Relative Residence Time Prolongation in Intracranial Aneurysms: A Possible Association With Atherosclerosis 査読有り

    Shin-ichiro Sugiyama, Kuniyasu Niizuma, Toshio Nakayama, Hiroaki Shimizu, Hidenori Endo, Takashi Inoue, Miki Fujimura, Makoto Ohta, Akira Takahashi, Teiji Tominaga

    NEUROSURGERY 73 (5) 767-776 2013年11月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1227/NEU.0000000000000096  

    ISSN:0148-396X

    eISSN:1524-4040

    詳細を見る 詳細を閉じる

    BACKGROUND: Intracranial aneurysms can have atherosclerotic wall properties that may be important in predicting aneurysm history or estimating the potential risks of surgical treatments. OBJECTIVE: To investigate hemodynamic characteristics of atherosclerotic lesions in intracranial aneurysms using computational fluid dynamics. METHODS: Intraoperative video recordings of 30 consecutive patients with an unruptured middle cerebral artery aneurysm were examined to identify atherosclerotic lesions on an aneurysm wall. For computational fluid dynamics analyses, geometries of aneurysms and adjacent arteries were reconstructed from 3-dimensional rotational angiography. Transient simulations were conducted under patient-specific pulsatile inlet conditions measured by phase-contrast magnetic resonance velocimetry. Three hemodynamic wall parameters were calculated: time-averaged wall shear stress, oscillatory shear index, and relative residence time (RRT). Statistical analyses were performed to discriminate the risk factors of atherosclerotic lesion formation. RESULTS: Among 30 aneurysms, 7 atherosclerotic lesions with remarkable yellow lipid deposition were identified in 5 aneurysms. All 7 atherosclerotic lesions spatially agreed with the area with prolonged RRT. Univariate analysis revealed that male sex (P = .03), cigarette smoking (P = .047), and maximum RRT (P = .02) are significantly related to atherosclerotic lesion on the intracranial aneurysmal wall. Of those variables that influenced atherosclerotic lesion of the intracranial aneurysmal wall, male sex (P = .005) and maximum RRT (P = .004) remained significant in the multivariate regression model. CONCLUSION: The area with prolonged RRT colocalized with atherosclerotic change on the aneurysm wall. Male sex and maximum RRT were independent risk factors for atherogenesis in intracranial aneurysms.

  261. Treatment Results of Glioblastoma during the Last 30 Years in a Single Institute 査読有り

    Toshihiro Kumabe, Ryuta Saito, Masayuki Kanamori, Masashi Chonan, Yui Mano, Ichiyo Shibahara, Tomohiro Kawaguchi, Hideaki Kato, Yoji Yamashita, Yukihiko Sonoda, Jun Kawagishi, Hidefumi Jokura, Mika Watanabe, Ryuichi Katakura, Takamasa Kayama, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 53 (11) 786-796 2013年11月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.oa2013-0212  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Treatment results of glioblastoma (GB) during the last 30 years in Tohoku University were analyzed to identify any improvements in patient outcome in all 332 histologically proven cases of newly diagnosed GB treated consecutively in our department between 1982 and 2011. These 30 years was divided into 5 treatment eras, Group 1 (1982-1988, without preoperative evaluation by magnetic resonance [MR] imaging, n = 46), Group 2 (1989-1996, with preoperative MR imaging, n = 41), Group 3 (1997-1999, additionally underwent intraoperative functional brain mapping and neuronavigation system, n = 38), Group 4 (2000-August 2006, underwent 30 Gy of whole brain radiation followed by 30 Gy of extended local accelerated hyperfractionated radiation therapy, n = 96), and Group 5 (September 2006-2011, adjuvant usage of temozolomide [TMZ], n = 111). Overall survival (OS) was calculated from the date of surgery to the death from any cause. The median survival time/2-year OS/5-year OS of Groups 1 to 5 were 10.7 months/10.9%/0%, 17.3 months/26.2%/6.9%, 15.9 months/23.7%/5.3%, 20.1 months/34.8%/15.5%, and 20.9 months/45.5%/19.7%. The prognosis for patients with GB improved significantly after the introduction of MR imaging. Younger GB, defined as patients aged below 60 years, or total tumor resection with all ages in Group 5 had 5-year OS of 31.0% and 30.1%, respectively. The prognosis of GB was improved significantly after the introduction of TMZ for elderly GB, recursive partitioning analysis class 5, or totally resected GB. Introduction of MR imaging and TMZ, and total resection of the tumor were important in the improvement of outcome for patients with GB.

  262. Computational simulation of convection-enhanced drug delivery in the non-human primate brainstem: a simple model predicting the drug distribution 査読有り

    Shin-ichiro Sugiyama, Ryuta Saito, Kenichi Funamoto, Toshio Nakayama, Yukihiko Sonoda, Yoji Yamashita, Tomoo Inoue, Toshihiro Kumabe, Toshiyuki Hayase, Teiji Tominaga

    NEUROLOGICAL RESEARCH 35 (8) 773-781 2013年10月

    出版者・発行元:MANEY PUBLISHING

    DOI: 10.1179/1743132813Y.0000000215  

    ISSN:0161-6412

    詳細を見る 詳細を閉じる

    Objectives: Convection-enhanced delivery (CED) is a technique that delivers therapeutic agents directly and effectively into the brain parenchyma. Application of CED is now under investigation as a new treatment for various diseases. Diffuse brainstem glioma is one of the important candidates that could be targeted with CED. Especially when targeting brainstem lesions, prediction of drug distribution prior to CED will be necessary. This study evaluated the computational simulation of CED in the primate brainstem using a simplified model. Methods: Three in vivo experiments infusing gadolinium solution into the non-human primate brainstem were analyzed. T1-weighted magnetic resonance (MR) images were acquired during infusion of a total of 300 mu l gadolinium solution. Computational simulation reconstructed the surface geometry of the brainstem from the MR images. The volume of the whole structure was meshed by grid generating software. Under the assumptions that the brainstem surface was rigid and the interior was filled with cerebrospinal fluid, the equations of continuity and Darcy's law were solved within a computational fluid dynamics package using a finite volume method. The results of computational simulations were compared with those of the in vivo experiments. Results: The distribution volume (V-d) in the simulations corresponded well with the in vivo experiments. Under the condition without massive 'catheter back flow', computational simulations predicted almost 70% of the V-d of the in vivo experiments. Conclusions: The simplified computational simulations were consistent with the experiments in vivo. The methodology used in this study can be applied to predict convective drug distribution in the primate brainstem.

  263. Tissue dissection before direct manipulation to the pathology with pulsed laser-induced liquid jet system in skull base surgery-preservation of fine vessels and maintained optic nerve function 査読有り

    Yoshikazu Ogawa, Atsuhiro Nakagawa, Toshikatsu Washio, Tatsuhiko Arafune, Teiji Tominaga

    ACTA NEUROCHIRURGICA 155 (10) 1879-1886 2013年10月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-013-1817-7  

    ISSN:0001-6268

    詳細を見る 詳細を閉じる

    Most difficulties in skull base tumor removal are generally caused by adhesion of feeding arteries to the vital structures and cranial nerves. Water jet technology provides tissue dissectability with preservation of fine blood vessels both in experimental and clinical situations. However problems still remain regarding whether tumor removal with preservation of peripheral nerve function is possible or not. This clinical investigation evaluated functional preservation of peripheral nerves and dissectability with a newly developed pulsed laser-induced liquid jet (LILJ) system under intraoperative electrophysiological monitoring. The LILJ system was used to treat 21 patients with skull base tumors manifesting as severe visual disturbance through the extended transsphenoidal approach. The LILJ system consists of a bayonet-shaped catheter incorporating a jet generator, and total weight is around 7 g. Intraoperative visual evoked potential (VEP), and pre/postoperative conventional visual assessments were investigated. Precise dissections of the tumor were obtained, resulting in gross total removal in 19 of 21 patients. Two patients with meningiomas with tight adhesion to the origin of the lenticulostriate arteries had small remnants. Of the 21 patients, 16 showed immediate improvement on intraoperative VEP, 2 had no change, and 3 had prolonged latency, which required intermittent suspension of procedure. A total of 20 patients and 40 eyes showed good recovery at discharge, and all patients evaluated had recovered good visual status. The LILJ system can achieve safe and optimal removal with functional preservation of optic nerves, probably because of the high resistance of the arachnoidal sheath and fine vascular tissue.

  264. Clinical significance and limitations of repeat resection for pediatric malignant neuroepithelial tumors 査読有り

    Tomohiro Kawaguchi, Toshihiro Kumabe, Ryuta Saito, Masayuki Kanamori, Yoji Yamashita, Yukihiko Sonoda, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-PEDIATRICS 12 (4) 309-316 2013年10月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2013.6.PEDS12606  

    ISSN:1933-0707

    詳細を見る 詳細を閉じる

    Object. Maximized tumor resection and minimized surgical morbidity are extremely important in the treatment of children with malignant neuroepithelial tumors. However, the indications for repeat surgery for these tumors remain unclear. The present study investigated the clinical significance and limitations of repeat resection for these tumors. Methods. This study included 61 consecutive pediatric patients with malignant neuroepithelial tumor, histologically diagnosed as WHO Grades III and IV. All patients were initially treated between January 1997 and March 2011 and had follow-up of more than 2 years. The number of surgeries, presence of leptomeningeal dissemination, survival, WHO grade, and Eastern Cooperative Oncology Group performance status before and after surgery were retrospectively reviewed. Results. Repeat resections were performed for 21 patients (34.4%). Eastern Cooperative Oncology Group performance status was not aggravated by surgery, even after multiple operations. The 5-year survival rates of patients who received single and repeat surgery were 58.6% and 38.7%, respectively (p = 0.12). The mean interval between initial surgery and leptomeningeal dissemination detection was 331 +/- 108 days in the single-surgery group and 549 +/- 122 days in the repeat-surgery group (p = 0.19). The median survival time after leptomeningeal dissemination was 580 days in the single-surgery group and 890 days in the repeat-surgery group (p = 0.74). Conclusions. Repeat resection with minimized surgical morbidity is an effective method to achieve better local control of pediatric malignant neuroepithelial tumors. Leptomeningeal dissemination was a leading cause of death, but repeat surgery did not increase the frequency of death.

  265. Resources for Business Continuity in Disaster-Based Hospitals in the Great East Japan Earthquake: Survey of Miyagi Prefecture Disaster Base Hospitals and the Prefectural Disaster Medicine Headquarters 査読有り

    Daisuke Kudo, Hajime Furukawa, Atsuhiro Nakagawa, Satoshi Yamanouchi, Yuichi Koido, Takashi Matsumura, Yoshiko Abe, Ryota Konishi, Masaaki Matoba, Teiji Tominaga, Shigeki Kushimoto

    DISASTER MEDICINE AND PUBLIC HEALTH PREPAREDNESS 7 (5) 461-466 2013年10月

    出版者・発行元:CAMBRIDGE UNIV PRESS

    DOI: 10.1017/dmp.2013.77  

    ISSN:1935-7893

    eISSN:1938-744X

    詳細を見る 詳細を閉じる

    Objective To clarify advance measures for business continuity taken by disaster base hospitals involved in the Great East Japan Earthquake. Methods The predisaster situation regarding stockpiles was abstracted from a 2010 survey. Timing of electricity and water restoration and sufficiency of supplies to continue operations were investigated through materials from Miyagi Prefecture disaster medicine headquarters (prefectural medical headquarters) and disaster base hospitals (14 hospitals) in Miyagi Prefecture after the East Japan earthquake. Results The number of hospitals with less than 1 day of stockpiles in reserve before the disaster was 7 (50%) for electricity supplies, 8 (57.1%) for water, 6 (42.9%) for medical goods, and 6 (42.9%) for food. After the disaster, restoration of electricity and water did not occur until the second day or later at 8 of 13 (61.5%) hospitals, respectively. By the fourth postdisaster day, 14 hospitals had requested supplies from the prefectural medical headquarters: 9 (64.3%) for electricity supplies, 2 (14.3%) for water trucks, 9 (64.3%) for medical goods, and 6 (42.9%) for food. Conclusions The lack of supplies needed to continue operations in disaster base hospitals following the disaster clearly indicated that current business continuity plans require revision.

  266. Transsphenoidal microsurgical results of female patients with prolactinomas 査読有り

    Hidetoshi Ikeda, Kazuo Watanabe, Teiji Tominaga, Takashi Yoshimoto

    Clinical Neurology and Neurosurgery 115 (9) 1621-1625 2013年9月

    DOI: 10.1016/j.clineuro.2013.02.016  

    ISSN:0303-8467 1872-6968

    詳細を見る 詳細を閉じる

    Objective: We investigated surgical cure rate and surgical complications of patients with macroprolactinomas who desired pregnancy to evaluate the efficacy of transsphenoidal surgery. Methods: Surgical cure rate was investigated in 138 female patients who were under 40 years old. Results: We found a significant correlation between serum prolactin levels and adenoma volume (r = 0.004 p &lt 0.0001), adenoma volume and age (r = -0.213 p &lt 0.03), and proliferative index of the adenoma and age (r = -0.15 p &lt 0.007). Seventy-seven out of 81 patients with enclosed macroadenoma were considered cured, and therefore the overall surgical cure rate was 95%. However, during long-term follow-up, recurrence of adenomas with hyperprolactinemia was seen in 5 out of 81 patients (6%), and the long-term cure rate in patients with enclosed macroadenomas was 89%. Adenomas that did not invade the cavernous sinus showed a significantly higher surgical curability and lower serum prolactin levels, and a smaller size than those adenomas that invaded the cavernous sinus. Conclusions: The long-term surgical cure rate was found to be 89% and this success rate far surpasses the complication rate of 39% during pregnancy by dopamine agonist therapy. Thus, transsphenoidal surgery should be considered as a first-line treatment for female patients who desire pregnancy. © 2013 Elsevier B.V.

  267. The expression status of CD133 is associated with the pattern and timing of primary glioblastoma recurrence. 国際誌 査読有り

    Ichiyo Shibahara, Yukihiko Sonoda, Ryuta Saito, Masayuki Kanamori, Yoji Yamashita, Toshihiro Kumabe, Mika Watanabe, Hiroyoshi Suzuki, Takashi Watanabe, Chikashi Ishioka, Teiji Tominaga

    Neuro-oncology 15 (9) 1151-9 2013年9月

    DOI: 10.1093/neuonc/not066  

    ISSN:1522-8517

    詳細を見る 詳細を閉じる

    BACKGROUND: Glioblastoma carries a poor prognosis primarily because of its high rate of recurrence. The ability to predict the recurrence pattern and timing would be highly useful for determining effective treatment strategies. We examined the correlation between prognostic factors and the pattern of recurrence in patients with primary glioblastoma. In particular, we examined whether there was a correlation between the expression of CD133 and glioblastoma recurrence. METHODS: We retrospectively analyzed 112 patients with primary glioblastoma. The timing and pattern (local or distant) of the initial recurrence were obtained from medical records. To identify factors predictive of recurrence, we examined CD133 expression by Western blots and immunohistochemistry, clinical (age, sex, KPS, Ki67 labeling index, surgery, ventricular entry) and genetic (IDH1, 7p, 9p, 10q, MGMT) factors. RESULTS: Of the 112 patients, 99 suffered recurrence. The first recurrence was local in 77 patients and distant in 22 patients. Among the factors to predict the pattern of recurrence, CD133 expression was significantly higher in distant than in local recurrence. Of the factors to predict the timing of recurrence, high CD133 expression was associated with shorter time to distant recurrence in both univariate and multivariate analyses (P = .0011 and P = .038, respectively). CONCLUSIONS: The expression of CD133 may be a predictor of the pattern and timing of recurrence of primary glioblastoma.

  268. Medial posterior choroidal artery territory infarction associated with tumor removal in the pineal/tectum/thalamus region through the occipital transtentorial approach 査読有り

    Ryuta Saito, Toshihiro Kumabe, Masayuki Kanamori, Yukihiko Sonoda, Shunji Mugikura, Shoki Takahashi, Teiji Tominaga

    CLINICAL NEUROLOGY AND NEUROSURGERY 115 (8) 1257-1263 2013年8月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.clineuro.2012.11.020  

    ISSN:0303-8467

    詳細を見る 詳細を閉じる

    Object: Damage to the deep venous system, occipital lobe, and/or corpus callosum is well known to cause complications associated with the occipital transtentorial approach (OTA), but ischemic complications are not well documented. The authors investigated the high incidences of ischemic complications associated with removal of pineal/tectal/thalamic tumors through the OTA. Methods: Clinical records of 29 patients who underwent 31 surgeries using the OTA from December 2001 to May 2011 were retrospectively studied. Tumor locations were the pineal/tectal/thalamic region for 19, cerebellum for 7, and medial temporal lobe for 3. Results: Postoperative diffusion-weighted magnetic resonance images obtained within 72 h after surgery detected infarction in the tectal/splenial/thalamic region, presumably representing the medial posterior choroidal artery (MPChA) territory, in 10 patients. All these patients had tumor in the pineal/tectal/thalamic region. Deteriorated or newly developed eye symptoms including vertical gaze palsy tended to persist in these patients compared to those without ischemic complications. Conclusions: A relatively high incidence of MPChA territory infarction was associated with removal of tumors in the pineal/tectal/thalamic region through the OTA. Eye symptoms often occurred post-surgery and tended to persist in these patients. Neurosurgeons must be aware of the possibility of MPChA territory infarction to further increase the safety of the OTA. (C) 2012 Elsevier B.V. All rights reserved.

  269. Moyamoya Disease in Pregnancy: A Single Institute Experience 査読有り

    Miki Fujimura, Kozo Akagi, Hiroshi Uenohara, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 53 (8) 561-564 2013年8月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.53.561  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    Moyamoya disease is a rare chronic, occlusive cerebrovascular disease characterized by bilateral stenoocclusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. Moyamoya disease particularly affects children and young adults with female predominance, thus pregnant patients with moyamoya disease are not uncommon. Among 4,400 patients with consecutive deliveries in our hospital, 6 patients (0.14%) aged from 24 to 40 years (mean 32.7 years) were found to have moyamoya disease, all of whom underwent cesarean section. Four patients who had been diagnosed with moyamoya disease before pregnancy did not show neurological events in pregnancy and puerperium, but two patients who were newly diagnosed or progressed during the perinatal period suffered neurological deterioration due to ischemic stroke. Surgical revascularization at the subacute stage relieved their symptoms and they did not suffer permanent neurological deficit. We recommend that pregnant patients with moyamoya disease should be carefully managed under the collaboration of obstetricians and neurosurgeons, and that the procedure of the delivery should selected, by the obstetricians to avoid unfavorable sequelae caused by hyperventilation and/or blood pressure elevation.

  270. Clinical and histological characteristics of recurrent oligodendroglial tumors: comparison between primary and recurrent tumors in 18 cases 査読有り

    Masayuki Kanamori, Toshihiro Kumabe, Ichiyo Shibahara, Ryuta Saito, Yoji Yamashita, Yukihiko Sonoda, Hiroyoshi Suzuki, Mika Watanabe, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 30 (3) 151-159 2013年7月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1007/s10014-012-0119-8  

    ISSN:1433-7398

    詳細を見る 詳細を閉じる

    Changes in histological and genetic characteristics were investigated in 18 paired primary and recurrent oligodendroglial tumors, using sequencing analysis for isocitrate dehydrogenase (IDH) 1 and 2 gene mutation, Ki-67 and p53 immunohistochemistry, and fluorescent in situ hybridization for loss of heterozygosity of chromosomes 1p and 19q (1p/19q co-deletion). Malignant transformation occurred in 5 of 8 cases with World Health Organization (WHO) grade II tumors, but in 0 of 10 cases with WHO grade III tumors progressing to glioblastoma. Thirteen of the 18 cases carried IDH1 gene mutation. Tumors with IDH1 mutation tended to survive for longer, even after recurrence, but newly developed microvascular proliferation, tumor necrosis, and elevated Ki-67 labeling index were common. Eleven of the 13 IDH1-mutation tumors had either 1p/19q co-deletion or nuclear expression of p53, but all 5 IDH1/2 wild-type tumors had neither. All cases had the same profile for 1p/19q status at recurrence, but nuclear expression of p53 changed from negative to positive in 2 of 6 cases with IDH1 mutation and 1p/19q co-deletion. WHO grade II oligodendroglial tumors show a high rate of malignant transformation, possibly involving p53 in tumors with IDH1 mutation and 1p/19q co-deletion. Tumors with IDH1 mutation had a more aggressive histological phenotype despite their better prognosis.

  271. Infarction of the lateral posterior choroidal artery territory after manipulation of the choroid plexus at the atrium: causal association with subependymal artery injury. 国際誌 査読有り

    Ryuta Saito, Toshihiro Kumabe, Yukihiko Sonoda, Masayuki Kanamori, Shunji Mugikura, Shoki Takahashi, Teiji Tominaga

    Journal of neurosurgery 119 (1) 158-63 2013年7月

    DOI: 10.3171/2013.2.JNS121221  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    OBJECT: The atrium of the lateral ventricle is often affected by tumors, and some patients with these tumors suffer neurological deficits, including hemiparesis after surgery. The authors of this study investigated the possible mechanisms causing the relatively high incidences of ischemic complications associated with surgery approaching the atrium of the lateral ventricle. METHODS: Clinical records and radiological images of 28 patients were retrospectively studied. These patients had their lateral ventricles opened at the atrium during the resection of gliomas as well as other nonbenign brain tumors, and were treated for gliomas at our tertiary referral center in the Tohoku district, Japan, between January 2008 and December 2010. RESULTS: Routine postoperative diffusion-weighted MR images obtained within 72 hours after surgery detected infarction in the periatrial/periventricular regions in 7 patients, presumably corresponding to the lateral posterior choroidal artery (LPChA) territory. Five of these 7 patients suffered neurological sequelae with varying severities. The choroid plexus at the atrium was coagulated to achieve hemostasis during the surgery in all of these patients. Detailed analysis of microangiograms revealed ventriculofugal arteries arising from the lateral ventricle. Damage of the subependymal artery that supplies the ventriculofugal arteries caused by coagulation of the choroid plexus at the atrium probably resulted in the infarction in these patients. CONCLUSIONS: Neurosurgeons must be aware of the possibility of LPChA territory infarction during surgery in the atrial or periatrial regions caused by subependymal artery obstruction after manipulating or coagulating the choroid plexus near the atrium.

  272. Pilomyxoid astrocytoma of the cerebellum with Williams syndrome: a case report 査読有り

    Masashi Chonan, Masayuki Kanamori, Toshihiro Kumabe, Ryuta Saito, Mika Watanabe, Teiji Tominaga

    CHILDS NERVOUS SYSTEM 29 (7) 1211-1214 2013年7月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00381-013-2107-7  

    ISSN:0256-7040

    詳細を見る 詳細を閉じる

    A 3-year-old boy with Williams syndrome associated with supravalvular aortic stenosis was admitted to our hospital with disturbance of consciousness and a 2-month history of truncal ataxia. T1-weighted magnetic resonance imaging with contrast medium showed a heterogeneously enhanced tumor in the right cerebellum with severe hydrocephalus. The patient underwent tumor resection via suboccipital craniotomy. At the end of resection of the tumor, sudden cardiac arrest occurred after ST segment elevation. Despite immediate cardiopulmonary resuscitation, the patient died. Histological examination of the cerebellar tumor revealed that the tumor consisted of monomorphous bipolar spindle cells on a background of myxoid matrix, and angiocentric arrangement without Rosenthal fibers or eosinophilic granular body. The final diagnosis was pilomyxoid astrocytoma. This case of Williams syndrome with cerebellar pilomyxoid astrocytoma suggests the importance of investigation of the development of brain tumors and occurrence of intraoperative cardiac arrest associated with Williams syndrome.

  273. Risk Assessment for Venous Thromboembolism in Patients With Neuroepithelial Tumors: Pretreatment Score to Identify High Risk Patients 査読有り

    Tomohiro Kawaguchi, Toshihiro Kumabe, Masayuki Kanamori, Ryuta Saito, Yoji Yamashita, Yukihiko Sonoda, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 53 (7) 467-473 2013年7月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.53.467  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    The independent risk factors for venous thromboembolism (VTE) were investigated in patients with neuroepithelial tumor to establish a risk score for VTE. Our prospective study enrolled 395 hospitalized cases with neuroepithelial tumors. All cases underwent measurement of serum D-dimer concentration and neurological examination on admission. Serum D-dimer concentration was measured on days 1, 3, and 7 after surgery and weekly during follow up in patients who underwent surgery, and once a week during follow up in patients without surgery. Fourteen clinical parameters were evaluated as indicators of VTE, and among them, age, body-mass index, chemotherapy, radiation therapy, corticosteroid usage, pretreatment serum D-dimer concentration, paresis of the lower extremity (manual muscle test: MMT), performance status, and World Health Organization grade of the tumor achieved statistical significance. Multivariable logistic regression analysis demonstrated age &gt;65 years, corticosteroid usage, paresis of the lower extremity, and serum D-dimer concentration over 1.0 mg/dl were independent factors. Total risk score was defined as the total of the scores for risk factors assigned based on the adjusted odds ratio: pretreatment serum D-dimer concentration over 1.0 mg/dl (2 points), and age over 65 years old, paresis of the lower extremity of MMT &lt;= 2, and corticosteroid usage (1 point each). Rates of VTE were 2.0% in the low risk (total score 0 or 1), 14.8% in the intermediate risk (total score 2 or 3), and 51.9% in the high risk groups (total score = 4 or 5). This pretreatment risk score for VTE might be useful to identify patients who would benefit from thromboprophylaxis.

  274. Quantitative assessment of cerebral hemodynamics using single photon emission computed tomography with venous blood sampling 査読有り

    Takashi Inoue, Miki Fujimura, Hiroaki Shimizu, Yoshitake Takahashi, Teiji Tominaga

    CLINICAL NEUROLOGY AND NEUROSURGERY 115 (6) 684-689 2013年6月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.clineuro.2012.08.020  

    ISSN:0303-8467

    詳細を見る 詳細を閉じる

    Objective: Quantitative cerebral blood flow (CBF) measured by single photon emission computed tomography (SPECT) with arterial blood sampling is one of the most reliable methods to assess the hemodynamics in individual patients. SPECT with venous blood sampling is less invasive. The present study compared the measurement of CBF using N-isopropyl-p-(iodine-123)-iodoamphetamine SPECT with venous blood sampling and with arterial blood sampling in patients with major cerebral artery occlusive disease. Methods: Two normal subjects and 14 patients with major cerebral artery occlusive disease underwent SPECT with arterial and venous blood sampling. The microsphere method was used for quantitative SPECT imaging. Whole brain radioactivity was corrected when the detectors rotated in the forward direction (F-1-F-7). Venous sampling was performed 30 min after radiotracer injection. Arterial blood radioactivity was estimated by multiple regression analysis from these parameters. The cerebrovascular reactivity to acetazolamide was also measured. Results: Multiple regression analysis established the following formula: Ca-10 = -1.099F(1) + 1.629F(2) - 2.143F(3) - 2.766F(4) - 1.208F(5) + 2.113F(6) + 3.259F(7) + 1.241Cv(30) + 94.958 (where Ca-10 is the arterial blood radioactivity at 10 min, F-1-F-7 are the whole brain radioactivity in the forward direction, Cv(30) is the venous blood radioactivity at 30 min). Mean CBF values were 32.2 +/- 6.6 ml/100 g/min for measured arterial radioactivity and 42.2 +/- 7.8 ml/100 g/min for calculated arterial radioactivity based on venous radioactivity. Conclusions: The present modified method of calculating quantitative CBF from whole brain and venous blood radioactivities correlated well with values determined with arterial blood radioactivity. (C) 2012 Elsevier B.V. All rights reserved.

  275. 5-aminolevulinic acid fluorescence-guided resection of intramedullary ependymoma: Report of 9 cases 査読有り

    Tomoo Inoue, Toshiki Endo, Kenichi Nagamatsu, Mika Watanabe, Teiji Tominaga

    Neurosurgery 72 (2 Suppl Operative) ons159-ons168 2013年6月

    DOI: 10.1227/NEU.0b013e31827bc7a3  

    ISSN:0148-396X

    詳細を見る 詳細を閉じる

    BACKGROUND:: Resection guided by 5-aminolevulinic acid (5-ALA) fluorescence has proved to be useful in intracranial glioma surgery. However, the effects of 5-ALA on spinal cord tumors remain unknown. OBJECTIVE:: To evaluate the usefulness of 5-ALA fluorescence-guided resection of intramedullary ependymoma for achieving maximum tumor resection. METHODS:: This study included 10 patients who underwent surgical resection of an intramedullary ependymoma. Nine patients were orally administered 5-ALA (20 mg/kg) 2 hours before the induction of anesthesia. 5-ALA fluorescence was visualized with an operating microscope. Tumors were removed in a standardized manner with electrophysiological monitoring. The extent of resection was evaluated on the basis of intraoperative findings and postoperative magnetic resonance imaging. Histopathological diagnosis was established according to World Health Organization 2007 criteria. Cell proliferation was assessed by Ki-67 labeling index. RESULTS:: 5-ALA fluorescence was positive in 7 patients (6 grade II and 1 grade III) and negative in 2 patients (grade II). Intraoperative findings were dichotomized: Tumors covered by the cyst were easily separated from the normal parenchyma, whereas tumors without the cyst appeared to be continuous to the spinal cord. In these cases, 5-ALA fluorescence was especially valuable in delineating the ventral and cranial and caudal margins. Ki-67 labeling index was significantly higher in 5-ALA-positive cases compared with 5-ALA-negative cases. All patients improved neurologically or stabilized after surgery. CONCLUSION:: 5-ALA fluorescence was useful for detecting tumor margins during surgery for intramedullary ependymoma. When combined with electrophysiological monitoring, fluorescence-guided resection could help to achieve maximum tumor resection safely. ABBREVIATIONS:: 5-ALA, 5-aminolevulinic acidLI, labeling indexMEP, motor evoked potential. Copyright © 2012 by theCongress of Neurological Surgeons.

  276. Rathke's cleft cysts with significant squamous metaplasia-high risk of postoperative deterioration and close origins to craniopharyngioma 査読有り

    Yoshikazu Ogawa, Mika Watanabe, Teiji Tominaga

    ACTA NEUROCHIRURGICA 155 (6) 1069-1075 2013年6月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-012-1593-9  

    ISSN:0001-6268

    詳細を見る 詳細を閉じる

    Rathke's cleft cyst (RCC) with significant squamous and/or stratified epithelium including smooth transition from single cuboidal to squamous epithelium (tRCC) is rare and possibly represents an intermediate form to craniopharyngioma. Twelve patients with histologically confirmed tRCC were retrospectively investigated from a series of 167 cases of RCC and 96 cases of craniopharyngiomas. Clinical data were reviewed, and immunohistochemistry findings for cytokeratins and beta-catenin were examined. All lesions were located in the sella turcica with marked extension to suprasellar cistern. Six of the 12 patients had suffered postoperative re-enlargement, and three of these six patients required more than two additional operations and irradiation. CAM5.2 was positive in the glandular epithelium in all tRCCs and focally positive in the squamous epithelium of all these tRCCs. 34 beta E12 was positive in the squamous epithelium in all tRCCs and focally positive in the glandular epithelium in all but one tRCC. The findings of cytokeratin expression of tRCCs were very similar to those of craniopharyngioma. beta-Catenin showed nuclear translocation in five cases. All patients with nuclear translocation of beta-catenin suffered postoperative re-enlargement. tRCC carries an extremely high risk of re-enlargement. Cytokeratin expression resembles that in craniopharyngioma, which might indicate a very close origin of these pathologies. Nuclear translocation of beta-catenin may be related to the aggressive clinical course.

  277. [I. Convection-enhanced delivery for treatment of glioma]. 査読有り

    Saito R, Tominaga T

    Gan to kagaku ryoho. Cancer & chemotherapy 40 (6) 705-707 2013年6月

    ISSN:0385-0684

  278. Experimental application of pulsed laser-induced water jet for endoscopic submucosal dissection: Mechanical investigation and preliminary experiment in swine 査読有り

    Chiaki Sato, Toru Nakano, Atsuhiro Nakagawa, Masato Yamada, Hiroaki Yamamoto, Takashi Kamei, Go Miyata, Akira Sato, Fumiyoshi Fujishima, Masaaki Nakai, Mitsuo Niinomi, Kazuyoshi Takayama, Teiji Tominaga, Susumu Satomi

    DIGESTIVE ENDOSCOPY 25 (3) 255-263 2013年5月

    出版者・発行元:WILEY-BLACKWELL

    DOI: 10.1111/j.1443-1661.2012.01375.x  

    ISSN:0915-5635

    詳細を見る 詳細を閉じる

    Background and Aim A current drawback of endoscopic submucosal dissection (ESD) for early-stage gastrointestinal tumors is the lack of instruments that can safely assist with this procedure. We have developed a pulsed jet device that can be incorporated into a gastrointestinal endoscope. Here, we investigated the mechanical profile of the pulsed jet device and demonstrated the usefulness of this instrument in esophageal ESD in swine. Methods The device comprises a 5-Fr catheter, a 14-mm long stainless steel tube for generating the pulsed water jet, a nozzle and an optical quartz fiber. The pulsed water jet was generated at pulse rates of 3Hz by irradiating the physiological saline (4 degrees C) within the stainless steel tube with an holmium-doped yttrium-aluminum-garnet (Ho:YAG) laser at 1.1J/pulse. Mechanical characteristics were evaluated using a force meter. The device was used only for the part of submucosal dissection in the swine ESD model. Tissues removed using the pulsed jet device and a conventional electrocautery device, and the esophagus, were histologically examined to assess thermal damage. Results The peak impact force was observed at a stand-off distance of 40mm (1.1J/pulse). ESD using the pulsed jet device was successful, as the tissue specimens showed precise dissection of the submucosal layer. The extent of thermal injury was significantly lower in the dissected bed using the pulsed jet device. Conclusion The results showed that the present endoscopic pulsed jet system is a useful alternative for a safe ESD with minimum tissue injury.

  279. Parental satisfaction and seizure outcome after corpus callosotomy in patients with infantile or early childhood onset epilepsy 査読有り

    Masaki Iwasaki, Mitsugu Uematsu, Tojo Nakayama, Naomi Hino-Fukuyo, Yuko Sato, Tomoko Kobayashi, Kazuhiro Haginoya, Shin-ichiro Osawa, Kazutaka Jin, Nobukazu Nakasato, Teiji Tominaga

    SEIZURE-EUROPEAN JOURNAL OF EPILEPSY 22 (4) 303-305 2013年5月

    出版者・発行元:W B SAUNDERS CO LTD

    DOI: 10.1016/j.seizure.2013.01.005  

    ISSN:1059-1311

    詳細を見る 詳細を閉じる

    Purpose: To elucidate the benefit of corpus callosotmy in terms of parental satisfaction and seizure outcome. Method: This study included 16 consecutive patients with infantile or early childhood onset epilepsy who underwent total corpus callosotomy for alleviation of seizures. Questionnaires were sent anonymously to the parents asking about relative changes in seizures and about parental satisfaction for the post-operative outcome. Results: The improvements in frequency, intensity, and duration of seizures were correlated with the level of satisfaction (Spearman's rank-order correlation coefficient, rho = 0.87, 0.93, and 0.75, respectively). The highest level of satisfaction was only seen in patients who achieved freedom from all seizures or drop attacks. Conclusion: Complete seizure freedom and freedom from drop attacks are important goals of corpus callosotomy for parental satisfaction. These factors should be considered in assessing post-operative outcome after corpus callosotomy. (C) 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  280. Dynamic changes in magnetic resonance imaging appearance of dysembryoplastic neuroepithelial tumor with or without malignant transformation Report of 2 cases 査読有り

    Yui Mano, Toshihiro Kumabe, Ichiyo Shibahara, Ryuta Saito, Yukihiko Sonoda, Mika Watanabe, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-PEDIATRICS 11 (5) 518-525 2013年5月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2013.1.PEDS11449  

    ISSN:1933-0707

    eISSN:1933-0715

    詳細を見る 詳細を閉じる

    Dysembryoplastic neuroepithelial tumors (DNETs) have conventionally been regarded as benign and stable tumors and considered curable with surgery without adjunctive therapy. Recently, recurrent DNETs with or without malignant transformation have been described. The authors report 2 unusual cases of DNET: 1) an enlarging lesion that developed an enhancing component over the natural course of 4 years, and 2) a recurrent DNET that developed an enhancing component 10-11 years after gross-total resection. The patient in the first case was treated with subtotal resection and adjuvant radiochemotherapy; histological examination of the tumor led to the diagnosis of DNET, WHO Grade I, for the nonenhancing component and anaplastic oligodendroglioma, WHO Grade III, for the enhancing component. The patient in the second case was treated with repeat gross-total resection; the original tumor had been histologically diagnosed as DNET, and the nonenhancing and enhancing components of the recurrent tumor were diagnosed as simple and complex forms of DNET, respectively. These and previous reports suggest an aggressive subtype of DNETs. If follow-up MRI reveals progressive behavior, resection should be performed without delay. Additional radiochemotherapy is needed if the histological diagnosis demonstrates malignant transformation. (http://thejns.org/doi/abs/10.3171/2013.1.PEDS11449)

  281. Use of microscope-integrated near-infrared indocyanine green videoangiography in the surgical treatment of intramedullary cavernous malformations: report of 8 cases 査読有り

    Toshiki Endo, Misaki Aizawa-Kohama, Kenichi Nagamatsu, Kensuke Murakami, Akira Takahashi, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-SPINE 18 (5) 443-449 2013年5月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2013.1.SPINE12482  

    ISSN:1547-5654

    詳細を見る 詳細を閉じる

    Object. The characteristics and efficacy of indocyanine green (ICG) videoangiography in cavernous malformation (CM) have not been fully elucidated. The purpose of this paper is to examine the potential utility of ICG videoangiography in the surgical treatment of intramedullary CMs. Methods. The authors conducted a retrospective review of 8 cases involving 5 men and 3 women who had undergone surgery for intramedullary CM between January 2008 and July 2011. All patients were evaluated by means of MRI. The MRI findings and clinical history in all cases suggested intramedullary CM as a preoperative diagnosis. In 2, of 8 cases, dilated venous structures associated with CMs were demonstrated. In one of these cases, there were coexisting extramedullary CMs. Intraoperatively, ICG fluorescence was observed for 5 minutes using microscope-integrated videoangiography. Results. In all 8 cases, intra- and extramedullary CMs were seen as avascular areas on ICG videoangiography. Indocyanine green videoangiography helped surgeons to localize and predict margins of the lesions before performing myelotomy. Importantly, in the cases with associated venous anomalies, ICG videoangiography was useful in delineating and preserving the venous structures. In extramedullary CMs located dorsal to the spinal cord, gradual ICG infiltration was seen, starting at 110 seconds and maximal at 210 seconds after injection. Postoperative MRI confirmed total removal of the lesions in all cases, and subsequent recovery of all patients was uneventful. Conclusions. Indocyanine green videoangiography provided useful information with regard to the detection of lesion margins by demonstrating intramedullary CMs as avascular areas. In cases associated with venous anomalies, ICG contributed to safe and complete removal of the CMs by visualizing the venous structure. In extramedullary CMs, ICG videoangiography demonstrated the characteristie of slow blood flow within CMs. (http://thejns.org/doi/abs/10.3171/2013.1.SPINE12482)

  282. Cilostazol for the Prevention of Acute Progressing Stroke: A Multicenter, Randomized Controlled Trial 査読有り

    Hiroaki Shimizu, Teiji Tominaga, Akira Ogawa, Takamasa Kayama, Kazuo Mizoi, Kiyoshi Saito, Yasuo Terayama, Kuniaki Ogasawara, Etsuro Mori

    JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 22 (4) 449-456 2013年5月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.jstrokecerebrovasdis.2013.02.009  

    ISSN:1052-3057

    詳細を見る 詳細を閉じる

    Background: Progressing stroke is one of the major determinants of outcome after acute ischemic stroke. A pilot randomized controlled trial was conducted to investigate the effect of cilostazol on progressing stroke. Methods: Adult patients with noncardioembolic ischemic stroke within 24 hours after onset were randomized to receive cilostazol 200 mg/day (cilostazol group) or no medication (control group) in addition to the optimum medical treatments (a free radical scavenger plus an antiplatelet agent or an antithrombin agent). The primary endpoints were the rate of progressing stroke, defined as aggravation of the National Institutes of Health Stroke Scale (NIHSS) score by &gt;= 4 points on days 3 and/or 5 and a modified Rankin Scale score of 0 to 1 at 3 months after enrollment. Aggravation caused by systemic complications, edema, hemorrhagic infarction, or recurrent stroke was not considered as progressing stroke. This trial was registered as UMIN000001630. Results: A total of 510 patients were enrolled from 55 institutions in Japan between February 2009 and July 2010. The rate of progressing stroke was 3.2% and 6.3% in the cilostazol and control groups, respectively (P = .143). The modified Rankin Scale score of 0 to 1 at 3 months did not differ between the groups. Conclusions: Cilostazol failed to show a preventive effect against acute progressing stroke. However, the tendency to reduce progressing stroke and the results of stratified analyses may encourage additional studies to clarify the effect of cilostazol in the treatment of acute ischemic stroke.

  283. [A primary epileptogenic tuber revealed after corpus callosotomy in a patient with tuberous sclerosis complex and multiple tubers]. 査読有り

    Keisuke Sato, Masaki Iwasaki, Mitsugu Uematsu, Nobukazu Nakasato, Teiji Tominaga

    No shinkei geka. Neurological surgery 41 (5) 421-8 2013年5月

    ISSN:0301-2603

    詳細を見る 詳細を閉じる

    Identification of primary epileptogenic tuber is often challenging in patients with bilateral multiple tubers in tuberous sclerosis complex. We report a 3 year old girl with tuberous sclerosis complex presenting with intractable epilepsy and multiple tubers, who was successfully treated by corpus callosotomy and subsequent resective surgery. She initially presented with West syndrome which was intractable to ACTH therapy and multiple antiepileptic medications. Her EEG was characterized by generalized and multifocal spikes, and by non-focal changes at seizure onset. Ictal single photon emission computed tomography(SPECT)showed no focal hyperperfusion. Total corpus callosotomy was performed to alleviate her drop attacks. Post-operatively, interictal spikes were completely lateralized to the right hemisphere. Since her seizures were still kept uncontrolled with medications, second pre-surgical evaluation was planned and ictal SPECT disclosed focal hyperperfusion at a tuber in the right frontal lobe. After complete resection of the right frontal tuber, she was completely seizure free on antiepileptic medications for 1 year with no additional neurological deficits. Generalized or multifocal electroencephalographic(EEG)spikes are occasionally lateralized to one hemisphere after corpus callosotomy, which may help identifying the primary epileptogenic focus. Repeat pre-surgical evaluation is important after corpus callosotomy in patients with generalized or multifocal epileptiforms in EEG.

  284. The great East Japan earthquake: lessons learned at Tohoku University Hospital during the first 72 hours. 査読有り

    Nakagawa A, Furukawa H, Konishi R, Kudo D, Matsumura T, Sato D, Abe Y, Washio T, Arafune T, Yamanouchi S, Kushimoto S, Tominaga T

    IEEE pulse 4 (3) 20-27 2013年5月

    DOI: 10.1109/MPUL.2013.2250851  

    ISSN:2154-2287

  285. Malignant pediatric brain tumor of primitive small round cell proliferation with bland-looking mesenchymal spindle cell elements 査読有り

    Akira Ito, Toshihiro Kumabe, Ryuta Saito, Yukihiko Sonoda, Mika Watanabe, Yoichi Nakazato, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 30 (2) 109-116 2013年4月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1007/s10014-012-0106-0  

    ISSN:1433-7398

    詳細を見る 詳細を閉じる

    It is often difficult to classify rare malignant pediatric mixed brain tumors composed of mesenchymal elements. A 6-year-old boy presented to our hospital with a left frontal massive tumor manifesting as complaints of rapidly progressive right hemiparesis and motor aphasia over 2 weeks. Computed tomography showed a left frontal mass with thick calcification. Magnetic resonance imaging revealed an enhanced lesion with perifocal edema and mass effect. Total removal of the tumor was performed. Histological examination of the resected tumor revealed an anaplastic malignant small round cell component with a bland-looking mesenchymal spindle cell component. The patient was treated with irradiation to the whole craniospinal axis and a boost to the tumor bed, followed by chemotherapy consisting of ifosfamide, cisplatin, and etoposide, resulting in good control without local recurrence or metastasis at 2 years. A combined malignant tumor composed of ectodermal and mesenchymal components is generally named malignant ectomesenchymoma (MEM). The more malignant part of MEM is the mesenchymal component in most cases. In the present case, the more malignant component was not the mesenchymal component, but the small round cells.

  286. Noninvasive measurement of human brain temperature adjacent to arteriovenous malformation using 3.0 T magnetic resonance spectroscopy 査読有り

    Takashi Inoue, Hiroaki Shimizu, Miki Fujimura, Atsushi Saito, Yoshichika Yoshioka, Tsuyoshi Matsuda, Teiji Tominaga

    CLINICAL NEUROLOGY AND NEUROSURGERY 115 (4) 445-449 2013年4月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.clineuro.2012.06.022  

    ISSN:0303-8467

    詳細を見る 詳細を閉じる

    Object: The brain temperature at rest is determined by the balance between heat produced by cerebral energy turnover, which is identical to cerebral metabolism, and heat that is removed, primarily by cerebral blood flow. The present study investigated whether brain temperature measured by proton magnetic resonance (MR) spectroscopy can detect cerebral hemodynamic impairment in patients with arteriovenous malformations (AVMs) as shown by single photon emission computed tomography (SPECT). Methods: Brain temperature, cerebral blood flow, and cerebrovascular reactivity were measured using proton MR spectroscopy and SPECT in five healthy volunteers and six patients with AVMs. Regions of interest were selected adjacent to the AVMs and in the corresponding contralateral region. Results: Brain temperature around AVMs was calculated in all subjects using MR spectroscopy. The mean brain temperature in volunteers was 37.1 +/- 0.41 degrees C. A significant correlation was observed between brain temperature ratio (affected side/contralateral side) and cerebrovascular reactivity ratio (affected side/contralateral side) (r = -0.82, p = 0.0480). Conclusion: Brain temperature measured by proton MR spectroscopy can detect cerebral hemodynamic impairment in patients with AVMs. Further investigations regarding the relationships between brain temperature and clinical feature in patients with AVMs are needed. (c) 2012 Elsevier B.V. All rights reserved.

  287. Metachronous, multicentric glioma of pilocytic astrocytoma with oligodendroglioma-like component and oligodendroglioma through distinct genetic aberrations Case report 査読有り

    Atsushi Kanoke, Masayuki Kanamori, Toshihiro Kumabe, Ryuta Saito, Mika Watanabe, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 118 (4) 854-858 2013年4月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2012.9.JNS112353  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    This patient presented with a rare case of metachronous, multicentric gliomas first manifesting as headache and nausea in 1983 when he was an 8-year-old boy. Computed tomography revealed a cerebellar tumor and the tumor was subtotally resected. The histological diagnosis was pilocytic astrocytoma, and radiation therapy to the posterior fossa and chemotherapy consisting of nimustine hydrochloride and fluorouracil were performed. In 1989, at age 14 years, the patient presented with local recurrence. He underwent gross-total resection of the tumor, and histological examination revealed that the tumor consisted of classic pilocytic astrocytoma with a biphasic pattern and a small oligodendroglioma-like component. In 2011, at age 36 years, he presented with seizure. Magnetic resonance imaging revealed a mass lesion in the right middle frontal gyms. Gross-total resection of the tumor was performed, and the histological diagnosis was oligodendroglioma. Genetic analyses revealed amplification of the BRAF gene in both the primary cerebellar pilocytic astrocytoma and the recurrent tumor with biphasic features, as well as a BRAF V600E missense mutation in the oligodendroglioma-like component. On the other hand, the IDH1 R132H mutation, instead of aberrations of the BRAF gene, was identified in the oligodendroglioma arising in the right frontal lobe. Different types of aberrations of the BRAT gene in the classic and oligodendroglioma-like component in the recurrent pilocytic astrocytoma suggest that they had different cell origins or that amplification of BRAF was negatively selected under the de novo BRAF V600E mutation. In addition, the aberration profiles of IDH1 and BRAF suggest that the oligodendroglioma arose independent of cerebellar pilocytic astrocytoma. (http://thejns.org/doi/abs/10.3171/2012.9.JNS112353)

  288. Increase in the number of patients with seizures following the Great East-Japan Earthquake. 国際誌 査読有り

    Ichiyo Shibahara, Shin-Ichiro Osawa, Hiroyuki Kon, Takahiro Morita, Nobukazu Nakasato, Teiji Tominaga, Norio Narita

    Epilepsia 54 (4) e49-52-52 2013年4月

    DOI: 10.1111/epi.12070  

    ISSN:0013-9580

    詳細を見る 詳細を閉じる

    In the afternoon of March 11, 2011, Kesennuma City was hit by the Great East-Japan Earthquake and a devastating tsunami. The purpose of this retrospective study is to document possible changes in the number of patients with distinct neurologic diseases seeking treatment following this disaster. Because of Kesennuma's unique geographical location, the city was isolated by the disaster, allowing for a study with relatively limited population selection bias. Patients admitted for neurologic emergencies from January 14 to May 5 in 2011 (n = 117) were compared with patients in the corresponding 16-week periods in 2008-2010 (n = 323). The number of patients with unprovoked seizures was significantly higher during the 8-week period after the earthquake (n = 13) than during the same periods in 2008 (n = 6), 2009 (n = 3), and 2010 (no patients) (p = 0.0062). In contrast, the number of patients treated for other neurologic diseases such as stroke, trauma, and tumors remained unchanged. To our knowledge, this is the first report of an increase in the number of patients with seizures following a life-threatening natural disaster. We suggest that stress associated with life-threatening situations may enhance seizure generation.

  289. Optogenetically Induced Seizure and the Longitudinal Hippocampal Network Dynamics 査読有り

    Shin-ichiro Osawa, Masaki Iwasaki, Ryosuke Hosaka, Yoshiya Matsuzaka, Hiroshi Tomita, Toru Ishizuka, Eriko Sugano, Eiichi Okumura, Hiromu Yawo, Nobukazu Nakasato, Teiji Tominaga, Hajime Mushiake

    PLOS ONE 8 (4) e60928 2013年4月

    出版者・発行元:PUBLIC LIBRARY SCIENCE

    DOI: 10.1371/journal.pone.0060928  

    ISSN:1932-6203

    詳細を見る 詳細を閉じる

    Epileptic seizure is a paroxysmal and self-limited phenomenon characterized by abnormal hypersynchrony of a large population of neurons. However, our current understanding of seizure dynamics is still limited. Here we propose a novel in vivo model of seizure-like afterdischarges using optogenetics, and report on investigation of directional network dynamics during seizure along the septo-temporal (ST) axis of hippocampus. Repetitive pulse photostimulation was applied to the rodent hippocampus, in which channelrhodopsin-2 (ChR2) was expressed, under simultaneous recording of local field potentials (LFPs). Seizure-like afterdischarges were successfully induced after the stimulation in both W-TChR2V4 transgenic (ChR2V-TG) rats and in wild type rats transfected with adeno-associated virus (AAV) vectors carrying ChR2. Pulse frequency at 10 and 20 Hz, and a 0.05 duty ratio were optimal for afterdischarge induction. Immunohistochemical c-Fos staining after a single induced afterdischarge confirmed neuronal activation of the entire hippocampus. LFPs were recorded during seizure-like afterdischarges with a multi-contact array electrode inserted along the ST axis of hippocampus. Granger causality analysis of the LFPs showed a bidirectional but asymmetric increase in signal flow along the ST direction. State space presentation of the causality and coherence revealed three discrete states of the seizure-like afterdischarge phenomenon: 1) resting state; 2) afterdischarge initiation with moderate coherence and dominant septal-to-temporal causality; and 3) afterdischarge termination with increased coherence and dominant temporal-to-septal causality. A novel in vivo model of seizure-like afterdischarge was developed using optogenetics, which was advantageous in its reproducibility and artifact-free electrophysiological observations. Our results provide additional evidence for the potential role of hippocampal septo-temporal interactions in seizure dynamics in vivo. Bidirectional networks work hierarchically along the ST hippocampus in the genesis and termination of epileptic seizures.

  290. Surgical indication and outcome in patients with postoperative retethered cord syndrome Clinical article 査読有り

    Toshiaki Hayashi, Jun Takemoto, Tatschiro Ochiai, Tomomi Kimiwada, Reizo Shirane, Kiyohide Sakai, Haruo Nakagawa, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-PEDIATRICS 11 (2) 133-139 2013年2月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2012.10.PEDS12220  

    ISSN:1933-0707

    eISSN:1933-0715

    詳細を見る 詳細を閉じる

    Object. After untethering of spinal dysraphism, some patients present with neurological deterioration, defined as retethered cord syndrome. It is known that surgical untethering is an option for improving the symptoms of retethered cord syndrome. Previous reports have shown that postoperative improvement in retethered cord syndrome was noted in the majority of patients presenting with pain, and in more patients with motor weakness than in those with urological symptoms. The authors speculate that subjective symptoms may be detected while symptoms are still reversible. In contrast, changes in urological function are less easy to diagnose, and delays in treatment may be complicated by advanced symptoms. In this study, patients with retethered cord syndrome were evaluated to investigate the benefits of performing routine urodynamic study to detect detrusor overactivity, which is considered to be a subclinical change of urological function, and to investigate the efficacy of early untethering surgery on the symptoms of retethered cord syndrome. Methods. Surgical indications and outcomes of 78 untethering operations (20 for myelomeningocele, 58 for spinal lipoma) for retethered cord syndrome were examined. Diagnosis of retethered cord syndrome was defined by a multidisciplinary spina bifida team, and included routine urodynamic study. Results. Preoperative symptoms included urological symptoms (70%), lower-extremity symptoms (45%), and others. The most frequent urological symptom was detrusor overactivity detected by urodynamic study (88.7%). Urinary incontinence was only found in 9.4% of patients. Postoperatively, progressive motor weakness improved in all patients, and sensory symptoms improved in 94%. Urological symptoms improved in 80% of the patients with urinary incontinence and in 75% of the patients with detrusor overactivity. Postoperative urodynamic study showed a significant increase in bladder volume (p &lt; 0.05). The most common complication was temporary lower leg paresthesia that recovered at follow-up. Aggravated dysuria was noted in 3 patients. Conclusions. Early untethering operations offer symptomatic relief to patients with retethered cord syndrome. Urodynamic study findings, especially detrusor overactivity, are considered to be the most significant indicators for early diagnosis of retethered cord syndrome. (http://thejns.org/doi/abs/10.3171/2012.10.PEDS12220)

  291. Concurrent dural and perimedullary arteriovenous fistulas at the craniocervical junction: Case series with special reference to angioarchitecture ; Clinical article 査読有り

    Kenichi Sato, Toshiki Endo, Kuniyasu Niizuma, Miki Fujimura, Takashi Inoue, Hiroaki Shimizu, Teiji Tominaga

    Journal of Neurosurgery 118 (2) 451-459 2013年2月

    DOI: 10.3171/2012.10.JNS121028  

    ISSN:0022-3085 1933-0693

    eISSN:1933-0693

    詳細を見る 詳細を閉じる

    Object. Dural arteriovenous fistulas (DAVFs) and perimedullary arteriovenous fistulas (PAVFs) are uncommonly associated in the craniocervical junction. The purpose of this study was to describe the clinical and angiographic characteristics of such concurrent lesions. Methods. Authors reviewed 9 cases with a coexistent DAVF and PAVF at the craniocervical junction. Clinical presentation, angiographic characteristics, intraoperative findings, and treatment outcomes were assessed. Results. All patients (male/female ratio 5:4 mean age 66.3 years) presented with subarachnoid hemorrhage. Angiography revealed that 8 patients had both a DAVF and PAVF on the same side, whereas 1 patient had 3 arteriovenous fistulas, 1 DAVF, and 1 PAVF on the right side and 1 DAVF on the left side. All of the fistulas shared dilated perimedullary veins (anterior spinal vein, 7 cases anterolateral spinal vein, 2 cases) as a main drainage route. The shared drainage route was rostrally directed in 8 of 9 cases. Eight patients exhibited an arterial aneurysm on the distal side of the feeding arteries to the PAVF, and the aneurysm in each case was intraoperatively confirmed as a bleeding point. One patient had ruptured venous ectasia at the perimedullary fistulous point. All patients underwent direct surgery via a posterolateral approach. No recurrence was observed in the 4 patients who underwent postoperative angiography, and no rebleeding event was recorded among any of the 9 patients during the follow-up period (mean 38.4 months). Conclusions. The similarity of the angioarchitecture and the close anatomical relationship between DAVF and PAVF at the craniocervical junction suggested that these lesions are pathogenetically linked. The pathophysiological mechanism and anatomical features of these lesions represent a unique vascular anomaly that should be recognized angiographically to plan a therapeutic strategy. © AANS, 2013.

  292. Randomized trial of chemoradiotherapy and adjuvant chemotherapy with nimustine (ACNU) versus nimustine plus procarbazine for newly diagnosed anaplastic astrocytoma and glioblastoma (JCOG0305) 査読有り

    Soichiro Shibui, Yoshitaka Narita, Junki Mizusawa, Takaaki Beppu, Kuniaki Ogasawara, Yutaka Sawamura, Hiroyuki Kobayashi, Ryo Nishikawa, Kazuhiko Mishima, Yoshihiro Muragaki, Takashi Maruyama, Junichi Kuratsu, Hideo Nakamura, Masato Kochi, Yoshio Minamida, Toshiaki Yamaki, Toshihiro Kumabe, Teiji Tominaga, Takamasa Kayama, Kaori Sakurada, Motoo Nagane, Keiichi Kobayashi, Hirohiko Nakamura, Tamio Ito, Takahito Yazaki, Hikaru Sasaki, Katsuyuki Tanaka, Hideaki Takahashi, Akio Asai, Tomoki Todo, Toshihiko Wakabayashi, Jun Takahashi, Shingo Takano, Takamitsu Fujimaki, Minako Sumi, Yasuji Miyakita, Yoichi Nakazato, Akihiro Sato, Haruhiko Fukuda, Kazuhiro Nomura

    Cancer Chemotherapy and Pharmacology 71 (2) 511-521 2013年2月

    DOI: 10.1007/s00280-012-2041-5  

    ISSN:0344-5704 1432-0843

    詳細を見る 詳細を閉じる

    Purpose: Glioblastoma (GBM) is one of the worst cancers in terms of prognosis. Standard therapy consists of resection with concomitant chemoradiotherapy. Resistance to nimustine hydrochloride (ACNU), an alkylating agent, has been linked to methylguanine DNA methyltransferase (MGMT). Daily administration of procarbazine (PCZ) has been reported to decrease MGMT activity. This study investigated the efficacy of ACNU + PCZ compared to ACNU alone for GBM and anaplastic astrocytoma (AA). Methods: Patients (20-69 years) who had newly diagnosed AA and GBM were randomly assigned to receive radiotherapy with ACNU alone or with ACNU + PCZ. The primary endpoint was overall survival (OS). This was designed as a phase II/III trial with a total sample size of 310 patients and was registered as UMIN-CTR C000000108. Results: After 111 patients from 19 centers in Japan were enrolled, this study was terminated early because temozolomide was newly approved in Japan. The median OS and median progression-free survival (PFS) with ACNU alone (n = 55) or ACNU + PCZ (n = 56) in the intention-to-treat population were 27.4 and 22.4 months (p = 0.75), and 8.6 and 6.9 months, respectively. The median OS and median PFS of the GBM subgroup treated with ACNU alone (n = 40) or ACNU + PCZ (n = 41) were 19.0 and 19.5 months, and 6.2 and 6.3 months, respectively. Grade 3/4 hematologic adverse events occurred in more than 40 % of patients in both arms, and 27 % of patients discontinued treatment because of adverse events. Conclusions: The addition of PCZ to ACNU was not beneficial, in comparison with ACNU alone, for patients with newly diagnosed AA and GBM. © 2012 Springer-Verlag Berlin Heidelberg.

  293. Clinicopathological analysis of nine consecutive central nervous system primitive neuroectodermal tumors in a single institute 査読有り

    Misaki Aizawa-Kohama, Toshihiro Kumabe, Ryuta Saito, Masayuki Kanamori, Yoji Yamashita, Yukihiko Sonoda, Mika Watanabe, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 30 (1) 15-27 2013年1月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1007/s10014-012-0097-x  

    ISSN:1433-7398

    詳細を見る 詳細を閉じる

    The objective of this study was to determine the outcome of central nervous system primitive neuroectodermal tumors (CNS PNETs) and to clarify the histopathological findings as prognostic factors. We performed a retrospective analysis of nine consecutive patients with CNS PNETs who underwent treatment at our institute between 1993 and 2011. All patients were treated by surgical resection followed by chemoradiotherapy. Additional treatment, including surgical resection, was performed at relapse. Expression of immunohistochemical markers was examined for neuronal, astrocytic, mesenchymal, and epithelial differentiation, and also for TP53, O-6-methylguanine-DNA methyltransferase, and Ki-67. Five-year progression-free survival was 18.2 % and the overall survival was 52.5 %. Five the 9 patients had recurrence and 4 patients died during the median follow-up period of 41.1 months. All 4 patients died of dissemination not local recurrence. After relapses, the extent of differentiation was different in each case and TP53 changed to positive or negative, but the Ki-67 labeling index did not reveal any differences between primary and recurrent tumors. A treatment procedure to prevent and treat dissemination of CNS PNETs should be established. Because the pathological change after relapse was different in each case, definitive histopathological prognostic factors for CNS PNETs are still difficult to propose.

  294. Medullary infarction as a poor prognostic factor after internal coil trapping of a ruptured vertebral artery dissection Clinical article 査読有り

    Hidenori Endo, Yasushi Matsumoto, Ryushi Kondo, Kenichi Sato, Miki Fujimura, Takashi Inoue, Hiroaki Shimizu, Akira Takahashi, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 118 (1) 131-139 2013年1月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2012.9.JNS12566  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Object. Internal coil trapping is a treatment method used to prevent rebleeding from a ruptured intracranial vertebral artery dissection (VAD). Postoperative medullary infarctions have been reported as a complication of this treatment strategy. The aim of this study was to determine the relationship between a postoperative medullary infarction and the clinical outcomes for patients with ruptured VADs treated with internal coil trapping during the acute stage of a subarachnoid hemorrhage (SAH). Methods. A retrospective study identified 38 patients who presented between 2006 and 2011 with ruptured VADs and underwent internal coil trapping during the acute stage of SAH. The SAH was identified on CT scanning, and the diagnosis for VAD was rendered by cerebral angiography. Under general anesthesia, the dissection was packed with coils, beginning at the distal end and proceeding proximally. When VAD involved the origin of the posterior inferior cerebellar artery (PICA) with a large cerebellar territory, an occipital artery (OA)-PICA anastomosis was created prior to internal coil trapping. The pre- and postoperative radiological findings, clinical course, and outcomes were analyzed. Results. The internal coil trapping was completed within 24 hours after admission. An OA-PICA anastomosis followed by internal coil trapping was performed in 5 patients. Postoperative rebleeding did not occur in any patient during a mean follow-up period of 16 months. The postoperative MRI studies showed medullary infarctions in 18 patients (47%). The mean length of the trapped VAD for the infarction group (15.7 +/- 6.0 mm) was significantly longer than that of the non-infarction group (11.5 +/- 4.3 mm) (p = 0.019). Three of the 5 patients treated with OA-PICA anastomosis had postoperative medullary infarction. The clinical outcomes at 6 months were favorable (modified Rankin Scale Scores 0-2) for 23 patients (60.5%) and unfavorable (modified Rankin Scale Scores 3-6) for 15 patients (39.5%). Of the 18 patients with postoperative medullary infarctions, the outcomes were favorable for 6 patients (33.3%) and unfavorable for 12 patients (66.7%). A logistic regression analysis predicted the following independent risk factors for unfavorable outcomes: postoperative medullary infarctions (OR 21.287 [95% CI 2.622-498.242], p = 0.003); preoperative rebleeding episodes (OR 7.450 [95% CI 1.140-71.138], p = 0.036); and a history of diabetes mellitus (OR 45.456 [95% CI 1.993-5287.595], p = 0.013). Conclusions. A postoperative medullary infarction was associated with unfavorable outcomes after internal coil trapping for ruptured VADs. Coil occlusion of the long segment of the VA led to medullary infarction, and an OA-PICA bypass did not prevent medullary infarction. A VA-sparing procedure, such as flow diversion by stenting, is an alternative treatment in the future, if this approach is demonstrated to effectively prevent rebleeding. (http://thejns.org/doi/abs/10.3171/2012.9.JNS12566)

  295. Transplantation of bone marrow stromal cell-derived neural precursor cells ameliorates deficits in a rat model of complete spinal cord transection. 国際誌 査読有り

    Misaki Aizawa-Kohama, Toshiki Endo, Masaaki Kitada, Shohei Wakao, Akira Sumiyoshi, Dai Matsuse, Yasumasa Kuroda, Takahiro Morita, Jorge J Riera, Ryuta Kawashima, Teiji Tominaga, Mari Dezawa

    Cell transplantation 22 (9) 1613-25 2013年

    DOI: 10.3727/096368912X658791  

    ISSN:0963-6897

    詳細を見る 詳細を閉じる

    After severe spinal cord injury, spontaneous functional recovery is limited. Numerous studies have demonstrated cell transplantation as a reliable therapeutic approach. However, it remains unknown whether grafted neuronal cells could replace lost neurons and reconstruct neuronal networks in the injured spinal cord. To address this issue, we transplanted bone marrow stromal cell-derived neural progenitor cells (BM-NPCs) in a rat model of complete spinal cord transection 9 days after the injury. BM-NPCs were induced from bone marrow stromal cells (BMSCs) by gene transfer of the Notch-1 intracellular domain followed by culturing in the neurosphere method. As reported previously, BM-NPCs differentiated into neuronal cells in a highly selective manner in vitro. We assessed hind limb movements of the animals weekly for 7 weeks to monitor functional recovery after local injection of BM-NPCs to the transected site. To test the sensory recovery, we performed functional magnetic resonance imaging (fMRI) using electrical stimulation of the hind limbs. In the injured spinal cord, transplanted BM-NPCs were confirmed to express neuronal markers 7 weeks following the transplantation. Grafted cells successfully extended neurites beyond the transected portion of the spinal cord. Adjacent localization of synaptophysin and PSD-95 in the transplanted cells suggested synaptic formations. These results indicated survival and successful differentiation of BM-NPCs in the severely injured spinal cord. Importantly, rats that received BM-NPCs demonstrated significant motor recovery when compared to the vehicle injection group. Volumes of the fMRI signals in somatosensory cortex were larger in the BM-NPC-grafted animals. However, neuronal activity was diverse and not confined to the original hind limb territory in the somatosensory cortex. Therefore, reconstruction of neuronal networks was not clearly confirmed. Our results indicated BM-NPCs as an effective method to deliver neuronal lineage cells in a severely injured spinal cord. However, reestablishment of neuronal networks in completed transected spinal cord was still a challenging task.

  296. Effect of Cilostazol in the Treatment of Acute Ischemic Stroke in the Lenticulostriate Artery Territory 査読有り

    Ryushi Kondo, Yasushi Matsumoto, Eisuke Furui, Ryo Itabashi, Shoichiro Sato, Yukako Yazawa, Hiroaki Shimizu, Satoru Fujiwara, Akira Takahashi, Teiji Tominaga

    EUROPEAN NEUROLOGY 69 (2) 122-128 2013年

    出版者・発行元:KARGER

    DOI: 10.1159/000343799  

    ISSN:0014-3022

    詳細を見る 詳細を閉じる

    Background: Cilostazol, an inhibitor of phosphodiesterase 3, has various pleiotropic effects besides its antiplatelet activity. This study examined the efficacy of cilostazol for the treatment of acute perforating artery infarction. Methods: In this prospective, randomized, open-label, blinded-end point trial, 100 patients with cerebral infarction in the territory of the lenticulostriate arteries were enrolled within 48 h of onset. Patients were randomly treated with both cilostazol and ozagrel for 14 days (n = 50, cilostazol group) or ozagrel alone for 14 days (n = 50, control group). The primary end point was the proportion of favorable outcomes 30 days after randomization as defined by a modified Rankin Scale (mRS) score of 0-2. Secondary end points included the incidence of neurological deterioration (an increase of 6 2 on the National Institutes of Health Stroke Scale within 7 days). Results: Favorable outcomes (mRS scores 0-2) were similar in both groups (81.3 and 82.0% in the cilostazol and control groups, respectively). The incidence of neurological deterioration was lower in the cilostazol group than the control group (12.5 and 16.0%, respectively) with a 21.9% relative risk reduction, although the difference was not statistically significant. Conclusions: Cilostazol did not prevent the neurological deterioration of perforating artery infarction. Copyright (C) 2012 S. Karger AG, Basel

  297. Thyroid-stimulating hormone-secreting pituitary adenoma presenting with recurrent hyperthyroidism in post-treated Graves' disease: a case report. 査読有り

    Ogawa Y, Tominaga T

    Journal of medical case reports 7 27 2013年1月

    DOI: 10.1186/1752-1947-7-27  

  298. Surgical treatment of scaphocephaly with sinus pericranii. 査読有り

    Kimiwada T, Hayashi T, Sanada T, Shirane R, Tominaga T

    Neurologia medico-chirurgica 53 (2) 121-125 2013年

    DOI: 10.2176/nmc.53.121  

    ISSN:0470-8105

  299. Clinicopathological Investigation of Vascular Endothelial Growth Factor and von Hippel-Lindau Gene-Related Protein Expression in Immunohistochemically Negative Pituitary Adenoma - Possible Involvement in Tumor Aggressiveness 査読有り

    Yoshiteru Shimoda, Yoshikazu Ogawa, Mika Watanabe, Teiji Tominaga

    ENDOCRINE RESEARCH 38 (4) 242-250 2013年

    出版者・発行元:INFORMA HEALTHCARE

    DOI: 10.3109/07435800.2013.774411  

    ISSN:0743-5800

    詳細を見る 詳細を閉じる

    Objectives. Immunohistochemically negative pituitary adenoma is known to be relatively indolent, but a few aggressive and highly vascular cases have been reported, which sometimes show high expression of vascular endothelial growth factor (VEGF). Methods. The present study investigated the relationship between high expression of VEGF and the clinical character of pituitary adenomas in 30 cases of immunohistochemically negative pituitary adenomas using immunohistochemical staining with monoclonal VEGF antibody and related upstream factors, including von Hippel-Lindau gene-related protein (pVHL). Correlations between the histological findings and the clinical characteristics were investigated. Results. Immunohistochemical staining using VEGF antibody showed high expression in 7 (23.3%) and low expression in 23 (76.7%) cases, and pVHL staining showed high expression in 24 (80%) and low expression in 6 (20%) cases. The pVHL low expression group showed significantly higher expression of VEGF (p = 0.005019), and significantly higher recurrence or regrowth rate (p = 0.04535) than the pVHL high expression group, whereas Ki-67 labeling index of &gt;3% also showed significant correlation with recurrence or regrowth rate (p = 0.01745). However, there was no significant correlation between pVHL staining and Ki-67 labeling index (p = 0.49978). Conclusion. Low expression of pVHL with high expression of VEGF may be involved in the unusual aggressive clinical course in some pituitary adenomas.

  300. Summary of 15 years experience of awake surgeries for neuroepithelial tumors in tohoku university. 査読有り

    Toshihiro Kumabe, Kiyotaka Sato, Masaki Iwasaki, Ichiyo Shibahara, Tomohiro Kawaguchi, Ryuta Saito, Masayuki Kanamori, Yoji Yamashita, Yukihiko Sonoda, Osamu Iizuka, Kyoko Suzuki, Ken-Ichi Nagamatsu, Shintaro Seki, Nobukazu Nakasato, Teiji Tominaga

    Neurologia medico-chirurgica 53 (7) 455-66 2013年

    DOI: 10.2176/nmc.53.455  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    We retrospectively analyzed 15 years experience of awake surgeries for neuroepithelial tumors in Tohoku University. Awake surgeries mostly for language mapping were performed for 42 of 681 newly diagnosed cases (6.2%) and 59 of 985 surgeries including for recurrence (6.0%). When the same histologies and locations as cases resected under awake condition are selected from the parent population treated by radical resection, awake surgeries were most frequently performed for 14 of 55 newly diagnosed cases (25.5%) and 14 of 62 surgeries (22.6%) with grade II gliomas. In the results, 8 of 59 surgeries (13.6%) could not achieve complete language monitoring until the final stage of tumor resection, considered as failed awake surgery. Gross total resection was accomplished in 20 of 42 newly diagnosed cases (47.6%) and 32 of 59 surgeries (54.2%). Mortality rate was 0%. Late severe deficits were observed in 2 of 42 newly diagnosed cases (4.8%) and 3 of 59 surgeries (5.1%). Negative language mapping cases did not suffer severe deficits in both early and late stages. In contrast, high incidence of severe deficits, 3 as early and 2 as late of 8 cases, were identified with failed awake surgery. The overall survival of patients treated by awake surgery compared favorably with those treated without stimulation mapping and with stimulation mapping under general anesthesia. Awake surgery may contribute to improve the outcome of gliomas near eloquent areas by maximizing the tumor resection and minimizing the surgical morbidity.

  301. Follicle-stimulating hormone-secreting pituitary adenoma manifesting as recurrent ovarian cysts in a young woman - Latent risk of unidentified ovarian hyperstimulation: A case report 査読有り

    Tomohiro Kawaguchi, Yoshikazu Ogawa, Kenji Ito, Mika Watanabe, Teiji Tominaga

    BMC Research Notes 6 (1) 408 2013年

    DOI: 10.1186/1756-0500-6-408  

    ISSN:1756-0500

    詳細を見る 詳細を閉じる

    Background: Ovarian hyperstimulation caused by follicle-stimulating hormone-secreting gonadotroph cell adenoma is a rare, with a few reported cases, but almost certainly unnoticed cases occur because of the absence of detailed examinations. We retrospectively reviewed 200 patients treated for gonadotroph cell adenoma in our institute and identified 26 women of reproductive age. Two of these 26 patients had a history of ovarian cysts. One patient was considered to have had typical ovarian hyperstimulation, successfully treated by transsphenoidal surgery. The other patient initially underwent transsphenoidal surgery because of visual disturbance, but endocrinological examinations suggested possible relationships with previous ovarian hyperstimulation. We present the former case and discuss the latent risk of failure to identify this entity. Case presentation. A 36-year-old woman with a sellar tumor was referred to our hospital with suspected ovarian hyperstimulation. She had a history of repeated surgery for ovarian cysts. Serum follicle-stimulating hormone and estradiol levels were within the normal ranges, and only the luteinizing hormone level was suppressed significantly. Transsphenoidal surgery achieved gross total tumor removal, and the histological diagnosis was follicle-stimulating hormone-secreting gonadotroph cell adenoma. The serum follicle-stimulating hormone, luteinizing hormone, and estradiol levels returned to the normal ranges postoperatively, and the ovarian cysts subsequently decreased in size without particular interventions. Conclusion: Ovarian hyperstimulation could regress after resolving the causes of high follicle-stimulating hormone level, so avoiding unnecessary ovary surgery. Detailed endocrinological examination including estradiol evaluation with pituitary imaging is quite important in women of reproductive age to establish the correct diagnosis. © 2013 Kawaguchi et al. licensee BioMed Central Ltd.

  302. IDH1/2 gene status defines the prognosis and molecular profiles in patients with grade III gliomas 査読有り

    Ichiyo Shibahara, Yukihiko Sonoda, Masayuki Kanamori, Ryuta Saito, Yoji Yamashita, Toshihiro Kumabe, Mika Watanabe, Hiroyoshi Suzuki, Shunsuke Kato, Chikashi Ishioka, Teiji Tominaga

    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 17 (6) 551-561 2012年12月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1007/s10147-011-0323-2  

    ISSN:1341-9625

    詳細を見る 詳細を閉じる

    The discovery of isocitrate dehydrogenase 1 and 2 gene (IDH1/2) mutations has enabled grade III glioma to be divided into mutated and wild-type IDH1/2 groups, which are known to carry different prognosis and molecular features. However, detailed subgroup analysis of grade III glioma is limited. To address this, we investigated molecular and prognostic features of grade III glioma with and without IDH1/2 mutation. We retrospectively analyzed 115 grade III glioma patients. Clinical parameters were obtained from medical records. The mutation of IDH1/2 and TP53 was analyzed by direct sequencing. O-6-methylguanine methyltransferase gene (MGMT) gene promoter methylation status was determined by methylation-specific polymerase chain reaction. Detection of chromosome copy number changes of 1p, 7p (EGFR), 9p (CDKN2A), 10q (PTEN), and 19q was carried out by multiple ligation-dependent probe amplification. Patients were divided into two groups, mutated IDH1/2 and wild-type IDH1/2, for correlation with the factors analyzed. In our series, as previously reported, IDH1/2 mutation was an independent prognostic marker for improved progression-free and overall survival (OS) (P &lt; 0.0001 and P &lt; 0.0001, respectively) in patients with grade III gliomas. Subgroup analysis found that incomplete resection, 7p gain, and TP53 mutation were independent prognostic factors of poor outcome in grade III glioma patients with mutated IDH1/2 (P = 0.0092, P = 0.015 and P = 0.026, respectively), while there were none in patients with wild-type IDH1/2. IDH1/2 gene status was significantly associated with prognosis in grade III gliomas. Subgroup analysis found that poor prognostic factors existed even in patients with IDH1/2 mutation.

  303. A case of moyamoya disease presenting with progressive stroke during the late perinatal period successfully managed by bilateral revascularization surgeries 査読有り

    Takashi Sasaki, Miki Fujimura, Yosuke Akamatsu, Naoto Kimura, Masayuki Ezura, Hiroshi Uenohara, Kozo Akagi, Teiji Tominaga

    Neurological Surgery 40 (12) 1095-1099 2012年12月

    ISSN:0301-2603 1882-1251

    詳細を見る 詳細を閉じる

    We report a case of moyamoya disease presenting with progressive stroke during the late perinatal period, which was successfully managed by emergency caesarean section and subsequent bilateral revascularization surgeries. A 27-year-old woman at 33 weeks of pregnancy suffered from progressive monoparesis on her left hand. Magnetic resonance (MR) imaging/angiography revealed definitive moyamoya disease presenting with acute spotty cerebral infarctions on the right cerebral hemisphere. At 34 weeks of pregnancy, she was transferred to our hospital, where both neurosurgeons and obstetricians were involved in her management. She underwent emergency caesarean section on the day of admission without deterioration of her neurological status, while MRI demonstrated newly-formed spotty infarction on the left hemisphere. Then she was managed by antithrombotic therapy for 4 weeks, and then underwent right superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis, followed by left STA-MCA anastomosis one month later without complications. Postoperative course was uneventful, and MRI after surgeries showed no expansion of ischemic lesion. The MRA showed apparently patent STA-MCA bypasses bilaterally. She was discharged without complication, and her symptom significantly improved two weeks after the left revascularization surgery.

  304. Required knowledge for neuroendovascular surgeon (4) basic technique of the coil embolization and parent artery occlusion for cerebral aneurysms 査読有り

    Hidenori Endo, Yasushi Matsumoto, Ryushi Kondo, Ichiro Suzuki, Toshio Kikuchi, Teiji Tominaga

    Neurological Surgery 40 (12) 1107-1118 2012年12月

    ISSN:0301-2603 1882-1251

  305. Hemodynamic Analysis of Growing Intracranial Aneurysms Arising from a Posterior Inferior Cerebellar Artery 査読有り

    Shin-Ichiro Sugiyama, Hui Meng, Kenichi Funamoto, Takashi Inoue, Miki Fujimura, Toshio Nakayama, Shunsuke Omodaka, Hiroaki Shimizu, Akira Takahashi, Teiji Tominaga

    WORLD NEUROSURGERY 78 (5) 462-468 2012年11月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.wneu.2011.09.023  

    ISSN:1878-8750

    詳細を見る 詳細を閉じる

    OBJECTIVE: The role of hemodynamics in the growth of intracranial aneurysms is not completely clear. We present a hemodynamic study with two adjacent unruptured aneurysms arising from one parent artery but growing in different ways. This study aimed to investigate whether there were differences in hemodynamic characteristics between the two growing aneurysms. METHODS: A 62-year-old female patient presented with six unruptured intracranial aneurysms. Catheter angiography at 6-month intervals revealed that two aneurysms located adjacently at the right posterior inferior cerebellar artery were growing over a 1-year period. Three-dimensional aneurysm geometries were acquired via rotational angiography. Computational fluid dynamic simulations were conducted on the 3D aneurysm geometries under patient-specific pulsatile flow conditions that were measured by magnetic resonance velocimetry. RESULTS: The proximal multilobular aneurysm demonstrated high flow and physiological levels of wall shear stress (WSS) in the region of growth, whereas the distal rounded aneurysm had low flow and low WSS in the growing sac. CONCLUSION: Growing aneurysms can have heterogeneous hemodynamic and morphologic characteristics and different growing patterns. Growing regions of an aneurysm could be exposed to either high WSS at the inflow zone or low WSS and high oscillatory shear in the aneurysm sac.

  306. Childhood transverse sinus dural arteriovenous fistula treated with endovascular and direct surgery: A case report 査読有り

    Kuniyasu Niizuma, Hiroyuki Sakata, Shinya Koyama, Hiroyuki Kon, Masashi Chonan, Tatsuya Sasaki, Michiharu Nishijima, Masayuki Ezura, Teiji Tominaga

    Neurological Surgery 40 (11) 1015-1020 2012年11月

    ISSN:0301-2603 1882-1251

    詳細を見る 詳細を閉じる

    Infantile dural arteriovenous fistula is a rare cerebrovascular malformation carrying a poor prognosis with an anatomic cure of only 9%. Endovascular embolization is mainly selected to treat this entity, aiming to obtain normal development of the patients. We present a case of a 20-month-old girl with epilepsy. Digital subtraction angiography revealed a dural arteriovenous fistula involving the right transverse sinus. The artenovenous fistula was fed by multiple dural branches from the middle meningeal, occipital, meningohypophyseal. and anteroinferior cerebellar arteries. The right transverse sinus was transvenously embolized with platinum coils. Although the shunt flow remained, the patient was liberated from epilepsy. Nine months later, the patient suffered from a recurrence of epilepsy. Digital subtraction angiography demonstrated some increase in shunt flow. Right middle meningeal, occipital, posterior deep temporal, and tentorial arteries were transarterially embolized using N-butyl cyanoacrylate, followed by complete surgical resection of the nght transverse sinus. The shunt flow disappeared after surgery, and her epilepsy improved significantly. Our experience suggests that the combination of endovascular and surgical treatment is effective for recurrent infantile dural arteriovenous fistula.

  307. Influence of surface model extraction parameter on computational fluid dynamics modeling of cerebral aneurysms 査読有り

    Shunsuke Omodaka, Takashi Inoue, Kenichi Funamoto, Shin-ichirou Sugiyama, Hiroaki Shimizu, Toshiyuki Hayase, Akira Takahashi, Teiji Tominaga

    JOURNAL OF BIOMECHANICS 45 (14) 2355-2361 2012年9月

    出版者・発行元:ELSEVIER SCI LTD

    DOI: 10.1016/j.jbiomech.2012.07.006  

    ISSN:0021-9290

    詳細を見る 詳細を閉じる

    Threshold image intensity for reconstructing patient-specific vascular models is generally determined subjectively. We assessed the effects of threshold image intensity differences on computational fluid dynamics (CFD) using a simple method of threshold determination. This study included 11 consecutive patients with internal carotid artery aneurysms collected retrospectively between April 2009 and March 2010. In 3-dimensional rotational angiography image data, we set a line probe across the coronal cross-section of the parent internal carotid artery, and calculated a profile curve of the image intensity along this line. We employed the threshold coefficient (C-thre) value in this profile curve, in order to determine the threshold image intensity objectively. We assessed the effects of C-thre value differences on vascular model configuration and the wall shear stress (WSS) distribution of the aneurysm. The threshold image intensity increased as the C-thre value increased. The frequency of manual editing increased as the C-thre value decreased, while disconnection of the posterior communicating artery occurred more frequently as the C-thre value increased. The volume of the vascular model decreased and WSS increased according to the C-thre value increase. The pattern of WSS distribution changed remarkably in one case. Threshold image intensity differences can produce profound effects on CFD. Our results suggest the uniform setting of C-thre value is important for objective CFD. (c) 2012 Elsevier Ltd. All rights reserved.

  308. [Case of chordoid glioma of the third ventricle]. 査読有り

    Ayumi Narisawa, Toshihiro Kumabe, Ryuta Saito, Yukihiko Sonoda, Mika Watanabe, Teiji Tominaga

    No shinkei geka. Neurological surgery 40 (9) 805-11 2012年9月

    ISSN:0301-2603

  309. Subgroup-specific structural variation across 1,000 medulloblastoma genomes 査読有り

    Paul A. Northcott, David J. H. Shih, John Peacock, Livia Garzia, A. Sorana Morrissy, Thomas Zichner, Adrian M. Stuetz, Andrey Korshunov, Jueri Reimand, Steven E. Schumacher, Rameen Beroukhim, David W. Ellison, Christian R. Marshall, Anath C. Lionel, Stephen Mack, Adrian Dubuc, Yuan Yao, Vijay Ramaswamy, Betty Luu, Adi Rolider, Florence M. G. Cavalli, Xin Wang, Marc Remke, Xiaochong Wu, Readman Y. B. Chiu, Andy Chu, Eric Chuah, Richard D. Corbett, Gemma R. Hoad, Shaun D. Jackman, Yisu Li, Allan Lo, Karen L. Mungall, Ka Ming Nip, Jenny Q. Qian, Anthony G. J. Raymond, Nina Thiessen, Richard J. Varhol, Inanc Birol, Richard A. Moore, Andrew J. Mungall, Robert Holt, Daisuke Kawauchi, Martine F. Roussel, Marcel Kool, David T. W. Jones, Hendrick Witt, Africa Fernandez-L, Anna M. Kenney, Robert J. Wechsler-Reya, Peter Dirks, Tzvi Aviv, Wieslawa A. Grajkowska, Marta Perek-Polnik, Christine C. Haberler, Olivier Delattre, Stephanie S. Reynaud, Francois F. Doz, Sarah S. Pernet-Fattet, Byung-Kyu Cho, Seung-Ki Kim, Kyu-Chang Wang, Wolfram Scheurlen, Charles G. Eberhart, Michelle Fevre-Montange, Anne Jouvet, Ian F. Pollack, Xing Fan, Karin M. Muraszko, G. Yancey Gillespie, Concezio Di Rocco, Luca Massimi, Erna M. C. Michiels, Nanne K. Kloosterhof, Pim J. French, Johan M. Kros, James M. Olson, Richard G. Ellenbogen, Karel Zitterbart, Leos Kren, Reid C. Thompson, Michael K. Cooper, Boleslaw Lach, Roger E. McLendon, Darell D. Bigner, Adam Fontebasso, Steffen Albrecht, Nada Jabado, Janet C. Lindsey, Simon Bailey, Nalin Gupta, William A. Weiss, Laszlo Bognar, Almos Klekner, Timothy E. Van Meter, Toshihiro Kumabe, Teiji Tominaga, Samer K. Elbabaa, Jeffrey R. Leonard, Joshua B. Rubin, Linda M. Liau, Erwin G. Van Meir, Maryam Fouladi, Hideo Nakamura, Giuseppe Cinalli, Miklos Garami, Peter Hauser, Ali G. Saad, Achille Iolascon, Shin Jung, Carlos G. Carlotti, Rajeev Vibhakar, Young Shin Ra, Shenandoah Robinson, Massimo Zollo, Claudia C. Faria, Jennifer A. Chan, Michael L. Levy, Poul H. B. Sorensen, Matthew Meyerson, Scott L. Pomeroy, Yoon-Jae Cho, Gary D. Bader, Uri Tabori, Cynthia E. Hawkins, Eric Bouffet, Stephen W. Scherer, James T. Rutka, David Malkin, Steven C. Clifford, Steven J. M. Jones, Jan O. Korbel, Stefan M. Pfister, Marco A. Marra, Michael D. Taylor

    NATURE 488 (7409) 49-56 2012年8月

    出版者・発行元:NATURE PUBLISHING GROUP

    DOI: 10.1038/nature11327  

    ISSN:0028-0836

    詳細を見る 詳細を閉じる

    Medulloblastoma, the most common malignant paediatric brain tumour, is currently treated with nonspecific cytotoxic therapies including surgery, whole-brain radiation, and aggressive chemotherapy. As medulloblastoma exhibits marked intertumoural heterogeneity, with at least four distinct molecular variants, previous attempts to identify targets for therapy have been underpowered because of small samples sizes. Here we report somatic copy number aberrations (SCNAs) in 1,087 unique medulloblastomas. SCNAs are common in medulloblastoma, and are predominantly subgroup-enriched. The most common region of focal copy number gain is a tandem duplication of SNCAIP, a gene associated with Parkinson's disease, which is exquisitely restricted to Group 4 alpha. Recurrent translocations of PVT1, including PVT1-MYC and PVT1-NDRG1, that arise through chromothripsis are restricted to Group 3. Numerous targetable SCNAs, including recurrent events targeting TGF-beta signalling in Group 3, and NF-kappa B signalling in Group 4, suggest future avenues for rational, targeted therapy.

  310. Coexistence of Sporadic Cerebellar Hemangioblastoma and Pituitary Null Cell Adenoma: Simultaneous Expression of von Hippel-Lindau Gene Product -Case Report- 査読有り

    Yoshiteru Shimoda, Yoshikazu Ogawa, Hidenori Endo, Mika Watanabe, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 52 (8) 591-594 2012年8月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.52.591  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    Coexistence of brain tumors of different pathologies is rare, and the majority of the cases were related to genetic disorders or secondary tumors occurring after radiotherapy. A 73-year-old man was introduced to the outpatient department suffering from severe nausea and vertigo. Magnetic resonance imaging showed a cystic tumor in the left cerebellar hemisphere and another lesion in the sella turcica. There was no evident family history of von Hippel-Lindau (VHL) disease, and the systemic investigation failed to detect any other tumors or signs of VHL disease. Treatment was performed in two stages, and he was discharged with remaining slight ataxic gait. The diagnoses were cerebellar hemangioblastoma and pituitary null cell adenoma. Additional immunohistochemical investigation using VHL disease gene-related protein in both tumors showed minute granular positive staining in the cytoplasm of stromal cells in the former, and diffuse and strong granular cytoplasmic positive staining in the latter. Further analysis is required to confirm the true implication of the VHL gene mutation, and the possible involvement of VHL gene-related protein in the pathogenesis of these coexisting tumors.

  311. Annual rupture risk of growing unruptured cerebral aneurysms detected by magnetic resonance angiography Clinical article 査読有り

    Takashi Inoue, Hiroaki Shimizu, Miki Fujimura, Atsushi Saito, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 117 (1) 20-25 2012年7月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2012.4.JNS112225  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Object. In this paper, the authors' goals were to clarify the characteristics of growing unruptured cerebral aneurysms detected by serial MR angiography and to establish the recommended follow-up interval. Methods. A total of 1002 patients with 1325 unruptured cerebral aneurysms were retrospectively identified. These patients had undergone follow-up evaluation at least twice. Aneurysm growth was defined as an increase in maximum aneurysm diameter by 1.5 times or the appearance of a bleb. Results. Aneurysm growth was observed in 18 patients during the period of this study (1.8%/person-year). The annual rupture risk after growth was 18.5%/person-year. The proportion of females among patients with growing aneurysms was significantly larger than those without growing aneurysms (p = 0.0281). The aneurysm wall was reddish, thin, and fragile on intraoperative findings. Frequent follow-up examination is recommended to detect aneurysm growth before rupture. Conclusions. Despite the relatively short period, the annual rupture risk of growing unruptured cerebral aneurysms detected by MR angiography was not as low as previously reported. Surgical or endovascular treatment can be considered if aneurysm growth is detected during the follow-up period. (http://thejns.org/doi/abs/10.3171/2012.4.JNS112225)

  312. An analysis of flow dynamics in cerebral cavernous malformation and orbital cavernous angioma using indocyanine green videoangiography 査読有り

    Kensuke Murakami, Toshiki Endo, Teiji Tominaga

    ACTA NEUROCHIRURGICA 154 (7) 1169-1175 2012年7月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-012-1354-9  

    ISSN:0001-6268

    詳細を見る 詳細を閉じる

    Cerebral cavernous malformations (CCMs) are known to be vascular anomalies with low perfusion because of being angiographically occult. We attempted direct visualization of blood flow within CCMs and orbital cavernous angiomas (CAs), and analyzed flow dynamics using indocyanine green videoangiography (ICG-VAG). This series included seven CCMs and two orbital CAs. ICG-VAG was performed to visualize blood flow of the lesions before resection. Time to peak of staining was evaluated by reviewing recorded ICG-VAG. In five of seven CCMs, stain was identified. CCMs were seen as avascular areas in both arterial and venous phases, and were stained gradually. Stain was maximized late after venous phase. The orbital CAs were also stained lately, but more intensely than CCMs. The present study directly demonstrated slow and low perfusion within CCM and orbital CA using ICG-VAG. On the basis of characteristic flow dynamics of CCMs, intraoperative ICG-VAG provides useful information in microsurgical resection.

  313. Complete remission of seizures after corpus callosotomy 査読有り

    Masaki Iwasaki, Mitsugu Uematsu, Yuko Sato, Tojo Nakayama, Kazuhiro Haginoya, Shin-ichiro Osawa, Hisashi Itabashi, Kazutaka Jin, Nobukazu Nakasato, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-PEDIATRICS 10 (1) 7-13 2012年7月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2012.3.PEDS11544  

    ISSN:1933-0707

    詳細を見る 詳細を閉じる

    Object. Corpus callosotomy is usually intended to alleviate - not to achieve total control of - epileptic seizures. A few patients experience complete seizure control after callosotomy, but the associated clinical factors are unknown. The object of this study was to investigate clinical factors associated with lone-term seizure remission after total corpus callosotomy in patients with infantile or early childhood onset epilepsy. Methods. Thirteen consecutive patients with infantile or early childhood onset epilepsy underwent 1-stage total corpus callosotomy for alleviation of seizures. Their age at surgery ranged from 1 year and 5 months to 24 years (median 7 years). Eleven patients had West syndrome at the onset of disease, and the other 2 had Lennox-Gastaut syndrome. All patients suffered from spasms, axial tonic seizures, or atonic seizures. Six patients had proven etiology of epilepsy, including tuberous sclerosis, polymicrogyria, trauma, and Smith-Magenis syndrome. The association between postoperative seizure freedom and preoperative factors including age at surgery, no MRI abnormalities, proven etiology, and focal electroencephalographic epileptiform discharges was examined. Results. Postoperative seizure freedom was achieved in 4 of 13 patients for a minimum of 12 months. All 4 patients had no MRI abnormalities and no identified etiology. None of the 8 patients with MRI abnormality, 6 patients with known etiology of epilepsy, or 4 patients aged older than 10 years at surgery achieved seizure freedom. Two of the 7 patients with focal electroencephalographic abnormalities became seizure free. Absence of MRI abnormalities was significantly associated with postoperative seizure freedom (p &lt; 0.01). Conclusions. Complete seizure remission is achieved after total corpus callosotomy in a subgroup of patients with intractable epilepsy following West syndrome or Lennox-Gastaut syndrome. One-stage total corpus callosotomy at a young age may provide a higher rate of seizure freedom, especially for patients with no MRI abnormalities and no identified etiology of epilepsy. (http://thejns.org/doi/abs/10.3171/2012.3.PEDS11544)

  314. Safety and feasibility of convection-enhanced delivery of nimustine hydrochloride co-infused with free gadolinium for real-time monitoring in the primate brain 査読有り

    Shin-ichiro Sugiyama, Ryuta Saito, Taigen Nakamura, Yoji Yamashita, Michiko Yokosawa, Yukihiko Sonoda, Toshihiro Kumabe, Mika Watanabe, Teiji Tominaga

    NEUROLOGICAL RESEARCH 34 (6) 581-587 2012年7月

    出版者・発行元:MANEY PUBLISHING

    DOI: 10.1179/1743132812Y.0000000050  

    ISSN:0161-6412

    詳細を見る 詳細を閉じる

    Objectives: Convection-enhanced delivery (CED) has been developed as an effective drug-delivery strategy for brain tumors. Ideally, direct visualization of the tissue distribution of drugs infused by CED would assure successful delivery of therapeutic agents to the brain tumor while minimizing exposure of the normal brain tissue. We previously showed the anti-tumor efficacy of nimustine hydrochloride (ACNU) delivered via CED against a rodent intracranial xenografted tumor model. Here, we developed a method to monitor the drug distribution using a non-human primate brain. Methods: CED of a mixture of ACNU with gadodiamide was performed using three non-human primates under real-time magnetic resonance imaging monitoring. Animals were clinically observed for any toxicity after infusion. Two months later, their brains were subjected to histological examination for the evaluation of local toxicity. Another one animal was euthanized immediately after CED of a mixture of ACNU, gadodiamide, and Evans blue dye to evaluate the concordance between ACNU and gadodiamide distributions. The harvested brain was cut into blocks and the ACNU content was measured. Results and discussion: Real-time magnetic resonance imaging monitoring of co-infused gadodiamide confirmed the success of the infusion maneuver. In the monkey that also received Evans blue, the distribution of Evans blue was similar to that of gadodiamide and paralleled the measured ACNU content, suggesting concordance between ACNU and gadodiamide distributions. Histological examination revealed minimum tissue damage with the infusion of ACNU at 1 mg/ml, determined as a safe dose in our previous rodent study. CED of ACNU can be co-administered with gadodiamide to ensure successful infusion and monitor the distribution volume.

  315. Occipital Artery-Anterior Inferior Cerebellar Artery Bypass With Microsurgical Trapping for Exclusively Intra-meatal Anterior Inferior Cerebellar Artery Aneurysm Manifesting as Subarachnoid Hemorrhage -Case Report- 査読有り

    Miki Fujimura, Takashi Inoue, Hiroaki Shimizu, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 52 (6) 435-438 2012年6月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.52.435  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 77-year-old woman presented with an extremely rare exclusively intra-meatal anterior inferior cerebellar artery (AICA) aneurysm manifesting as subarachnoid hemorrhage. The aneurysm was located at a non-branching site of its meatal loop, deeply inside the internal auditory canal. The ipsilateral posterior inferior cerebellar artery was hypoplastic and the affected AICA supplied a wide vascular territory in the right cerebellum. The patient underwent microsurgical trapping of the distal AICA aneurysm in the acute stage. Collateral back flow to the parent artery was poor, so right occipital artery (OA)-AICA anastomosis was performed prior to aneurysm trapping. The postoperative course was uneventful, and magnetic resonance imaging after surgery did not demonstrate any ischemic change. Postoperative angiography showed complete disappearance of the AICA aneurysm and the apparently patent OA-AICA bypass. She did not suffer neurological deficit except for right incomplete hearing disturbance, and postoperative single photon emission computed tomography demonstrated absence of hemodynamic compromise in the cerebellum. OA-AICA anastomosis with aneurysm trapping could be the optimal surgical management of the AICA aneurysm located exclusively inside the internal auditory canal, especially if the parent artery supplies a wide vascular territory.

  316. Lessons Learned From Moyamoya Disease: Outcome of Direct/Indirect Revascularization Surgery for 150 Affected Hemispheres 査読有り

    Miki Fujimura, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 52 (5) 327-332 2012年5月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.52.327  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    Moyamoya disease is a chronic, occlusive cerebrovascular disease with unknown etiology characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. Recent advances in molecular biology and genetic research have provided better understanding of the pathophysiology of moyamoya disease, but surgical revascularization still remains the preferred treatment for this entity. The present study investigated the clinical course of 106 consecutive patients with moyamoya disease who underwent superficial temporal artery-middle cerebral artery anastomosis with indirect pial synangiosis in 150 hemispheres. The outcomes of surgery on the operated hemisphere were favorable, with no cerebrovascular event during the outpatient follow-up period (mean 58.4 months) in 89.3% (134/150). Two patients suffered hemorrhagic events on the operated hemisphere during the follow-up period (2/150, 1.33%), one of whom suffered deteriorated neurological status after hemorrhage. Despite the favorable long-term outcome, the incidence of temporary neurological deterioration due to cerebral hyperperfusion was 18.0% (27/150), but no patients suffered permanent neurological deterioration directly caused by hyperperfusion. In conclusion, direct/indirect revascularization surgery is a safe and effective treatment for moyamoya disease, although the issue of bleeding/re-bleeding remains to be solved. Postoperative cerebral hyperperfusion and pen-operative infarction are potential complications of this procedure, so we recommend intensive postoperative care and cerebral blood flow measurement in the acute stage, because the management of hyperperfusion is contradictory to that of ischemia.

  317. Temporal Profile of De Novo Development of Moyamoya Vasculopathy in an Adult -Case Report 査読有り

    Yoshiteru Shimoda, Miki Fujimura, Takashi Inoue, Hiroaki Shimizu, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 52 (5) 339-342 2012年5月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.52.339  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 46-year-old woman developed transient ischemic attack (TIA) caused by progressive moyamoya vasculopathy in the right hemisphere. She had presented with minor cerebellar infarction due to left vertebral artery dissection 7 years prior to the onset of TIA. Initial carotid angiography at the onset of vertebral artery dissection demonstrated absence of steno-occlusive changes in the anterior circulation. During the next 7 years, she had been strictly followed up with magnetic resonance angiography every 6 months, which demonstrated the asymptomatic development of steno-occlusive change in the proximal right middle cerebral artery, finally involving the terminal internal carotid artery. Carotid angiography at the onset of TIA showed terminal internal carotid artery stenosis with abnormal vascular network at the right base of the brain, indicating a definitive diagnosis of moyamoya vasculopathy with unilateral involvement. She underwent right superficial temporal artery-middle cerebral artery anastomosis without complication one month later. TIA completely disappeared after surgery, and no cerebrovascular events occurred during the follow-up period of 6 months. De novo formation of moyamoya vasculopathy is extremely rare in adulthood. The present case demonstrated the entire temporal profile of the development of this rare entity in adulthood. The previous presentation of vertebral artery dissection before the development of moyamoya vasculopathy as well as the initiation of steno-occlusive change at the middle cerebral artery is apparently unique.

  318. Mutations in genes encoding the glycine cleavage system predispose to neural tube defects in mice and humans. 国際誌 査読有り

    Ayumi Narisawa, Shoko Komatsuzaki, Atsuo Kikuchi, Tetsuya Niihori, Yoko Aoki, Kazuko Fujiwara, Mitsuyo Tanemura, Akira Hata, Yoichi Suzuki, Caroline L Relton, James Grinham, Kit-Yi Leung, Darren Partridge, Alexis Robinson, Victoria Stone, Peter Gustavsson, Philip Stanier, Andrew J Copp, Nicholas D E Greene, Teiji Tominaga, Yoichi Matsubara, Shigeo Kure

    Human molecular genetics 21 (7) 1496-503 2012年4月1日

    DOI: 10.1093/hmg/ddr585  

    ISSN:0964-6906

    詳細を見る 詳細を閉じる

    Neural tube defects (NTDs), including spina bifida and anencephaly, are common birth defects of the central nervous system. The complex multigenic causation of human NTDs, together with the large number of possible candidate genes, has hampered efforts to delineate their molecular basis. Function of folate one-carbon metabolism (FOCM) has been implicated as a key determinant of susceptibility to NTDs. The glycine cleavage system (GCS) is a multi-enzyme component of mitochondrial folate metabolism, and GCS-encoding genes therefore represent candidates for involvement in NTDs. To investigate this possibility, we sequenced the coding regions of the GCS genes: AMT, GCSH and GLDC in NTD patients and controls. Two unique non-synonymous changes were identified in the AMT gene that were absent from controls. We also identified a splice acceptor site mutation and five different non-synonymous variants in GLDC, which were found to significantly impair enzymatic activity and represent putative causative mutations. In order to functionally test the requirement for GCS activity in neural tube closure, we generated mice that lack GCS activity, through mutation of AMT. Homozygous Amt(-/-) mice developed NTDs at high frequency. Although these NTDs were not preventable by supplemental folic acid, there was a partial rescue by methionine. Overall, our findings suggest that loss-of-function mutations in GCS genes predispose to NTDs in mice and humans. These data highlight the importance of adequate function of mitochondrial folate metabolism in neural tube closure.

  319. Extended transsphenoidal approach for tuberculum sellae meningioma-What are the optimum and critical indications? 査読有り

    Yoshikazu Ogawa, Teiji Tominaga

    ACTA NEUROCHIRURGICA 154 (4) 621-626 2012年4月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-011-1266-0  

    ISSN:0001-6268

    詳細を見る 詳細を閉じる

    Recent advances in minimally invasive surgery have allowed extended transsphenoidal approaches to treat large and complex lesions beyond the sella turcica including basal meningiomas, but the inclusion criteria and limitations of this approach remain unclear. Retrospective review of 19 consecutive patients (5 males and 14 females aged from 43 to 79 years) with tuberculum sellae meningioma with a maximum diameter of less than 30 mm surgically treated between December 2006 and August 2011 by a single surgeon. Operative outcomes and limitation-based indications were investigated. Total removal was achieved in 15 cases including Simpson's grade 1 in 2 cases (78.9%). All tumor remnants were located in the lateral portion of the internal carotid artery (ICA), as indicated by preoperative magnetic resonance (MR) imaging. Additional oblique imaging along the longitudinal axis of the C1-2 portion of the ICA revealed a paradoxical presence of tumor in between both sides of the ICA in some patients, even in the case with lateral extension over the ICA on coronal MR imaging. Total removal could be achieved in these patients, and after the introduction of additional preoperative oblique MR imaging, total removal was achieved in all patients. Visual outcomes of eyes showed improvement in 23, remained steady in 11, and showed deterioration in 4, and 89.5% eyes recovered to a good state. Deterioration was caused by injury of a small vein in one patient and previous disruption of the arachnoidal sheath in the remaining three. One patient suffered cerebrospinal fluid leakage and required re-operation. None of the patients developed endocrinological deficits or required prolonged hormonal supplementation. The extended transsphenoidal approach has equivalent potential to transcranial surgery for tuberculum sellae meningiomas with a maximum diameter of less than 30 mm. The tumors with lateral extension over the ICA have fewer chances of total removal. ICA-oriented simulation and surgical planning are important.

  320. [IDH gene mutation in brain tumors]. 査読有り

    Yukihiko Sonoda, Teiji Tominaga

    No shinkei geka. Neurological surgery 40 (4) 297-306 2012年4月

    ISSN:0301-2603

  321. Consistent focal cerebral ischemia without posterior cerebral artery occlusion and its real-time monitoring in an intraluminal suture model in mice Laboratory investigation 査読有り

    Yosuke Akamatsu, Hiroaki Shimizu, Atsushi Saito, Miki Fujimura, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 116 (3) 657-664 2012年3月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2011.11.JNS111167  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Object. In the intraluminal suture model of middle cerebral artery occlusion (MCAO) in the mouse, disturbance of blood flow from the internal carotid artery to the posterior cerebral artery (PCA) may affect the size of the infarction. In this study, PCA involvement in the model was investigated and modified for consistent MCAO without involving the PCA territory. Methods. Thirty-seven C57Bl/6 mice were randomly divided into 4 groups according to the length of coating over the tip of the suture (1, 2, 3, or 4 mm) and subjected to transient MCAO for 2 hours. Real-time topographical cerebral blood flow was monitored over both hemispheres by laser speckle flowmetry. After 24 hours of reperfusion, the infarct territories and volumes were evaluated. Results. The 1- and 2-mm coating groups showed all lesions in the MCA territory. In the 3- and 4-mm coating groups, 62.5% and 75% of mice, respectively, showed lesions in both the MCA and the PCA territories and other lesions in the MCA territory. Mice in the 1- and 2-mm coating groups had significantly smaller infarct volumes than the 3- and 4-mm groups. Laser speckle flowmetry was useful to distinguish whether the PCA territory would undergo infarction. Conclusions. Small changes in the coating length of the intraluminal suture may be critical, and 1-2 mm of coating appeared to be optimal to produce consistent MCAO without involving the PCA territory. Laser speckle flowmetry could predict the territory of infarction and improve the consistency of the infarct size. (DOI: 10.3171/2011.11.JNS111167)

  322. Localization of Abnormal Discharges Causing Insular Epilepsy by Magnetoencephalography 査読有り

    Hyeon-Mi Park, Nobukazu Nakasato, Teiji Tominaga

    TOHOKU JOURNAL OF EXPERIMENTAL MEDICINE 226 (3) 207-211 2012年3月

    出版者・発行元:TOHOKU UNIV MEDICAL PRESS

    DOI: 10.1620/tjem.226.207  

    ISSN:0040-8727

    eISSN:1349-3329

    詳細を見る 詳細を閉じる

    The insula, one of the five cerebral lobes of the brain, is located deep within the brain and lies mainly beneath the temporal lobe. Insular epilepsy can be easily confused and misdiagnosed as temporal lobe epilepsy (TLE) because of the similar clinical symptoms and scalp electroencephalography (EEG) findings due to the insula location and neuronal connections with the temporal lobe. Magnetoencephalography (MEG) has higher sensitivity and spatial resolution than scalp EEG, and thus can often identify epileptic discharges not revealed by scalp EEG. Simultaneous scalp EEG and MEG were performed to detect and localize epileptic discharges in two patients known to have insular epilepsy associated with cavernous angioma in the insula. Epileptic discharges were detected as abnormal spikes in the EEG and MEG findings. In Patient 1, the sources of all MEG spikes detected simultaneously by EEG and MEG (E/M-spikes) were localized in the anterior temporal lobe, similar to TLE. In contrast, the sources of all MEG spikes detected only by MEG (M-spikes) were adjacent to the insular lesion. In Patient 2, the sources of all MEG spikes detected simultaneously by EEG and MEG (E/M-spikes) were localized in the anterior temporal lobe. These findings indicate that MEG allows us to detect insular activity that is undetectable by scalp EEG. In conclusion, simultaneous EEG and MEG are helpful for detecting spikes and obtaining additional information about the epileptic origin and propagation in patients with insular epilepsy. (C) 2012 Tohoku University Medical Press

  323. Ruptured Aneurysm of a Posterior Inferior Cerebellar Artery Communicating Artery - Case Report and Histological Findings 査読有り

    Shin-ichiro Sugiyama, Miki Fujimura, Takashi Inoue, Hiroaki Shimizu, Mika Watanabe, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 52 (2) 81-83 2012年2月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.52.81  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A hypertensive 60-year-old man presented with a rare aneurysm arising from the posterior inferior cerebellar artery (PICA) communicating artery, manifesting as subarachnoid hemorrhage with intraventricular hemorrhage. Angiography showed a small aneurysm arising from a fine and tortuous artery interconnecting the bilateral vermian branches of distal PICAs. The right PICA was absent and its vermian territory was supplied by the left PICA through this communicating artery. The right anterior inferior cerebellar artery was also connected to the vermian branch of the right PICA. At surgery, a reddish and apparent fusiform aneurysm was noted at the top of the arterial loop under the cerebellar vermis. Microsurgical trapping and removal of the aneurysm was performed without complication. Histological examination demonstrated typical findings of a true aneurysm. Only four previous cases of aneurysm of the communicating artery between the bilateral distal PICAs have been reported. In all five reported cases including ours, the PICA communicating artery contributed to the collateral blood supply of the contralateral vermian territory based on vascular anomalies. Hemodynamic stress and congenital vulnerability may have caused this aneurysm. Trapping is suitable to treat this precarious aneurysm if other collateral vessels supply the contralateral vermian territory.

  324. A case of intravascular epithelioid hemangioendothelioma occurring 14 years after coil embolization for an extracranial internal carotid artery aneurysm 査読有り

    Shin-Ichiro Osawa, Atsushi Saito, Hiroaki Shimizu, Takenori Ogawa, Mika Watanabe, Teiji Tominaga

    JOURNAL OF VASCULAR SURGERY 55 (1) 230-233 2012年1月

    出版者・発行元:MOSBY-ELSEVIER

    DOI: 10.1016/j.jvs.2011.06.108  

    ISSN:0741-5214

    詳細を見る 詳細を閉じる

    Epithelioid hemangioendothelioma (EHE) is a rare neoplasm originating from various organs. The clinical outcome mostly depends on surgical resectability. The authors report an EHE of the extracranial internal carotid artery developed in a 59-year-old male patient 14 years after the intravascular coil embolization for a carotid aneurysm at the same site. Because the lesion was initially diagnosed as regrowth of the thrombosed aneurysm, decision for radical resection was delayed, and the patient died from rapid tumor progression. Differential diagnosis of atypical vascular mass lesions should include neoplasm, because initial radical resection may be the key to achieve a better prognosis. (J Vasc Surg 2012;55: 230-3.)

  325. [Recent advances in epilepsy management]. 査読有り

    Kazutaka Jin, Nobukazu Nakasato, Masaki Iwasaki, Teiji Tominaga

    No shinkei geka. Neurological surgery 40 (1) 5-14 2012年1月

    ISSN:0301-2603

  326. Antiplatelet therapy for prevention of thromboembolic complications associated with coil embolization of unruptured cerebral aneurysms 査読有り

    Yasushi Matsumoto, Ryushi Kondo, Yasuhiko Matsumori, Hiroaki Shimizu, Akira Takahashi, Teiji Tominaga

    Drugs in R and D 12 (1) 1-7 2012年

    DOI: 10.2165/11599070-000000000-00000  

    ISSN:1174-5886 1179-6901

    eISSN:1179-6901

    詳細を見る 詳細を閉じる

    Background: Antiplatelet agents are used during endovascular treatment of cerebral aneurysms to prevent thromboembolic complications. Objective: The aim of this study was to investigate the efficacy of clopidogrel for the prevention of thromboembolic complications during elective coil embolization of unruptured cerebral aneurysms. Methods: Sixty-three patients prospectively received oral clopidogrel 75mg/day from 3 days before and for 1 day after the procedure at our institute (Kohnan Hospital, Sendai, Japan) during 2007. Results: At 24 hours post-coiling, significantly less high-intensity areas, detected by MRI with diffusion-weighted imaging (MRI-DWI), were observed in clopidogrel-treated patients compared with a historical control cohort of aspirin (acetylsalicylic acid)-treated patients (13/63 [20.6%] vs 27/69 [39.1%] p = 0.02), primarily due to a statistically significantly lower rate during repair of small (&lt 10mm) lesions (p = 0.008).Also, the rate of periprocedural thromboembolic events was lower in the clopidogrel than the aspirin cohort (2/63 [3.2%] vs 5/69 [7.2%] p = 0.3). Conclusions: Clopidogrel was generally well tolerated with no signs of hemorrhagic complications or liver dysfunction. © 2012 Adis Data Information BV. All rights reserved.

  327. Efficacy of Prophylactic Blood Pressure Lowering according to a Standardized Postoperative Management Protocol to Prevent Symptomatic Cerebral Hyperperfusion after Direct Revascularization Surgery for Moyamoya Disease 査読有り

    Miki Fujimura, Takashi Inoue, Hiroaki Shimizu, Atsushi Saito, Shunji Mugikura, Teiji Tominaga

    CEREBROVASCULAR DISEASES 33 (5) 436-445 2012年

    出版者・発行元:KARGER

    DOI: 10.1159/000336765  

    ISSN:1015-9770

    詳細を見る 詳細を閉じる

    Background: Cerebral hyperperfusion is a potential complication of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease, but the optimal postoperative management has not been determined. Aggressive blood pressure lowering is controversial because of the risk of ischemic complications. Objective: To establish the optimal postoperative management protocol to prevent symptomatic cerebral hyperperfusion in moyamoya disease. Methods: N-isopropyl-p-[I-123]-iodoamphetamine single-photon emission computed tomography was performed 1 and 7 days after STA-MCA anastomosis on 152 hemispheres from 108 consecutive patients with moyamoya disease (2-69, mean 33.3 years). Between 2004 and 2007 (period 1), 65 patients were maintained under normotensive conditions after 93 operations, and only patients with cerebral hyperperfusion underwent blood pressure lowering. Between 2008 and 2010 (period 2), all 43 patients were prospectively subjected to intensive blood pressure lowering (! 130 mm Hg of systolic blood pressure) immediately after 59 operations. Then the incidence of symptomatic cerebral hyperperfusion was compared between the two groups. Results: Systolic blood pressure the day after surgery was significantly lower in period 2 (mean, 120.9 mm Hg) than in period 1 (133.9 mm Hg) (p &lt; 0.0001). Symptomatic cerebral hyperperfusion was seen in 22 patients during period 1 (23 hemispheres, 24.7%), but only in 4 patients during period 2 (6.7%, p = 0.0047). Multivariate analysis revealed that prophylactic blood pressure lowering was significantly associated with the prevention of symptomatic cerebral hyperperfusion (p = 0.015). Symptomatic cerebral hyperperfusion was relieved in all patients without developing a permanent neurological deficit due to cerebral hyperperfusion. Conclusion: Prophylactic blood pressure lowering prevents symptomatic cerebral hyperperfusion after STA-MCA anastomosis in patients with moyamoya disease. Accurate diagnosis of cerebral hyperperfusion and blood pressure lowering, and considering the severity of hemodynamic compromise in the contralateral and/or remote areas are essential for postoperative management of moyamoya disease. Copyright (C) 2012 S. Karger AG, Basel

  328. Local Hemodynamics at the Rupture Point of Cerebral Aneurysms Determined by Computational Fluid Dynamics Analysis 査読有り

    Shunsuke Omodaka, Shin-ichirou Sugiyama, Takashi Inoue, Kenichi Funamoto, Miki Fujimura, Hiroaki Shimizu, Toshiyuki Hayase, Akira Takahashi, Teiji Tominaga

    CEREBROVASCULAR DISEASES 34 (2) 121-129 2012年

    出版者・発行元:KARGER

    DOI: 10.1159/000339678  

    ISSN:1015-9770

    詳細を見る 詳細を閉じる

    Background: Cerebral aneurysms carry a high risk of rupture and so present a major threat to the patient's life. Accurate criteria for predicting aneurysm rupture are important for therapeutic decision-making, and some clinical and morphological factors may help to predict the risk for rupture of unruptured aneurysms, such as sex, size and location. Hemodynamic forces are considered to be key in the natural history of cerebral aneurysms, but the effect on aneurysm rupture is uncertain, and whether low or high wall shear stress (WSS) is the most critical in promoting rupture remains extremely controversial. This study investigated the local hemodynamic features at the aneurysm rupture point. Methods: Computational models of 6 ruptured middle cerebral artery aneurysms with intraoperative confirmation of rupture point were constructed from 3-dimensional rotational angiography images. Computational fluid dynamics (CFD) simulations were performed under pulsatile flows using patient-specific inlet flow conditions. Time-averaged WSS (TAWSS) and oscillatory shear index (OSI) were calculated, and compared at the rupture point and at the aneurysm wall without the rupture point. We performed an additional CFD simulation of a bleb-removed model for a peculiar case in which bleb formation could be confirmed by magnetic resonance angiography. Results: All rupture points were located at the body or dome of the aneurysm. The TAWSS at the rupture point was significantly lower than that at the aneurysm wall without the rupture point (1.10 vs. 4.96 Pa, p = 0.031). The OSI at the rupture point tended to be higher than at the aneurysm wall without the rupture point, although the difference was not significant (0.0148 vs. 0.0059, p = 0.156). In a bleb-removed simulation, the TAWSS at the bleb-removed area was 6.31 Pa, which was relatively higher than at the aneurysm wall (1.94 Pa). Conclusion: The hemodynamics of 6 ruptured cerebral aneurysms of the middle cerebral artery were examined using retrospective CFD analysis. We could confirm the rupture points in all cases. With those findings, local hemodynamics of ruptured aneurysms were quantitatively investigated. The rupture point is located in a low WSS region of the aneurysm wall. Bleb-removed simulation showed increased WSS of the bleb-removed area, associated with the flow impaction area. Although the number of subjects in this study was relatively small, our findings suggest that the location of the rupture point is related to a low WSS at the aneurysm wall. Further investigations will elucidate the detailed hemodynamic effects on aneurysm rupture. Copyright (c) 2012 S. Karger AG, Basel

  329. Convection-enhanced delivery: From mechanisms to clinical drug delivery for diseases of the central nervous system 査読有り

    Ryuta Saito, Teiji Tominaga

    Neurologia Medico-Chirurgica 52 (8) 531-538 2012年

    DOI: 10.2176/nmc.52.531  

    ISSN:0470-8105 1349-8029

    詳細を見る 詳細を閉じる

    The evolution of cancer chemotherapy has been a major advance in medical science in the late 20th century. However, patients with malignant gliomas have not benefitted much. The blood-brain barrier (BBB), which always hinders the entry of therapeutic agents into the central nervous system (CNS), may at least partly be responsible. Convection-enhanced delivery (CED), a method for distributing large and small molecular weight compounds bypassing the BBB, enables robust distribution of the infused molecules at the site of infusion. CED is promising as an effective treatment not only for malignant gliomas but also for multiple CNS disorders because this method can effectively distribute multiple molecules that are potentially effective against different diseases. Although the method is quite simple, several problems require solution in developing novel CED-based strategies, including what, where, when, and how to infuse. This review discusses basic considerations when developing CED-based strategies for CNS diseases, focusing mainly on brain tumors.

  330. [Physicians' emotional barriers toward epilepsy surgery]. 査読有り

    Nobukazu Nakasato, Kazutaka Jin, Masaki Iwasaki, Naoshi Itabashi, Teiji Tominaga

    Rinsho shinkeigaku = Clinical neurology 52 (11) 1080-2 2012年

    DOI: 10.5692/clinicalneurol.52.1080  

    ISSN:0009-918X

    eISSN:1882-0654

    詳細を見る 詳細を閉じる

    Guidelines for epilepsy recommend timely referral of potential surgical candidate to an epilepsy center for evaluation. However, many patients are never referred for evaluation, or referred even a few decades after medically intractable condition. Physician's negative attitudes toward surgery may increase risk of morbidity and mortality in epilepsy patients. The aim of this review is to identify barriers toward epilepsy surgery among physicians. Importance of long-term epilepsy monitoring is emphasized.

  331. Epidemiology of chronic subdural hematoma 査読有り

    Hiroshi Karibe, Motonobu Kameyama, Makoto Kawase, Takayuki Hirano, Tomohiro Kawaguchi, Teiji Tominaga

    Neurological Surgery 39 (12) 1149-1153 2011年12月10日

    ISSN:0301-2603

    詳細を見る 詳細を閉じる

    Background and Purpose: The Japanese population is aging faster than any other population in the world, affecting the epidemiology of which frequently occurs in the elderly. In this study, the epidemiological aspect of chronic subdural hematoma (CSDH) is investigated, using data of the Miyagi Traumatic Head Injury Registry Project. Patients and Methods: From January 2005 to December 2007, 1,445 patients with CSDH were registered in the project (M:F=1.021:424, mean age 71.2±12.8 y.o.). Using these patient's records, the incidence of CSDH was investigated, as well as causes of head injury, severity, and outcome. Results: The overall incidence of CSDH was 20.6/100,000/year, with 76.5 in the age group of 70-79 y.o. and 127.1 in the over 80 y.o. group. Ground level fall was the most frequent cause of trauma in the elderly, in contrast to traffic accident, which was the most frequent cause in the younger generation. Compared to the younger generation, neurological condition was severer in the elderly at the time of admission, and the outcome was poorer at the time of discharge. Conclusion: Compared to previous reports, this study demonstrates a marked increase in the incidence of CSDH. Not only population aging but also current medical trends (such as increases of the elderly patients who receive hemodialysis, anticoagulant, and/or antiplatelet therapy) may influence the increase of CSDH incidence.

  332. Prognostic factors of operated Rathke&apos;s cleft cysts with special reference to re-accumulation and recommended surgical strategy 査読有り

    Yoshikazu Ogawa, Mika Watanabe, Teiji Tominaga

    ACTA NEUROCHIRURGICA 153 (12) 2427-2433 2011年12月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-011-1072-8  

    ISSN:0001-6268

    詳細を見る 詳細を閉じる

    Rathke&apos;s cleft cyst is known as an indolent disease, but has become intractable in a few cases. In this clinical investigation, the initial operative outcomes of Rathke&apos;s cleft cyst and the mechanism of re-accumulation were investigated to identify the optimum surgical strategy for the second operation. We conducted a retrospective review of 155 patients with Rathke&apos;s cleft cyst (58 males and 97 females, aged from 13 to 84 years) surgically treated between April 1996 and March 2010. The same initial operative strategy was adopted in all patients. Operative outcomes and prognostic factors were investigated. Re-accumulation occurred in 27 patients (17.4%), and re-operation was required in eight patients because of neurological deficits (5.2%). Three types of re-accumulating mechanism were identified. First, cysts with cerebrospinal fluid (CSF)-like intensity on magnetic resonance imaging had a higher risk of re-accumulation (logrank test, p &lt; 0.001). The cyst wall should be extensively removed in the suprasellar cistern to allow communication between the cyst and CSF spaces at the second operation. Second, cysts with epithelial transition had a significant higher risk of re-accumulation compared to other types of epithelium (logrank test, p &lt; 0.001). Aggressive removal and irradiation should be performed at the second treatment. Third, classic Rathke&apos;s cleft cyst was found in the majority of cases. No change in operative strategy is required at the second treatment with lower risk of intractability. Enlargement of Rathke&apos;s cleft cyst requiring re-treatment needs selection of surgical strategy according to the individual re-accumulation mechanism.

  333. Subarachnoid Hemorrhage Due to Ruptured Posterior Cerebral Artery Aneurysm Simultaneously Associated With Multiple Remote Intracerebral Hemorrhages-Case Report 査読有り

    Shinya Sonobe, Miki Fujimura, Hidenori Endo, Takashi Inoue, Hiroaki Shimizu, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 51 (12) 836-838 2011年12月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.51.836  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 61-year-old woman presented with aneurysmal subarachnoid hemorrhage (SAH) associated with multiple remote intracerebral hemorrhages (ICHs). She had undergone microsurgical neck clipping for ruptured right middle cerebral artery aneurysm and ventriculo-peritoneal shunting 16 years previously. Computed tomography revealed SAH predominantly in the basal cistern and ambient cistern, in association with multiple ICHs in the bilateral tegmentum of the brain stem and right caudate nucleus. Digital subtraction angiography revealed an aneurysm at the P(1) segment of the left posterior cerebral artery. The ruptured aneurysm was microsurgically clipped via a left subtemporal approach without complications. Simultaneous occurrence of aneurysmal SAH and multiple remote ICHs is rare. The spatial pattern of the ICHs in the present case is apparently unique.

  334. Lateralization of interictal spikes after corpus callosotomy 査読有り

    Masaki Iwasaki, Nobukazu Nakasato, Yosuke Kakisaka, Akitake Kanno, Mitsugu Uematsu, Kazuhiro Haginoya, Teiji Tominaga

    CLINICAL NEUROPHYSIOLOGY 122 (11) 2121-2127 2011年11月

    出版者・発行元:ELSEVIER IRELAND LTD

    DOI: 10.1016/j.clinph.2011.04.013  

    ISSN:1388-2457

    詳細を見る 詳細を閉じる

    Objective: Corpus callosotomy may limit secondary bilateral synchrony into the primary epileptogenic hemisphere. This study investigated whether pre-operative EEG can predict post-operative spike lateralization. Methods: The subjects included 14 patients with medically intractable drop attacks who underwent total corpus callosotomy. Pre-operative patterns of inter-hemispheric propagation were quantified by peak-latency analysis with the template-based spike averaging technique. Results: Postoperative lateralization of interictal spikes was observed in 5 of the 14 patients. Inter-hemispheric latency was significantly longer in these 5 patients (mean 14.0 ms, range from 0 to 78 ms, versus mean 5.2 ms, range from 0 to 29 ms, p &lt; 0.01). The lateralization occurred in association with the presence of structural lesions (p &lt; 0.05). The post-operative spikes were lateralized to the lesion side in 3 of 4 patients with unilateral epileptogenic lesion. Three patients presented one-way inter-hemispheric propagation pattern pre-operatively. The post-operative spikes were lateralized to the hemisphere of the leading spikes in two. Conclusions: Interictal spikes are lateralized to the epileptogenic hemisphere in some patients after callosotomy. Lateralization can be expected in the presence of structural lesions and/or longer inter-hemispheric latency. Significance: Analysis of pre-operative EEG spikes may predict the primary epileptogenic hemisphere before corpus callosotomy. (C) 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  335. Predictive role of modified clinical diffusion mismatch in early neurological deterioration due to atherothrombotic ischemia in the anterior circulation 査読有り

    Atsushi Saito, Hiroaki Shimizu, Miki Fujimura, Takashi Inoue, Teiji Tominaga

    ACTA NEUROCHIRURGICA 153 (11) 2205-2210 2011年11月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-011-1084-4  

    ISSN:0001-6268

    詳細を見る 詳細を閉じる

    Atherothrombotic ischemia is the most frequent cause of cerebral ischemia; however, few reports have addressed the prognostic factors predicting early neurological deterioration (END) when the occlusive lesion is limited to the anterior main trunk, middle cerebral artery (MCA) or internal cerebral artery (ICA). Between 2006 and 2008, 122 atherothrombotic ischemia patients were diagnosed with MCA or ICA occlusive disease on magnetic resonance angiography. The National Institutes of Health Stroke Scale (NIHSS) score and the modified Alberta Stroke Program Early CT Score on diffusion-weighted imaging [ASPECTS-DW (modified)] were calculated. Clinical-DWI mismatch (CDM) was evaluated using NIHSS and the ASPECTS-DW (modified) to examine the predictive efficacy for early neurological deterioration. Eighteen of 122 (14.8%) patients fulfilled the definition of CDM. END was observed in 24 patients (19.7%) within 15 days after admission. CDM was observed in 14 cases in the END (+) group (14 of 24 cases, 58.3%) and 4 cases in the END (-) group (4 of 98 cases, 4.1%) (p = 0.001). Multivariate logistic regression analysis demonstrated that CDM was a significant predictive factor of END (odds ratio 26.68, p = 0.0001). CDM based on NIHSS and ASPECTS-DW (modified) could be a significant predictive factor for END of atherothrombotic ischemia in MCA/ICA.

  336. Local convection-enhanced delivery of chemotherapeutic agent transiently opens blood-brain barrier and improves efficacy of systemic chemotherapy in intracranial xenograft tumor model 査読有り

    Taigen Nakamura, Ryuta Saito, Shin-ichiro Sugiyama, Yukihiko Sonoda, Toshihiro Kumabe, Teiji Tominaga

    CANCER LETTERS 310 (1) 77-83 2011年11月

    出版者・発行元:ELSEVIER IRELAND LTD

    DOI: 10.1016/j.canlet.2011.06.018  

    ISSN:0304-3835

    詳細を見る 詳細を閉じる

    Recently, local chemotherapy proved its efficacy against malignant gliomas. Under the hypothesis that local delivery of chemotherapeutic agents into the brain parenchyma induce opening of the blood-brain barrier (BBB), we evaluated the opening of BBB after convection-enhanced delivery of nimustine hydrochloride into the brain parenchyma. Local convection-enhanced delivery of nimustine hydrochloride transiently opened the BBB from about 7-12 days after delivery in normal rodent brain. Systemic chemotherapy during this period of BBB disruption had synergistic effects resulting in prolonged survival of tumor-bearing rats. The present strategy may provide a new approach for glioma chemotherapy. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

  337. Immunoliposomal drug-delivery system targeting lectin-like oxidized low-density lipoprotein receptor-1 for carotid plaque lesions in rats Laboratory investigation 査読有り

    Atsushi Saito, Hiroaki Shimizu, Yusuke Doi, Tatsuhiro Ishida, Miki Fujimura, Takashi Inoue, Hiroshi Kiwada, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 115 (4) 720-727 2011年10月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2011.5.JNS10227  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Object. Targeted drug delivery with immunoliposomes has been applied to various in vivo animal models and is newly focused as a novel therapeutic target. Lectin-like oxidized low-density lipoprotein receptor-1 (LOX1) is a potent regulator of systemic atherosclerosis, and the authors focused on its effect on carotid plaques. The authors developed a LOX1-targeted liposomal rho-kinase inhibitor and examined the therapeutic effect on carotid intimal hypertrophy in rats. Methods. LOX1-targeted rho-kinase inhibitor fasudil-containing liposomes, composed of hydrogenated soy phosphatidylcholine/cholesterol/PEG(2000)-DSPE, were prepared by conjugating anti-LOX1 antibodies on the surface and by remote loading of fasudil. Carotid intimal hypertrophy was induced by balloon injury, and the drugs were intravenously administered on Day 3 postinjury. The rats were divided into 4 groups: nontreatment, treatment with intravenous fasudil (2 mg), treatment with liposomal fasudil (2 mg), and treatment with LOX1-targeted liposomal fasudil (2 mg). The authors compared intimal hypertrophy, atherosclerotic factor, and matrix metalloproteinase-9 expression among groups. Results. DiI-labeled LOX1-targeted liposomes were prominently observed in the lesions on Day 7 after the surgery. The intimal thickness was significantly reduced in the LOX1-targeted liposomal fasudil treated group (mean 81.6 +/- 13.9 mu m) compared with the other groups (no treatment 105.4 +/- 16.8 mu m; fasudil treatment 102.4 +/- 20.0 mu m; and liposomal fasudil treatment 102.8 +/- 22.2 mu m; p = 0.046). Matrix metalloproteinase-9 expression was also significantly reduced in the LOX1-targeted liposomal fasudil group. Conclusions. Liposomes conjugated with anti-LOX1 antibody effectively reached carotid artery lesions, and liposomal rho-kinase significantly inhibited intimal hypertrophy. The new liposomal drug delivery system targeting LOX1 may become a therapeutic strategy for atherosclerotic diseases. (DOI: 10.3171/2011.5.JN510227).

  338. Stachybotrys microspora triprenyl phenol-7, a novel fibrinolytic agent, suppresses superoxide production, matrix metalloproteinase-9 expression, and thereby attenuates ischemia/reperfusion injury in rat brain 査読有り

    Yosuke Akamatsu, Atsushi Saito, Miki Fujimura, Hiroaki Shimizu, Moataz Mekawy, Keiji Hasumi, Teiji Tominaga

    NEUROSCIENCE LETTERS 503 (2) 110-114 2011年10月

    出版者・発行元:ELSEVIER IRELAND LTD

    DOI: 10.1016/j.neulet.2011.08.018  

    ISSN:0304-3940

    詳細を見る 詳細を閉じる

    Stachybotrys microspora triprenyl phenol-7 (SMTP-7) is a novel fibrinolytic agent with anti-inflammatory effect. Previous study demonstrated that SMTP-7 further ameliorated infarction volume in a mouse embolic stroke model compared with tissue type plasminogen activator (tPA), but the reason SMTP-7 has more beneficial effect than tPA has not yet been determined. In the present study, we investigated whether SMTP-7 has an intrinsic neuroprotective effect against transient focal cerebral ischemia (tFCI). Sprague-Dawley rats were subjected to tFCI by intraluminal middle cerebral artery occlusion for 2 h. Following induction of tFCI, rats were randomized into two groups based on the agent administered: SMTP-7 group and vehicle group. We examined cerebral infarction volume 24 h after reperfusion, and evaluated superoxide production, the expressions of nitrotyrosine and matrix metalloproteinase-9 (MMP-9), which play major roles in secondary brain injury and hemorrhagic transformation. The findings showed that SMTP-7 significantly suppressed superoxide production, the expression of nitrotyrosine and MMP-9 after tFCI, and consequently attenuated ischemic neuronal damage. These results suggest that SMTP-7 has an intrinsic neuroprotective effect on ischemia/reperfusion injury through the suppression of oxidative stress and MMP-9 activation. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

  339. Logarithmic decrease of serum alpha-fetoprotein or human chorionic gonadotropin in response to chemotherapy can distinguish a subgroup with better prognosis among highly malignant intracranial non-germinomatous germ cell tumors 査読有り

    Tomohiro Kawaguchi, Toshihiro Kumabe, Masayuki Kanamori, Ryuta Saito, Yoji Yamashita, Yukihiko Sonoda, Mika Watanabe, Teiji Tominaga

    JOURNAL OF NEURO-ONCOLOGY 104 (3) 779-787 2011年9月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s11060-011-0544-2  

    ISSN:0167-594X

    詳細を見る 詳細を閉じる

    Intracranial non-germinomatous germ cell tumors (NGGCTs) are a heterogeneous group of tumors. Although alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) are considered reliable markers for making diagnosis, the relationship between serum concentration of them and prognosis remains unclear. The present study investigated the decrease of serum tumor markers AFP and HCG as prognostic factors for patients with highly malignant NGGCTs. Eight consecutive patients with AFP &gt; 1000 ng/ml or HCG &gt; 2000 mIU/ml at initial treatments after January 2004 were retrospectively reviewed. Serum AFP or HCG concentration and tumor volume were sequentially measured during the therapeutic period. Six patients were treated by neoadjuvant chemotherapy consisting of ifosfamide, cisplatin, and etoposide, followed by salvage surgery and/or radiation therapy. A 14-year-old boy with choriocarcinoma and a 2-year-old boy with yolk sac tumor underwent radical resection because of acute hydrocephalus and mass effect on the brain stem, followed by chemotherapy and radiation therapy. Five patients showed complete response and survived at follow-up periods of 9, 26, 41, 63, and 75 months, and the other three showed partial response but subsequent recurrence, finally died. Patients with complete response showed logarithmic decrease of serum AFP to the normal range in response to chemotherapy, but the others did not. Logarithmic decrease and normalization of serum AFP and HCG levels during neoadjuvant chemotherapy can distinguish a subgroup with better prognosis within highly malignant NGGCTs. To determine it, sequential measurement of serum tumor marker level was efficient. Outcomes were still dismal for slow responding patients, but this simple method may indicate more aggressive therapy.

  340. Cerebral Blood Flow After Surgery for Unruptured Cerebral Aneurysms: Effects of Surgical Manipulation and Irrigation Fluid 査読有り

    Hiroaki Shimizu, Takashi Inoue, Miki Fujimura, Atsushi Saito, Teiji Tominaga

    NEUROSURGERY 69 (3) 677-688 2011年9月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1227/NEU.0b013e3182195509  

    ISSN:0148-396X

    詳細を見る 詳細を閉じる

    BACKGROUND: Cerebral blood flow (CBF) is important in the management of cerebrovascular diseases. Surgical manipulation may compromise the appropriate interpretation of postoperative CBF changes, but the effects are not well understood. OBJECTIVE: To investigate the effect of surgical manipulation on postoperative CBF in a setting of prospective randomized comparison of 2 irrigation fluids during surgery. METHODS: Twenty patients undergoing the clipping of unruptured cerebral aneurysms through the pterional approach were randomly assigned to use of Artcereb, an artificial cerebrospinal fluid, or physiological saline as irrigation fluid. Postoperative CBF and clinical conditions were evaluated 3 times in the first 7 to 10 postoperative days. RESULTS: Postoperative CBF decreased by 10 to 15% on the first postoperative day in the ipsilateral inferior frontal gyrus, where surgical manipulation may be greatest. CBF reduction was less in regions remote from the surgical site and later in the follow-up periods. Selection of irrigation fluid did not influence postoperative CBF significantly, although postoperative clinical conditions may be better using Artcereb. CONCLUSION: Postoperative CBF changes due to surgical manipulation should be considered in patients whose hemodynamic conditions are important for appropriate management.

  341. Combination chemotherapy with ifosfamide, cisplatin, and etoposide for medulloblastoma: single-institute experience and differences in efficacy for subgroups of medulloblastoma 査読有り

    Ryuta Saito, Toshihiro Kumabe, Yukihiko Sonoda, Masayuki Kanamori, Yoji Yamashita, Mika Watanabe, Teiji Tominaga

    CHILDS NERVOUS SYSTEM 27 (9) 1399-1406 2011年9月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00381-011-1485-y  

    ISSN:0256-7040

    詳細を見る 詳細を閉じる

    Treatment for medulloblastoma consists of surgical resection, radiation therapy, and chemotherapy. In Japan, ICE chemotherapy consisting of cisplatin, ifosfamide, and etoposide is one of the most common regimens. Here, we summarize the toxicity and efficacy of ICE chemotherapy and evaluate the usefulness of the recently introduced molecular classification scheme to predict the outcome. Seventeen patients with medulloblastoma treated by ICE chemotherapy as an initial therapy at our institute were retrospectively reviewed. Eleven were categorized in the standard-risk group and six in the high-risk group. All patients underwent maximum cytoreductive surgery, radiation therapy, and ICE chemotherapy. Operative specimens were subjected to immunohistochemical staining using four antibodies-DKK1, SFRP1, NPR3, and KCNA1-to classify the cases into four subgroups, WNT group, SHH group, group C, and group D, respectively. ICE chemotherapy following surgery and radiation therapy was tolerable in most patients with appropriate management, although myelosuppression and hearing disturbance occurred. There was no significant difference in survival between patients with standard-risk disease and high-risk disease. Five-year survival and 5-year progression-free survival for the 17 patients were 80.7% and 63.5%, respectively. Three patients were classified as WNT group, 2 as SHH group, 1 as group C, and 11 as group D. Group D tended to have poorer prognosis after ICE chemotherapy. ICE chemotherapy was tolerable and active against medulloblastomas. Patients categorized as group D tended to have worse outcome after ICE chemotherapy.

  342. Ruptured aneurysm at the anterior wall of the internal carotid artery in a patient with systemic lupus erythematosus and secondary antiphospholipid syndrome 査読有り

    Masashi Chonan, Miki Fujimura, Takashi Inoue, Teiji Tominaga

    Neurological Surgery 39 (7) 675-680 2011年7月10日

    ISSN:0301-2603

    詳細を見る 詳細を閉じる

    A 60 year-old woman, who had a 45-year history of systemic lupus erythematosus (SLE) and secondary antiphospholipid syndrome, presented with subarachnoid hemorrhage due to a ruptured aneurysm at the anterior wall of the non-branching site of the right internal carotid artery. She underwent radical surgery on the day of onset. In light of the possibility of arterial dissection, we performed extracranial-intracranial bypass prior to careful exploration of the aneurysm. Based on the finding of saccular aneurysm, she ultimately underwent neck clipping of the aneurysm without complication. Postoperative course was uneventful, and she did not suffer from cerebral vasospasm. We recommend early surgical intervention in patients with aneurysmal SAH associated with SLE, while intrinsic pathologies of SLE such as fragile vascular structure and the risk for ischemic complication should be considered.

  343. Asymptomatic intracerebral hemorrhage under strict blood pressure control due to postoperative cerebral hyperperfusion in a patient with moyamoya disease 査読有り

    Akira Ito, Miki Fujimura, Takashi Inoue, Teiji Tominaga

    Neurological Surgery 39 (7) 681-686 2011年7月10日

    ISSN:0301-2603

    詳細を見る 詳細を閉じる

    We report a case of moyamoya disease manifesting as asymptomatic intracerebral hemorrhage due to postoperative cerebral hyperperfusion, despite the prophylactic intensive blood pressure control. This 35-year-old man initially suffered from right upper quadrantanopsia and was found to have cerebral infarction in the left occipital lobe due to moyamoya disease. He also manifested preoperatively a small intracerebral hemorrhage at the left caudate nucleus. The left cerebral hemisphere showed apparent hemodynamic compromise, thus he underwent left superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis with indirect pial synangiosis. He was subjected to prophylactic strict blood pressure control postoperatively to avoid hyperperfusion syndrome. The N-isopropyl-p-123I-lodoamphetamine SPECT (123I-IMP-SPECT) 1 day after surgery showed intense increase in cerebral blood flow (CBF) at the site of the anastomosis, and further blood pressure lowering was attempted. He did not suffer from neurologic deterioration during the postoperative period, while computed tomography (CT) 7 days after surgery revealed asymptomatic intracerebral hematoma (ICH) at the subcortex under the site of the anastomosis. Cerebral hyperperfusion is a potential complication of revascularization surgery for moyamoya disease. Accurate diagnosis and proper management of hyperperfusion are essential to avoid deleterious neurologic event due to hyperperfusion.

  344. New insights into glioma classification based on isocitrate dehydrogenase 1 and 2 gene status 査読有り

    Ichiyo Shibahara, Yukihiko Sonoda, Masayuki Kanamori, Ryuta Saito, Toshihiro Kumabe, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 28 (3) 203-208 2011年7月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1007/s10014-011-0050-4  

    ISSN:1433-7398

    詳細を見る 詳細を閉じる

    In glioma, mutations in the isocitrate dehydrogenase 1 and 2 (IDH1/2) genes have been receiving attention. IDH1/2 mutations are frequently found in grade II and III gliomas. These genetic alterations occur very early in gliomagenesis and strongly predict favorable outcome in patients with high-grade gliomas. Despite the evolution of studies on this topic, the underlying mechanism of the IDH1/2 mutations remains unknown. Here, we briefly review the current knowledge of IDH1/2 and discuss molecular diagnostics based on IDH1/2 gene status.

  345. Angiocentric Glioma and Surrounding Cortical Dysplasia Manifesting as Intractable Frontal Lobe Epilepsy-Case Report 査読有り

    Shihomi Takada, Masaki Iwasaki, Hiroyoshi Suzuki, Nobukazu Nakasato, Toshihiro Kumabe, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 51 (7) 522-526 2011年7月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.51.522  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    A 26-year-old man presented with a case of angiocentric glioma manifesting as medically refractory epilepsy. Magnetic resonance imaging revealed a hyperintense lesion in the right superior frontal gyrus on T(2)-weighted imaging, with cortical hyperintense rim on T(1)-weighted images and minimum contrast enhancement. Video-electroencephalography (EEG) monitoring characterized his seizures as originating from the right frontal lobe. Long-term EEG recording from implanted subdural electrodes disclosed epileptic activities extending beyond the margin of the radiological lesion. Extended cortical resection of the superior frontal gyrus including the tumor and the surrounding epileptic cortices was performed. Postoperatively, he became seizure-free with antiepileptic medication during a 12-month follow-up period. Histological examination of the surgical specimen showed the characteristic findings of angiocentric glioma. Associated cortical dyslamination consistent with cortical dysplasia was found in the surrounding cortex. Angiocentric glioma is a slow-growing or stable tumor frequently presenting with intractable epilepsy. Surgical treatment would be aimed primarily at control of epilepsy. Complete lesionectomy usually results in postoperative seizure freedom, but the present case shows evidence for associated cortical dysplasia with this tumor entity. Careful pre-surgical evaluation for epilepsy is necessary to achieve better seizure outcome.

  346. Mechanisms of Primary Blast-Induced Traumatic Brain Injury: Insights from Shock-Wave Research 査読有り

    Atsuhiro Nakagawa, Geoffrey T. Manley, Alisa D. Gean, Kiyonobu Ohtani, Rocco Armonda, Akira Tsukamoto, Hiroaki Yamamoto, Kazuyoshi Takayama, Teiji Tominaga

    JOURNAL OF NEUROTRAUMA 28 (6) 1101-1119 2011年6月

    出版者・発行元:MARY ANN LIEBERT, INC

    DOI: 10.1089/neu.2010.1442  

    ISSN:0897-7151

    詳細を見る 詳細を閉じる

    Traumatic brain injury caused by explosive or blast events is traditionally divided into four phases: primary, secondary, tertiary, and quaternary blast injury. These phases of blast-induced traumatic brain injury (bTBI) are biomechanically distinct and can be modeled in both in vivo and in vitro systems. The primary bTBI injury phase represents the response of brain tissue to the initial blast wave. Among the four phases of bTBI, there is a remarkable paucity of information about the cause of primary bTBI. On the other hand, 30 years of research on the medical application of shockwaves (SW) has given us insight into the mechanisms of tissue and cellular damage in bTBI, including both air-mediated and underwater SW sources. From a basic physics perspective, the typical blast wave consists of a lead SW followed by supersonic flow. The resultant tissue injury includes several features observed in bTBI, such as hemorrhage, edema, pseudoaneurysm formation, vasoconstriction, and induction of apoptosis. These are well-described pathological findings within the SW literature. Acoustic impedance mismatch, penetration of tissue by shock/bubble interaction, geometry of the skull, shear stress, tensile stress, and subsequent cavitation formation, are all important factors in determining the extent of SW-induced tissue and cellular injury. Herein we describe the requirements for the adequate experimental set-up when investigating blast-induced tissue and cellular injury; review SW physics, research, and the importance of engineering validation (visualization/pressure measurement/numerical simulation); and, based upon our findings of SW-induced injury, discuss the potential underlying mechanisms of primary bTBI.

  347. Development of intratumoral cyst or extratumoral arachnoid cyst in intracranial schwannomas following gamma knife radiosurgery 査読有り

    Kensuke Murakami, Hidefumi Jokura, Jun Kawagishi, Mika Watanabe, Teiji Tominaga

    ACTA NEUROCHIRURGICA 153 (6) 1201-1209 2011年6月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-011-0972-y  

    ISSN:0001-6268

    詳細を見る 詳細を閉じる

    Purpose Intracranial schwannomas presenting with cyst formation following gamma knife radiosurgery (GKRS) were investigated to clarify their clinicopathological characteristics. Methods Between 1994 and 2006, 492 patients presenting with intracranial schwannomas underwent GKRS. Among them, seven cases demonstrated either new formation of cysts or enlargement of preexisting cysts, which were treated with microsurgical intervention. These cases were retrospectively reviewed with regard to neuroradiological findings and histopathology. Results These seven cases included five vestibular and two trigeminal schwannomas. Preexisting cysts were enlarged following GKRS in three cases, while they were newly formed in four cases. Salvage microsurgery was carried out at 7-167 months after the GKRS, and subtotal resection was achieved in three, partial resection with or without cyst fenestration in four. Neurological symptoms were improved in all six symptomatic cases. Preoperative MRI demonstrated two characteristic types of cyst. One was the intratumoral type, indicating hemorrhagic change on the MRI. Histopathological analysis demonstrated a cavernous angioma within the solid compartment of tumor. These two cases demonstrated enlargement of residual tumor with new cyst formation after resection of only the cyst. The other type was extratumoral cyst, which had a structure with a thin cyst wall without contrast enhancement, and the cyst was composed of arachnoid cells without tumor cells. Extratumoral cysts enlarged despite effective control of the tumor itself, which may be caused by osmotic gradient induced by tumor degeneration following GKRS. Conclusions There were two types of cysts, intratumoral cyst and extratumoral arachnoid cyst, which developed following GKRS in intracranial schwannomas. Resection of the solid compartment as well as the cyst is required in schwannomas with expanding intratumoral cyst. Conversely, fenestration of the cyst alone might be effective in extratumoral arachnoid cysts.

  348. Intraorbital Arteriovenous Malformation Treated by Transarterial Embolization: Technical Case Report 査読有り

    Kenichi Sato, Yasushi Matsumoto, Ryushi Kondo, Teiji Tominaga

    NEUROSURGERY 68 (2 Suppl Operative) 383-387 2011年6月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1227/NEU.0b013e31821522ec  

    ISSN:0148-396X

    詳細を見る 詳細を閉じる

    BACKGROUND AND IMPORTANCE: Intraorbital arteriovenous malformations (AVMs) are rare, and their clinical management is controversial. A case of orbital AVM successfully treated by transarterial embolization with diluted glue is reported. CLINICAL PRESENTATION: A 53-year-old man developed a left pulsating exophthalmos, chemosis, and ocular pain, revealing the presence of a left intraorbital AVM. A microcatheter was selectively placed into the feeders arising from the left ophthalmic artery. Diluted glue was injected toward the nidus through the microcatheter, with monitoring by digital subtraction angiogram. These procedures were performed for 2 individual proper feeders. Superselective angiography for the central retinal artery was also performed instead of a retinal Wada test. His orbital symptoms improved immediately after the procedure without further visual disturbance. Follow-up digital subtraction angiogram revealed the disappearance of the AVM. CONCLUSION: Transarterial embolization can be considered one of the radical treatments for orbital AVMs.

  349. Extradural dermoid cyst of the parasellar region: a case report. 査読有り

    Endo H, Murakami K, Watanabe M, Tominaga T

    Skull base reports 1 (1) 3-6 2011年5月

    DOI: 10.1055/s-0030-1263284  

    ISSN:2157-6971

  350. Regression of recurrent glioblastoma infiltrating the brainstem after convection-enhanced delivery of nimustine hydrochloride Case report 査読有り

    Ryuta Saito, Yukihiko Sonoda, Toshihiro Kumabe, Ken-ichi Nagamatsu, Mika Watanabe, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-PEDIATRICS 7 (5) 522-526 2011年5月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2011.2.PEDS10407  

    ISSN:1933-0707

    詳細を見る 詳細を閉じる

    This 13-year-old boy with a history of cranial irradiation for the CNS recurrence of acute lymphocytic leukemia developed a glioblastoma in the right cerebellum. Resection and chemo- and radiotherapy induced remission of the disease. However, recurrence was noted in the brainstem region 8 months later. Because no effective treatment was available for this recurrent lesion, the authors decided to use convection-enhanced delivery (CED) to infuse nimustine hydrochloride. On stereotactic insertion of the infusion cannula into the brainstem lesion, CED of nimustine hydrochloride was performed with real-time MR imaging to monitor the co-infused chelated gadolinium. The patient&apos;s preinfusion symptom of diplopia disappeared after treatment. Follow-up MR imaging revealed the response of the tumor. The authors report on a case of recurrent glioblastoma infiltrating the brainstem that regressed after CED of nimustine hydrochloride. (DOI: 10.3171/2011.2.PEDS10407)

  351. Characteristics of an actuator-driven pulsed water jet generator to dissecting soft tissue 査読有り

    Takeshi Seto, Hiroaki Yamamoto, Kazuyoshi Takayama, Atsuhiro Nakagawa, Teiji Tominaga

    REVIEW OF SCIENTIFIC INSTRUMENTS 82 (5) 055105 2011年5月

    出版者・発行元:AMER INST PHYSICS

    DOI: 10.1063/1.3587069  

    ISSN:0034-6748

    詳細を見る 詳細を閉じる

    This paper reports characteristics of an actuator-driven pulsed water jet generator applied, in particular, to dissect soft tissues. Results of experiments, by making use of high speed recording of optical visualization and varying nozzle diameter, actuator time interval, and their effects on dissection performance are presented. Jet penetration characteristics are compared with continuous water jet and hence potential assessment of pulsed water jets to clinical applications is performed. (C) 2011 American Institute of Physics. [doi:10.1063/1.3587069]

  352. Infratentorial brain metastases of pediatric non-epithelial malignant tumors: three case reports 査読有り

    Shin-ichiro Osawa, Toshihiro Kumabe, Ryuta Saito, Yukihiko Sonoda, Hidetaka Niizuma, Mika Watanabe, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 28 (2) 167-174 2011年4月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1007/s10014-010-0014-0  

    ISSN:1433-7398

    eISSN:1861-387X

    詳細を見る 詳細を閉じる

    Three pediatric patients with infratentorial metastatic non-epithelial malignant brain tumors were successfully treated by radical surgical resection followed by aggressive radiochemotherapy. One patient with neuroblastoma and two with rhabdomyosarcoma were successfully treated by first line multimodal treatments, but developed infratentorial metastasis after several months of remission. All patients revealed intracranial metastases manifesting as rapidly progressing neurological symptoms caused by mass effect in the posterior fossa. Radical surgical resection was performed without morbidity. The patients were then treated by adjuvant radiochemotherapy with or without autologous peripheral blood stem cell transplantation, resulting in complete remission. Two patients developed extracranial recurrences 4 months after the treatments for intracranial metastases. One patient was treated by second high-dose chemotherapy with allogeneic cord blood transplantation, again resulting in complete remission. Another patient was treated by second chemotherapy and maintaining stable disease. The other patient maintained complete remission. All three patients were alive without neurological deficit for 8, 11, and 12 months after diagnosis of brain metastasis. Patients with infratentorial brain metastases of highly malignant pediatric non-epithelial tumors are in a severe clinical state, but still can have longer and useful lives with aggressive multimodal treatments combined with radical surgical resection.

  353. Significance of focal cerebral hyperperfusion as a cause of transient neurologic deterioration after extracranial-intracranial bypass for moyamoya disease: comparative study with non-moyamoya patients using N-isopropyl-p-[(123)I]iodoamphetamine single-pho 査読有り

    Fujimura M, Shimizu H, Inoue T, Mugikura S, Saito A, Tominaga T

    Neurosurgery 68 (4) 957-64; discussion 964 2011年4月

    DOI: 10.1227/NEU.0b013e318208f1da  

    ISSN:0148-396X

  354. Pulsed laser-induced liquid jet for skull base tumor removal with vascular preservation through the transsphenoidal approach: a clinical investigation 査読有り

    Yoshikazu Ogawa, Atsuhiro Nakagawa, Kazuyoshi Takayama, Teiji Tominaga

    ACTA NEUROCHIRURGICA 153 (4) 823-830 2011年4月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-010-0925-x  

    ISSN:0001-6268

    詳細を見る 詳細を閉じる

    The transsphenoidal approach has recently been used to treat complex lesions beyond the sella turcica, but the difficulties of dealing with small vessels, deep and narrow space, and working angle may limit the procedures. To overcome these problems, we have developed a pulsed laser-induced liquid jet (LILJ) system to dissect tumor tissue with preservation of fine blood vessels within deep and narrow working spaces and evaluated its utility and safety. The LILJ system was applied to 14 consecutive patients with uncharacteristically complex skull base tumor treated through the extended transsphenoidal approach. This system consists of a bayonet-shaped catheter incorporating a jet generator formed of stainless tube (external diameter 1.10 mm, internal diameter 0.78 mm), which was surrounded by a coaxial polytetrafluoroethylene 14-G equivalent suction tube to be able to incorporate into the confined working spaces. Minor modifications could be fitted for the catheter (15 to 18 cm length, straight or side flexion tip), and total weight was around 7 g. Precise dissection and mass reduction of the tumor were obtained in all cases except one recurrent case of chordoma with significant fibrosis due to radiation. Both small arteries and veins were preserved, allowing subsequent microsurgical devascularization. Intraoperative blood loss was minimal, and tumor removal rate was satisfactory after the introduction of the system. No complication was related to use of the LILJ system. Although comparison between conventional surgical instruments is mandatory in the future, the present study suggests that the LILJ system can achieve safe and optimum removal of complex skull base tumor. Potential application for minimally invasive endoscopic system, as well as potentials for changing the design of the catheter in according to preference of surgeon with low cost, may give advantages over conventional surgical instruments.

  355. Prognostic factors for patients with gliomatosis cerebri: retrospective analysis of 17 consecutive cases 査読有り

    Tomoo Inoue, Toshihiro Kumabe, Masayuki Kanamori, Yukihiko Sonoda, Mika Watanabe, Teiji Tominaga

    NEUROSURGICAL REVIEW 34 (2) 197-207 2011年4月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s10143-010-0306-1  

    ISSN:0344-5607

    詳細を見る 詳細を閉じる

    Gliomatosis cerebri (GC) is a rare fatal glial neoplasm of the central nervous system. Neuroimaging, histological, and clinical outcome data were reviewed of 17 consecutive patients, 8 males and 9 females aged 15-68 years (median, 37 years), treated for GC between April 1992 and October 2007. All patients received cranial irradiation to include the hyperintense area on T2-weighted magnetic resonance imaging. The total dose of the radiotherapy was 50-72 Gy (median, 60). Intravenous nimustine hydrochloride was administered in all patients, combined with temozolomide in four patients. The median survival time was 23.3 months, with a median follow-up of 23.3 months. Kaplan-Meier analysis demonstrated the overall survival rate which was 70.6% for 1 year, 23.5% for 3 years, and 17.7% for 5 years. Spinal enhanced lesions and nodular malignant transformation to glioblastoma were observed during follow-up in two patients each. Poor survival showed correlation with higher Ki-67 labeling index, higher choline/N-acetylaspartate ratio on magnetic resonance spectroscopy, tumor volumes, lower Karnofsky performance status on admission, cognitive/behavioral deterioration, poor response to the initial radiochemotherapy, and emergence of paraventricular enhanced lesions during the clinical course. The prognosis for patients with GC is unfavorable, but radiochemotherapy may prolong survival.

  356. Compromise of Brain Tissue Caused by Cortical Venous Reflux of Intracranial Dural Arteriovenous Fistulas Assessment With Diffusion-Weighted Magnetic Resonance Imaging 査読有り

    Kenichi Sato, Hiroaki Shimizu, Miki Fujimura, Takashi Inoue, Yasushi Matsumoto, Teiji Tominaga

    STROKE 42 (4) 998-1003 2011年4月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1161/STROKEAHA.110.597203  

    ISSN:0039-2499

    詳細を見る 詳細を閉じる

    Background and Purpose-Cortical venous reflux (CVR) is a high risk factor for aggressive behavior of intracranial dural arteriovenous fistulas (DAVF). The pathological conditions in brain tissue affected by CVR were investigated by diffusion-weighted magnetic resonance imaging. Methods-A retrospective review identified 56 patients with DAVFs who underwent diffusion-weighted imaging before treatment. Twenty patients had neurological symptoms corresponding to the brain area affected by CVR (Group I), 21 patients with CVR had no focal brain dysfunctions (Group II), and 15 patients had no CVR (Group III). Apparent diffusion coefficient (ADC) was measured for 11 brain areas predefined based on normal venous drainage patterns in the 56 patients and in 21 normal volunteers. The mean ADC ratio was calculated for each area by dividing the ADC value of patients by that of normal volunteers. Results-Areas affected by CVR in Group I showed a mean ADC-to-control ratio of 0.72, which was significantly lower than that of Group II (0.96, P&lt;0.01). Follow-up studies demonstrated significantly increased ADC ratios in brain areas affected by CVR after the DAVFs were treated successfully. The mean ADC ratio of an affected area remained low, with persistent symptoms in 1 patient who underwent palliative treatment. Conclusions-Decreased ADC was observed in the brain parenchyma affected by CVR and was associated with regional brain dysfunction. Successful treatment of the DAVF increased the ADC toward normal levels. The ADC may be a useful indicator of the severity of CVR. (Stroke. 2011;42:998-1003.)

  357. Hemosiderin Detected by T-2*-Weighted Magnetic Resonance Imaging in Patients With Unruptured Cerebral Aneurysms: Indication of Previous Bleeding? 査読有り

    Shihomi Takada, Takashi Inoue, Kuniyasu Niizuma, Hiroaki Shimizu, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 51 (4) 275-281 2011年4月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.51.275  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    Previous bleeding from a cerebral aneurysm indicates a higher risk of rupture. Hemosiderin may be detected during aneurysm surgery or by preoperative imaging sensitive to hemosiderin. The detection of hemosiderin deposits by T-2*-weighted magnetic resonance (MR) imaging was evaluated in 49 patients with unruptured cerebral aneurysms who underwent open surgery. MR imaging was performed using 3.0 tesla MR scanner. Two sequences of T-2*-weighted imaging, and proton density images were obtained. Preliminary study in patients with old subarachnoid hemorrhage provided the definitions of likely pathological findings during surgery and on T-2*-weighted imaging due to previous hemorrhage. Hemosiderin deposits in the subarachnoid space were observed during surgery in 9 of the 49 patients, although no obvious rupture site was detected around the aneurysm wall. Size, presence of bleb, location, and number of aneurysms showed no significant difference between patients with and without hemosiderin deposition. Hypointense areas on T-2*-weighted imaging were recognized in four patients. The mean size of the aneurysms in these patients was 9.8 mm, significantly larger than those in other patients (p = 0.029). Hemosiderin deposits were observed during surgery in sites close to the lesions on T-2*-weighted imaging in two of these four patients. Hemosiderin deposits are not rare in patients with unruptured aneurysms, and preoperative T-2*-weighted imaging can detect such deposits.

  358. Cerebral Arteritis With Extremely Late Onset Secondary to Bacterial Meningitis-Case Report 査読有り

    Tomohiro Kawaguchi, Yoshikazu Ogawa, Takashi Inoue, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 51 (4) 302-305 2011年4月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.51.302  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 59-year-old woman presented with bacterial meningitis causing arterial narrowing in the very late stage. She initially underwent transsphenoidal surgery for massive non-functioning pituitary adenoma resulting in gross total removal. The postoperative course was uneventful, and she was discharged 12 days after surgery. Fourteen months later, she presented with bacterial meningitis due to streptococcus. Administration of multiple antibiotics resulted in normalization of cerebrospinal fluid findings. Forty days after meningitis onset, she suddenly suffered motor weakness of the right extremities. Magnetic resonance (MR) angiography revealed multiple intracranial arterial narrowings. Despite intensive treatment, no improvement of arterial narrowing was seen, and she suffered cerebral infarction. Six months after the onset of meningitis, MR angiography still showed multiple arterial narrowings, and MR plaque imaging of the stenotic vessel disclosed thickened arterial wall. This case illustrates the complex time course of arteritis caused by severe bacterial meningitis, and the intractability to treatment.

  359. Simultaneous Occurrence of Subarachnoid Hemorrhage and Epistaxis Due to Ruptured Petrous Internal Carotid Artery Aneurysm: Association With Transsphenoidal Surgery and Radiation Therapy-Case Report 査読有り

    Hidenori Endo, Miki Fujimura, Takashi Inoue, Yasushi Matsumoto, Yoshikazu Ogawa, Jun Kawagishi, Hidefumi Jokura, Hiroaki Shimizu, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 51 (3) 226-229 2011年3月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.51.226  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 62-year-old woman presented with simultaneous subarachnoid hemorrhage (SAH) and massive epistaxis. The patient had been treated for pituitary prolactinoma by two transsphenoidal surgeries, gamma knife radiosurgery, and conventional radiation therapy since age 43 years. Cerebral angiography showed left petrous internal carotid artery (ICA) aneurysm with slight stenosis on the adjacent left petrous ICA. She underwent superficial temporal artery-middle cerebral artery (STA-MCA) double anastomosis with endovascular internal trapping without complication the day after onset. Postoperative course was uneventful; the patient did not develop symptomatic vasospasm, recurrent epistaxis, or cerebrospinal fluid rhinorrhea. Postoperative angiography demonstrated complete disappearance of the aneurysm with patent STA-MCA anastomosis. The patient was discharged 2 months after surgery without neurological deficit. The present case is extremely rare with simultaneous onset of SAH and epistaxis caused by ruptured petrous ICA aneurysm. The transsphenoidal surgeries and radiation therapies might have been critical in the formation of the petrous ICA aneurysm.

  360. Early detection of venous thromboembolism in patients with neuroepithelial tumor: efficacy of screening with serum d-dimer measurements and Doppler ultrasonography 査読有り

    Tomohiro Kawaguchi, Toshihiro Kumabe, Masayuki Kanamori, Taigen Nakamura, Ryuta Saito, Yoji Yamashita, Yukihiko Sonoda, Mika Watanabe, Teiji Tominaga

    JOURNAL OF NEURO-ONCOLOGY 101 (3) 495-504 2011年2月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s11060-010-0276-8  

    ISSN:0167-594X

    eISSN:1573-7373

    詳細を見る 詳細を閉じる

    The efficacy of combined serum d-dimer level measurement and Doppler ultrasonography of the lower extremity was investigated for screening of venous thromboembolism (VTE) in patients with neuroepithelial tumor. Eighty-one patients with neuroepithelial tumor were prospectively studied. All patients underwent measurement of serum d-dimer levels and Doppler ultrasonography of the lower extremity. The serum d-dimer level was measured every week, and Doppler ultrasonography was performed two and two weeks after surgery, then every two weeks until discharge, or every two weeks for patients who did not undergo surgery. If the serum d-dimer level increased over 10.0 mu g/ml, Doppler ultrasonography or computed tomography was performed to detect VTE. VTE occurred in 12 (14.8%) patients (seven males and five females; age 34-75, mean 59.0 years). Only one patient was symptomatic, whereas 11 patients identified by the screening were without symptoms. Five patients were treated with anticoagulant therapy, one with prophylactic inferior vena cava filter placement with anticoagulant therapy, and the other six were closely followed up without medication. No patient died of pulmonary embolism. Serial Doppler ultrasonography showed thrombus regression or organization and no thrombus extension. The maximum serum d-dimer value was significantly higher in patients with VTE than in those without VTE (mean 14.5 vs. 3.46 mu g/ml, P &lt; 0.001). The d-dimer cutoff value of 5.4 mu g/ml could be used to identify VTE with 83% sensitivity and 84% specificity. The combination of sequential serum d-dimer measurement and Doppler ultrasonography of the lower extremity is an efficient and non-invasive procedure for identifying asymptomatic VTE in patients with neuroepithelial tumor.

  361. Prediction of neurological recovery using apparent diffusion coefficient in cases of incomplete spinal cord injury. 査読有り

    Endo T, Suzuki S, Utsunomiya A, Uenohara H, Tominaga T

    Neurosurgery 68 (2) 329-336 2011年2月

    DOI: 10.1227/NEU.0b013e3182031ce7  

    ISSN:0148-396X

  362. A genome-wide association study identifies RNF213 as the first Moyamoya disease gene. 国際誌 査読有り

    Fumiaki Kamada, Yoko Aoki, Ayumi Narisawa, Yu Abe, Shoko Komatsuzaki, Atsuo Kikuchi, Junko Kanno, Tetsuya Niihori, Masao Ono, Naoto Ishii, Yuji Owada, Miki Fujimura, Yoichi Mashimo, Yoichi Suzuki, Akira Hata, Shigeru Tsuchiya, Teiji Tominaga, Yoichi Matsubara, Shigeo Kure

    Journal of human genetics 56 (1) 34-40 2011年1月

    DOI: 10.1038/jhg.2010.132  

    ISSN:1434-5161

    詳細を見る 詳細を閉じる

    Moyamoya disease (MMD) shows progressive cerebral angiopathy characterized by bilateral internal carotid artery stenosis and abnormal collateral vessels. Although ∼ 15% of MMD cases are familial, the MMD gene(s) remain unknown. A genome-wide association study of 785,720 single-nucleotide polymorphisms (SNPs) was performed, comparing 72 Japanese MMD patients with 45 Japanese controls and resulting in a strong association of chromosome 17q25-ter with MMD risk. This result was further confirmed by a locus-specific association study using 335 SNPs in the 17q25-ter region. A single haplotype consisting of seven SNPs at the RNF213 locus was tightly associated with MMD (P = 5.3 × 10(-10)). RNF213 encodes a really interesting new gene finger protein with an AAA ATPase domain and is abundantly expressed in spleen and leukocytes. An RNA in situ hybridization analysis of mouse tissues indicated that mature lymphocytes express higher levels of Rnf213 mRNA than their immature counterparts. Mutational analysis of RNF213 revealed a founder mutation, p.R4859K, in 95% of MMD families, 73% of non-familial MMD cases and 1.4% of controls; this mutation greatly increases the risk of MMD (P = 1.2 × 10(-43), odds ratio = 190.8, 95% confidence interval = 71.7-507.9). Three additional missense mutations were identified in the p.R4859K-negative patients. These results indicate that RNF213 is the first identified susceptibility gene for MMD.

  363. Neuromonitoring and neurocritical care for severe TBI: Current update 査読有り

    Atsuhiro Nakagawa, Teiji Tominaga, Geoffrey Manley

    Neurological Surgery 38 (12) 1081-1095 2010年12月10日

    ISSN:0301-2603

  364. In Reply. 国際誌 査読有り

    Hayashi T, Shirane R, Tominaga T

    Neurosurgery 67 (6) E1866 2010年12月

    DOI: 10.1227/NEU.0b013e3181faa69c  

    ISSN:0148-396X

    eISSN:1524-4040

  365. Developmental venous anomaly presenting as a brain parenchymal abnormality mimicking a brain tumor - A report of 3 cases and review of literature 査読有り

    Takahiro Morita, Hiroaki Shimizu, Toshihiro Kumabe, Atsushi Saito, Teiji Tominaga

    Brain and Nerve 62 (12) 1331-1336 2010年12月

    ISSN:1881-6096

    詳細を見る 詳細を閉じる

    Cases of brain parenchymal abnormality caused by a developmental venous anomaly (DVA) are rare. The purpose of this paper is to report 3 cases where DVA presented as abnormal lesions on magnetic resonance imaging (MRI) scans, mimicking brain tumors such as gliomas. Case 1: The patient was a 60-year-old woman who underwent MRI for mild memory disturbance. MRI revealed an abnormal lesion in the left temporal lobe, and a diagnosis of glioma was considered. She was transferred to our hospital for surgery 6 days later when the lesion had spontaneously decreased in size. Gadolinium-enhanced MRI (Gd-MRI) and conventional angiography revealed dilated medullary veins in the lesion. The patient was followed-up conservatively the lesion further decreased in size during the follow-up period, and only slight atrophy remained. Case 2: The patient was a 17-year-old girl with left hemiparesis and facial palsy. She was transferred to our hospital for surgery of an abnormal lesion in the right frontal lobe. The lesion showed high intensity on T2 weighted MRI and enlarged 2 weeks later, mimicking a glioma. Over the next 2 weeks, the size of the lesion spontaneously decreased, and the patient's symptoms improved. Gd-MRI and conventional angiography revealed the presence of typical caput medusae. The patient has been followed-up conservatively, and no further changes have been observed. Case 3: The patient was a 61-year-old man whose T2 weighted MRI scan incidentally revealed an abnormal high intensity lesion in the right frontal lobe. Gd-MRI was helped to detect the radially dilated medullary veins. Conclusion: The incidence of brain parenchymal abnormalities caused by DVAs may be higher than that reported previously. DVA should be included in the differential diagnosis of high intensity lesions on T2 weighted MRI.

  366. Paradoxical Association of Moyamoya Syndrome With Large Middle Cerebral Artery Aneurysm and Subarachnoid Hemorrhage -Case Report 査読有り

    Hidenori Endo, Miki Fujimura, Takashi Inoue, Hiroaki Shimizu, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 50 (12) 1088-1091 2010年12月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.50.1088  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 60-year-old woman was admitted to our hospital because of fluctuating dysarthria during the past 2 months. Magnetic resonance imaging revealed old cerebral infarction of the left cerebral hemisphere with acute subarachnoid hemorrhage in the left sylvian fissure. Cerebral angiography showed a large saccular aneurysm, 14 mm in diameter, at the bifurcation of the left middle cerebral artery (MCA) in association with moyamoya vasculopathy with atherosclerosis, including steno-occlusive changes at the bilateral terminal internal carotid arteries and abnormal net-like vessels at the base of the brain. She underwent microsurgical neck clipping of the large aneurysm followed by superficial temporal artery-MCA anastomosis without complication. Intraoperative findings showed no evidence of aneurysm rupture, suggesting that the subarachnoid hemorrhage was due to the intrinsic pathology of moyamoya vasculopathy. The postoperative course was uneventful, and the patient was discharged without neurological deficit. Association of moyamoya syndrome with large MCA aneurysm is extremely rare, and formation of large aneurysm at the vascular territory of an occluded vessel is apparently unique.

  367. [The safety of combination chemotherapy with ifosfamide, cisplatin, and etoposide (ICE): single-institution retrospective review of 108 cases]. 査読有り

    Masayuki Kanamori, Toshihiro Kumabe, Ryuta Saito, Yoji Yamashita, Yukihiko Sonoda, Teiji Tominaga

    No shinkei geka. Neurological surgery 38 (11) 997-1005 2010年11月

    ISSN:0301-2603

    詳細を見る 詳細を閉じる

    PURPOSE: The adverse effects of combination chemotherapy of ifosfamide, cisplatin, and etoposide (ICE) were evaluated in the treatment of various intracranial brain tumors. METHODS: 108 cases were retrospectively reviewed. The histological diagnosis was newly diagnosed or recurrent germ cell tumor in 45 cases, medulloblastoma in 19, primitive neuroectodermal tumor (PNET) in 7, anaplastic ependymoma in 6, recurrent glioblastoma in 13, and others in 18 cases. Patients received 1-8 cycles of ICE chemotherapy with or without radiation therapy. The adverse effects were analyzed based on the the clinical or laboratory examinations. RESULTS: Common Terminology Criteria for Adverse Events ver. 3.0 (CTCAE v3.0) grade 4 neutropenia, anemia, and thrombocytopenia occurred in 81.4%, 14.8%, and 35.2% of patients, respectively. Non-hematological adverse effects, including infection, elevated aspartate aminotransferase (AST)/alanine aminotransferase (ALT), high or low levels of serum sodium, and seizure, occurred in 26.8%, 29.6%, 28.7%, and 11.1% of patients, respectively. One patient died of opportunistic infection with neutropenia. The proportion of ICE cycles associated with CTCAE v3.0 grade 4 neutropenia, transfusion of platelets, and elevated AST/ALT significantly decreased after enforcement of dose reduction criteria. CONCLUSION: The high rate of adverse effects requires close follow up and dose reduction.

  368. Efficacy of Revascularization Surgery for Moyamoya Syndrome Associated With Graves&apos; Disease 査読有り

    Hidenori Endo, Miki Fujimura, Kuniyasu Niizuma, Hiroaki Shimizu, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 50 (11) 977-983 2010年11月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.50.977  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    Appropriate management of moyamoya syndrome associated with Graves&apos; disease is undetermined because of the rarity of this combination Patients tend to present with cerebrovascular events such as transient ischemic attack (TIA) in a thyrotoxic state, which is relieved by proper antithyroid therapy Four patients with moyamoya syndrome associated with Graves&apos; disease were successfully treated with revascularization surgery on 5 hemispheres among 58 consecutive patients (2-62 years old, mean 34 4 years) with moyamoya disease in 80 hemispheres treated from March 2004 to May 2007 Three patients presented with TIA, and one patient presented with intracerebral hemorrhage Three patients were thyrotoxic at the onset of the cerebrovascular events All patients underwent revascularization surgery after normalization of thyroid function Euthyroid state was strictly maintained perioperatively One patient developed symptomatic cerebral hyperperfusion, which was resolved by blood pressure control Postoperative courses of the other patients were uneventful, and all 4 patients have remained neurologically stable after discharge Cerebrovascular reconstruction surgery is a successful treatment option for moyamoya syndrome associated with Graves&apos; disease Timing of surgery during the euthyroid state and perioperative management considering the thyroid function and the cerebral hemodynamic change are the keys to successful surgical treatment

  369. CDC25A mRNA levels significantly correlate with Ki-67 expression in human glioma samples 査読有り

    Yoji Yamashita, Isao Kasugai, Masami Sato, Nobuhiro Tanuma, Ikuro Sato, Miyuki Nomura, Katsumi Yamashita, Yukihiko Sonoda, Toshihiro Kumabe, Teiji Tominaga, Ryuichi Katakura, Hiroshi Shima

    JOURNAL OF NEURO-ONCOLOGY 100 (1) 43-49 2010年10月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s11060-010-0147-3  

    ISSN:0167-594X

    eISSN:1573-7373

    詳細を見る 詳細を閉じる

    Cell division cycle 25 (CDC25) phosphatases are cell-cycle regulatory proteins which are overexpressed in a significant number of human cancers. This study evaluated the role of CDC25 phosphatases in human glioma proliferation. Upregulation of CDC25A was observed in human glioma specimens and human glioma cell lines. Comparison of expression levels of CDC25A and CDC25B messenger ribonucleic acid (RNA) to Ki-67 labeling index in glioma tissues found that Ki-67 labeling index was significantly correlated with the expression of CDC25A, but not with that of CDC25B. Depletion of CDC25A by small interfering RNA and inhibition of CDC25 suppressed cell proliferation and induced apoptosis in glioma cell lines, indicating that CDC25A is a potential target for the development of new therapy for glioma.

  370. Efficacy of intraoperative irrigation with saline for preventing shunt infection Clinical article 査読有り

    Toshiaki Hayashi, Reizo Shirane, Michiko Yokosawa, Tomomi Kimiwada, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-PEDIATRICS 6 (3) 273-276 2010年9月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2010.5.PEDS1018  

    ISSN:1933-0707

    詳細を見る 詳細を閉じる

    Object. The rate of infection following shunt procedures is unacceptably high. The authors have hypothesized that the key to reducing the shunt infection rate is in reducing bacteria in the operating field and wound. This hypothesis has been tested in a prospective nonrandomized controlled manner. Methods. Data obtained in all patients undergoing shunt insertions or revisions for hydrocephalus performed between October 1, 2003, and June 12, 2009, were reviewed. Starting in August 2006, we began routinely irrigating the operating field and wound with saline solution from a syringe. Prior to this, we had not used any irrigation techniques, providing an adequate control group (Group A) for the effect of the irrigation technique. Prior to November 2007, we used saline containing amikacin for irrigation (Group B). After that date, we used saline only for irrigation (Group C). Results. A total of 150 shunt procedures were performed in 79 girls and 71 boys during the study period. The mean age of all patients was 44.0 +/- 59.1 months. Groups A, B, and C comprised 61, 40, and 49 shunt procedures, respectively. There was no statistical difference in age among the 3 groups. Nine infections occurred within 90 days in the postoperative period. The overall infection rate was 6.0%. Eight infections occurred before introducing the irrigation procedure (infection rate 13.1%). One infection was noted after introducing irrigation (Group B [0.0%] + Group C [2.0%]; combined B and C infection rate = 1.1%). There was a statistical difference in the infection rate between Group A and Groups B and C combined (p = 0.003), Groups A and B (p = 0.021), and Groups A and C (p = 0.035). In contrast, no statistical difference was observed between Groups B and C (p &gt; 0.99). Six of the 9 infections were due to staphylococcal species. Conclusions. An irrigation technique used to reduce bacteria in the operating field and wound is effective for preventing shunt infection. Irrigation alone, and not antibiotics, contributed to the prophylaxis of shunt infection. (DO!: 10.3171/2010.5.PEDS1018)

  371. Imaging of hypoxic lesions in patients with gliomas by using positron emission tomography with 1-(2-[(18)F]fluoro-1-[hydroxymethyl]ethoxy)methyl-2-nitroimidazole, a new (18)F-labeled 2-nitroimidazole analog Clinical article 査読有り

    Ichiyo Shibahara, Toshihiro Kumabe, Masayuki Kanamori, Ryuta Saito, Yukihiko Sonoda, Mika Watanabe, Ren Iwata, Shuichi Higano, Kentaro Takanami, Yoshihiro Takai, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 113 (2) 358-368 2010年8月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2009.10.JNS09510  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Object. Assessment of hypoxic conditions in brain tumors is important for predicting tumor aggressiveness and treatment response. A new hypoxia imaging agent, 1-(2-[(18)F]fluoro-1-[hydroxymethyl]ethoxy)methyl-2-nitroimidazole (FRP-170), with higher image contrast and faster clearance than preexisting hypoxia tracers for PET, was used to visualize hypoxic tissues in 8 patients with glioma. Methods. The FRP-170 was injected and PET imaging was performed 2 hours later in 8 patients, including 3 with glioblastoma multiforme, 2 with oligodendroglioma, and 1 each with diffuse astrocytoma, anaplastic ganglioglioma, and recurrent anaplastic astrocytoma. All 8 patients also underwent MR imaging, and some patients underwent [(11)C]methionine or [(18)F]fluorodeoxyglucose PET, and proton MR spectroscopy for comparison. Tissues obtained at biopsy or radical resection were immunostained with hypoxia-inducible factor-1 alpha (HIF-1 alpha) antibody for the confirmation of hypoxia, except in the patient with recurrent anaplastic astrocytoma who was treated using Gamma Knife surgery. Results. The FRP-170 PET images showed marked uptake with upregulation of HIF-1 alpha in the 3 glioblastomas multiforme, and moderate uptake in the recurrent anaplastic astrocytoma and one oligodendroglioma, but no uptake in the other tumors. The FRP-170 PET images showed positive correlation with HIF-1 alpha immunoreactivity and some correlation with FDG PET and MR imaging enhancement, but no correlation with [(11)C]methionine PET. Imaging with FRP-170 PET seemed to be more sensitive for detecting hypoxia than identifying the lactate peak on proton MR spectroscopy. Conclusions. Imaging with FRP-170 PET can visualize hypoxic lesions in patients with glioma, as confirmed by histological examination. This new method can assess tumor hypoxia preoperatively and noninvasively. (DOI: 10.3171/2009.10.JNS09510)

  372. O (6)-Methylguanine DNA methyltransferase determined by promoter hypermethylation and immunohistochemical expression is correlated with progression-free survival in patients with glioblastoma 査読有り

    Yukihiko Sonoda, Michiko Yokosawa, Ryuta Saito, Masayuki Kanamori, Yoji Yamashita, Toshihiro Kumabe, Mika Watanabe, Teiji Tominaga

    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 15 (4) 352-358 2010年8月

    出版者・発行元:SPRINGER TOKYO

    DOI: 10.1007/s10147-010-0065-6  

    ISSN:1341-9625

    詳細を見る 詳細を閉じる

    The prognostic significance of O (6)-methylguanine DNA methyltransferase (MGMT) was evaluated by analysis of both MGMT promoter methylation and protein expression in a series of patients with newly diagnosed glioblastoma. Seventy-three patients with glioblastomas treated with alkylating agents were analyzed for MGMT expression by immunohistochemistry. Genomic DNA was isolated from frozen surgical specimens obtained from 62 of 73 patients. MGMT promoter methylation was determined by methylation-specific polymerase chain reaction. The prognostic significance of MGMT was evaluated together with other well-known prognostic factors. MGMT promoter hypermethylation was detected in 35 of 62 patients (56.4%). MGMT immunoreactivity was low in 26 (35.6%) tumors, moderate in 24 (32.9%), and high in 23 (31.5%). Significant correlation was observed between MGMT expression and MGMT promoter methylation (P &lt; 0.001). Both MGMT promoter methylation and low MGMT expression were independently associated with better progression-free survival but not with longer overall survival. However, in the subgroup analysis, MGMT promoter hypermethylation was significantly associated with longer overall survival in patients treated with temozolomide (TMZ) after nimustine hydrochloride (ACNU) treatment. Low MGMT expression and MGMT promoter methylation are both predictive markers for slower tumor progression in patients with glioblastoma.

  373. Convection-Enhanced Delivery of a Synthetic Retinoid Am80, Loaded into Polymeric Micelles, Prolongs the Survival of Rats Bearing Intracranial Glioblastoma Xenografts 査読有り

    Michiko Yokosawa, Yukihiko Sonoda, Shin-ichiro Sugiyama, Ryuta Saito, Yoji Yamashita, Masamichi Nishihara, Taku Satoh, Toshihiro Kumabe, Masayuki Yokoyama, Teiji Tominaga

    TOHOKU JOURNAL OF EXPERIMENTAL MEDICINE 221 (4) 257-264 2010年8月

    出版者・発行元:TOHOKU UNIV MEDICAL PRESS

    DOI: 10.1620/tjem.221.257  

    ISSN:0040-8727

    eISSN:1349-3329

    詳細を見る 詳細を閉じる

    Prognosis for the patients with glioblastoma, the most common malignant brain tumor, remains dismal. A major barrier to progress in treatment of glioblastoma is the relative inaccessibility of tumors to chemotherapeutic agents. Convection-enhanced delivery (CED) is a direct intracranial drug infusion technique to deliver chemotherapeutic agents to the central nervous system, circumventing the blood-brain barrier and reducing systemic side effects. CED can provide wider distribution of infused agents compared to simple diffusion. We have reported that CED of a polymeric micelle carrier system could yield a clinically relevant distribution of encapsulated agents in the rat brain. Our aim was to evaluate the efficacy of CED of polymeric micellar Am80, a synthetic agonist with high affinity to nuclear retinoic acid receptor, in a rat model of glioblastoma xenografts. We also used systemic administration of temozolomide, a DNA-alkylating agent, which has been established as the standard of care for newly diagnosed malignant glioma. U87MG human glioma cells were injected into the cerebral hemisphere of nude rats. Rats bearing U87MG xenografts were treated with CED of micellar Am80 (2.4 mg/m(2)) on day 7 after tumor implantation. Temozolomide (200 mg/m(2)/day) was intraperitoneally administered daily for 5 days, starting on day 7 after tumor implantation. CEO of micellar Am80 provided significantly longer survival than the control. The combination of CEO of micellar Am80 and systemic administration of temozolomide provided significantly longer survival than single treatment. In conclusion, temozolomide combined with CEO of micellar Am80 may be a promising method for the treatment of malignant gliomas.

  374. Usefulness of C-Arm Cone-Beam Computed Tomography in Endovascular Treatment of Traumatic Carotid Cavernous Fistulas: A Technical Case Report 査読有り

    Kenichi Sato, Yasushi Matsumoto, Ryushi Kondo, Teiji Tominaga

    NEUROSURGERY 67 (2) 467-469 2010年8月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1227/01.NEU.0000372087.71176.FB  

    ISSN:0148-396X

    詳細を見る 詳細を閉じる

    BACKGROUND: Detailed information about the anatomy of traumatic carotid cavernous fistula (CCF) is required for determining the appropriate treatment strategy. OBJECTIVE: We report the usefulness of C-arm cone-beam computed tomography (CBCT) for visualizing traumatic CCF during endovascular treatment. CLINICAL PRESENTATION: A 63-year-old woman presented with right pulsating tinnitus 1 week after a bicycle accident. Right internal carotid angiography demonstrated a right CCF but failed to visualize its precise location because the cavernous portion of the right internal carotid artery (ICA) was hidden by early filling of the cavernous sinus during both conventional digital subtraction angiography (DSA) and 3-dimensional digital angiography. TECHNIQUE: C-arm CBCT, performed with a flat-panel detector mounted in a C-arm angiographic system, clearly depicted the tear in the medial wall of the C4 segment of the right ICA. Transarterial embolization with coils achieved complete occlusion of the CCF, and the patient&apos;s symptoms resolved immediately after the procedure. CONCLUSION: C-arm CBCT is useful to visualize the communication between the ICA and cavernous sinus and helps to determine the treatment strategy for traumatic CCFs.

  375. Lectin-like oxidized low-density lipoprotein receptor 1 and matrix metalloproteinase expression in ruptured and unruptured multiple dissections of distal middle cerebral artery: case report 査読有り

    Atsushi Saito, Miki Fujimura, Takashi Inoue, Hiroaki Shimizu, Teiji Tominaga

    ACTA NEUROCHIRURGICA 152 (7) 1235-1240 2010年7月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-009-0560-6  

    ISSN:0001-6268

    詳細を見る 詳細を閉じる

    Oxidized low-density lipoprotein receptor 1 (LOX1) is a critical factor for atherosclerosis in a variety of vascular diseases; however, its major role in cerebral arterial dissecting aneurysm is unclear. We present a case of remarkable contrast of LOX1 expression in ruptured and unruptured multiple middle cerebral artery dissections and discuss the correlation of LOX1 with matrix metalloproteinases (MMPs). A 59-year-old woman presented with subarachnoid hemorrhage associated with left temporal subcortical hematoma. Emergent cerebral angiography demonstrated aneurysmal dilatation at the origin of the left anterior temporal artery (ATA) and occlusion on the distal side of ATA. Infectious aneurysm was excluded. Intraoperative findings showed ruptured dissection of the left ATA and unruptured aneurysmal dilatation of another temporal branch of the left M1 portion. Both lesions were trapped by clips and resected. Histopathological examination confirmed that both ruptured and unruptured aneurysmal dilatations were diagnosed as arterial dissections. Immunohistochemical examination demonstrated remarkable expressions of LOX1, MMP-2, and MMP-9 in hypertrophic media outside the intima in ruptured dissection, on the other hand, those expressions in the intima and inside hypertrophic media in the unruptured dissection. This is the first report to reveal immunohistochemical findings of LOX1 and MMPs in multiple dissections of MCA. The contrast localization of LOX1 and MMPs might contribute to the fragility of the arterial wall layer of ruptured/unruptured arterial dissections.

  376. Postoperative neurological deterioration in pediatric moyamoya disease: watershed shift and hyperperfusion Clinical article 査読有り

    Toshiaki Hayashi, Reizo Shirane, Miki Fujimura, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-PEDIATRICS 6 (1) 73-81 2010年7月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2010.4.PEDS09478  

    ISSN:1933-0707

    詳細を見る 詳細を閉じる

    Object. Young patients with moyamoya disease frequently exhibit extensive cerebral infarction at the time of initial presentation, and even in the early postoperative period. To investigate clinical characteristics in the early postoperative period, the authors prospectively analyzed findings of MR imaging, MR angiography, and SPECT before and after surgery. The authors focused in particular on how postoperative neurological deterioration occurred. Methods. Between August 2005 and June 2009, 22 patients younger than 18 years of age with moyamoya disease were treated at Miyagi Children&apos;s Hospital. The mean patient age (+/- SD) was 8.58 +/- 4.55 years (range 2-17 years). Superficial temporal artery middle cerebral artery bypass and indirect bypass of encephalosynangiosis between the brain surface and the temporal muscle, galea, and dura mater were performed in 35 hemispheres. Magnetic resonance imaging and MR angiography were performed before surgery, at 7 days postoperatively, and 3-6 months after surgery. A (123)I-isopropyl iodoamphetamine SPECT scan was also obtained pre- and postoperatively. Results. During the postoperative period, neurological deterioration was observed after 15 operations (10 cases of motor paresis, I of aphasia, and 4 of sensory disturbance) in 13 patients. All symptoms had resolved by the time of discharge, except in 2 patients who suffered cerebral infarction. All patients exhibited disappearance (94.3%) or reduction (5.7%) of transient ischemic attacks (TIAs) during the follow-up period. Perioperative studies revealed 2 different types of radiological findings, focal uptake decrease on SPECT indicative of cerebral ischemia due to dynamic change in cerebral hemodynamics caused by bypass flow, the so-called watershed shift, and perioperative edematous lesions on MR imaging due to cerebral hyperperfusion. The frequent occurrence of preoperative TIAs was significantly associated with watershed shift, whereas preoperative MR imaging findings and preoperative SPECT findings were not. Age at operation was the only factor significantly associated with postoperative hyperperfusion. Conclusions. In young patients, moyamoya disease exhibits rapid progression, resulting in poor clinical outcome. The risk of postoperative neurological deterioration in very young moyamoya patients with frequent TIAs should be noted. The findings in this study showed that direct bypass is not completely safe in patients with moyamoya disease because it causes dynamic change in postoperative cerebral hemodynamics. (DOI: 10.3171/2010.4.PEDS09478)

  377. A partially ossified solid and cystic Rathke cleft cyst 査読有り

    Yoshikazu Ogawa, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 112 (6) 1324-1326 2010年6月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2009.10.JNS09826  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Ratlike cleft cyst is considered to arise from the remnants of the Rathke pouch, and it consists of single cuboidal or columnar epithelium including cilia and goblet cells, which secrete mucus into the cyst. Magnetic resonance imaging characteristically shows a thin membranous cystic wall that enhances with Gd, and homogeneous intensity of the content suggesting fluid collection. Cases with an irregularly thickened and/or calcified cyst wall, presumably due to chronic inflammation of the wall, are rare. A 21-year-old woman presented with an extremely rare case of a solid and cystic Rathke cleft cyst with partial ossification, manifesting as bitemporal hemianopia. Magnetic resonance imaging showed a massive solid sellar lesion extending upward and compressing the optic chiasm and floor of the third ventricle. Transsphenoidal surgery was performed, resulting in total removal of the lesion and immediate recovery of visual function. Postoperative histological examination disclosed that the major part of the lesion consisted of various phases of clotting and granulation with significant fibrosis. Mature bone formation and abundant cholesterin clefts were also seen. Single cuboidal epithelium including goblet cells and cilia was found along this granulation, and the diagnosis was a Rathke cleft cyst. An ossified Rathke cleft cyst is extremely rare, and a solid Rathke cleft cyst has not before been reported. This case illustrates the extremely long and complex nature of this disease. (DOI: 10.3171/2009.10.JNS09826)

  378. Acute-stage diffusion-weighted magnetic resonance imaging for predicting outcome of poor-grade aneurysmal subarachnoid hemorrhage 査読有り

    Kenichi Sato, Hiroaki Shimizu, Miki Fujimura, Takashi Inoue, Yasushi Matsumoto, Teiji Tominaga

    JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM 30 (6) 1110-1120 2010年6月

    出版者・発行元:NATURE PUBLISHING GROUP

    DOI: 10.1038/jcbfm.2009.264  

    ISSN:0271-678X

    詳細を見る 詳細を閉じる

    We investigated the role of acute-stage diffusion-weighted images (DWIs) for predicting outcome of poor-grade subarachnoid hemorrhage (SAH). This study included 38 patients with poor-grade SAH who underwent DWI within 24 h after onset. DWI findings were divided into three groups on the basis of lesion area: none (N), spotty (S, &lt;= 10 mm(2)), or areal (A, &gt; 10 mm(2)). We evaluated the correlation between preoperative DWI findings and clinical outcome, and the characteristics of DWI abnormalities. DWI abnormalities were revealed in 81.6% of cases (group S 34.2%; group A 47.3%). All patients in groups N and S and 73.3% of patients in group A were treated radically. For those patients without rerupture, favorable outcomes were achieved in 100% of group N, 53.8% of group S, and 0% of group A. Abnormal lesions on initial DWI, which resulted in permanent lesions, showed a mean apparent diffusion coefficient ratio to the control value of 0.71, which was significantly lower than 0.95 observed in reversible lesions (P&lt; 0.01). We recommend radical treatment for even poor-grade SAH as long as the preoperative DWI shows no or only spotty lesions. DWI may provide an objective means to estimate the outcome of poor-grade SAH. Journal of Cerebral Blood Flow & Metabolism (2010) 30, 1110-1120; doi: 10.1038/jcbfm.2009.264; published online 6 January 2010

  379. Somatostatin-Producing Atypical Null Cell Adenoma Manifesting as Severe Hypopituitarism and Rapid Deterioration-Case Report 査読有り

    Yoshikazu Ogawa, Mika Watanabe, Teiji Tominaga

    ENDOCRINE PATHOLOGY 21 (2) 130-134 2010年6月

    出版者・発行元:HUMANA PRESS INC

    DOI: 10.1007/s12022-010-9110-2  

    ISSN:1046-3976

    詳細を見る 詳細を閉じる

    Atypical adenoma has an aggressive biological character, invades the surrounding structures, and grows rapidly. Morphological malignant findings such as increasing cellularity and nuclear atypism are not involved in this entity, but some cases with overt malignant features such as significant nuclear atypism and/or necrosis are known. Null cell adenoma generally grows slowly, but hormone secretion is little understood. Atypical null cell adenoma is rare, and hormone production is unknown. A 55-year-old woman presented with severe hypopituitarism and diabetes insipidus and bilateral upper temporal quadrantanopsia. Head magnetic resonance imaging revealed a large sellar tumor compressing the optic chiasm. Transsphenoidal surgery was performed, but the tumor was partially removed because of invasion into the neuronal structures. Histological examination showed atypical null cell adenoma with significant nuclear atypism and extensive necrosis. Immunohistochemistry showed positive reaction to somatostatin. Adjuvant treatment was planned, but the tumor regrew within 3 months. Conventional irradiation resulted in slight decrease in tumor size, but she required assistance for every type of daily activity. Atypical null cell adenoma has an aggressive biological character, and immediate adjuvant treatment is essential. Somatostatin secretion was proven in this tumor type.

  380. Surgical treatment of spinal intradural arachnoid cysts using endoscopy Clinical article 査読有り

    Toshiki Endo, Toshiyuki Takahashi, Hidefumi Jokura, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-SPINE 12 (6) 641-646 2010年6月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2009.12.SPINE09577  

    ISSN:1547-5654

    詳細を見る 詳細を閉じる

    Object. Spinal intradural arachnoid cysts are a rare cause of spinal cord compression. Since 2000, the authors have treated patients using 2- or 3-level hemilaminectomy or laminectomy followed by partial cyst wall resection as well as endoscopic inspection and fenestration of the cyst wall. They evaluated the usefulness and reliability of endoscopic treatment for this clinical entity based on long-term follow-up results. Methods. Between 1997 and 2003, 11 patients (3 males and 8 females) with spinal intradural arachnoid cysts were treated, and the authors conducted a retrospective review of these cases. Before 2000, 5 patients were surgically treated without the use of endoscopic techniques. During that time, more than 4 levels of hemilaminectomy were performed to expose and remove cyst walls that extended longitudinally over the spinal axis. Beginning in 2000, endoscopy was used in all 6 cases. Up to 3 levels of hemilaminectomy or 2 levels of laminectomy were performed, and the cyst wall was resected through the bone window. An endoscope was inserted into the cyst cavity and moved in the cranial and caudal direction to fenestrate the cyst wall, resulting in communication of the cyst cavity with the subarachnoid space. Results. Postoperatively, the neurological symptoms of all patients improved. During long-term follow-up (mean 114.8 months), none of the patients treated with or without endoscopy experienced recurrent cyst formation. Conclusions. Endoscopic techniques allow neurosurgeons to treat spinal intradural arachnoid cysts less invasively than with standard surgical approaches. Although the number of cases reviewed in this report is small, the data suggest that the use of endoscopy can be an important option in the surgical treatment of spinal arachnoid cysts. (DOI: 10.3171/2009.12.SPINE09577)

  381. Malignant Peripheral Nerve Sheath Tumor Arising From Benign Vestibular Schwannoma Treated by Gamma Knife Radiosurgery After Two Previous Surgeries: A Case Report With Surgical and Pathological Observations 査読有り

    Yosuke Akamatsu, Kensuke Murakami, Mika Watanabe, Hidefumi Jokura, Teiji Tominaga

    WORLD NEUROSURGERY 73 (6) 751-754 2010年6月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.wneu.2010.04.009  

    ISSN:1878-8750

    詳細を見る 詳細を閉じる

    BACKGROUND: Gamma knife radiosurgery (GKRS) is an effective treatment for vestibular schwannomas with lower morbidity and mortality. However, malignant transformation associated with GKRS, although uncommon, has been reported in recent publications. METHODS: We describe a case presenting with malignant peripheral nerve sheath tumor (MPNST) at 8 years after GKRS after incomplete resections. RESULTS: The tumor appeared to be a typical benign schwannoma at the surgery preceding GKRS, and rapidly enlarged after long-term control, causing progressive neurological deterioration. Operative findings showed that the tumor was composed of two different components, and histopathology distinctively demonstrated MPNST and benign schwannoma. CONCLUSIONS: The coexistence of benign and malignant components might indicate that the present MPNST had arisen from the benign schwannoma by transformation in association with GKRS.

  382. Relationship between lectin-like oxidized low-density lipoprotein receptor 1 expression and preoperative echogenic findings of vulnerable carotid plaque 査読有り

    Atsushi Saito, Miki Fujimura, Takashi Inoue, Hiroaki Shimizu, Teiji Tominaga

    ACTA NEUROCHIRURGICA 152 (4) 589-595 2010年4月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-009-0573-1  

    ISSN:0001-6268

    詳細を見る 詳細を閉じる

    Lectin-like oxidized low-density lipoprotein 1 (LOX1) is an important cell surface receptor for the progression of atherosclerosis. Our purpose is to clarify the relationships of LOX1 and atherosclerotic factors for the vulnerability of carotid plaque and preoperative echogenic findings. We examined LOX1 expression, matrix metalloproteinase (MMP)-2,9, and tissue inhibitor of MMP (TIMP)-2 by immunohistochemical analysis using carotid endarterectomy specimens obtained from 14 patients. Groups were divided into stable plaque group A and vulnerable plaque group B by preoperative echogenic findings of carotid plaques. Endothelial immunoreactivity was calculated, and the immunohistochemical findings were compared. LOX1 was remarkably expressed, especially in smooth muscle cells in vulnerable plaque and colocalized in MMP-9 positive cells and apoptotic cells. All LOX1, MMP-2,9, and TIMP2 were remarkably expressed in the subendothelial layer in group B compared with group A. The endothelial LOX1 index was 63.75 +/- 4.92 in group A and 83.0 +/- 5.02 in group B (p = 0.02). The endothelial MMP-2 index was 24.38 +/- 5.50 in group A and 32.83 +/- 6.79 in group B (p = 0.01). The endothelial MMP-9 index was 46.13 +/- 6.31 in group A and 59.17 +/- 2.14 in group B (p = 0.002). The endothelial TIMP-2 index had no significant difference between two groups (p = 0.14). LOX-1 may play an important role in the progression of vulnerable carotid plaque and might regulate vulnerable plaque formation in cooperation with MMPs and TIMP-2. Endothelial MMP-2 might suppress TIMP-2 activation in vulnerable plaques.

  383. Association of stem cell marker CD133 expression with dissemination of glioblastomas 査読有り

    Atsushi Sato, Kaori Sakurada, Toshihiro Kumabe, Toshio Sasajima, Takaaki Beppu, Kenichiro Asano, Hiroki Ohkuma, Akira Ogawa, Kazuo Mizoi, Teiji Tominaga, Chifumi Kitanaka, Takamasa Kayama

    NEUROSURGICAL REVIEW 33 (2) 175-183 2010年4月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s10143-010-0239-8  

    ISSN:0344-5607

    詳細を見る 詳細を閉じる

    Dissemination of glioblastoma was once considered rare but is now increasingly encountered with longer survival of glioblastoma patients. Despite the potential negative impact of dissemination on clinical outcome, however, molecular markers useful for prediction of dissemination risk still remains ill defined. We tested in this study for an association between the expression of stem cell marker CD133 and the risk of dissemination in 26 cases of glioblastoma (16 with dissemination and 10 without dissemination). The protein expression of CD133 was examined by western blot analysis of tumor specimens, and the CD133 expression levels were quantified by densitometry and normalized to beta-actin. The results indicated that CD133 expression levels are significantly higher in glioblastomas with dissemination (mean 10.3, range 0.20-27.8) than in those without (mean 1.18, range 0.07-3.58). The results suggest that CD133 could be a molecular predictor of glioblastoma dissemination, and also give rise to an intriguing idea that CD133-positive cancer stem cells may be implicated in the initiation of disseminated lesions.

  384. Dissemination limits the survival of patients with anaplastic ependymoma after extensive surgical resection, meticulous follow up, and intensive treatment for recurrence. 査読有り

    Saito R, Kumabe T, Kanamori M, Sonoda Y, Tominaga T

    Neurosurgical review 33 (2) 185-91; discussion 191 2010年4月

    DOI: 10.1007/s10143-010-0243-z  

    ISSN:0344-5607

  385. 2-hydroxyglutarate accumulation caused by IDH mutation is involved in the formation of malignant gliomas 査読有り

    Yukihiko Sonoda, Teiji Tominaga

    EXPERT REVIEW OF NEUROTHERAPEUTICS 10 (4) 487-489 2010年4月

    出版者・発行元:EXPERT REVIEWS

    DOI: 10.1586/ERN.10.19  

    ISSN:1473-7175

  386. Melanotic neuroectodermal tumor of the brain recurring 12 years after complete remission: case report 査読有り

    Shunsuke Omodaka, Ryuta Saito, Toshihiro Kumabe, Jun Kawagishi, Hidefumi Jokura, Yukihiko Sonoda, Mika Watanabe, Takamasa Kayama, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 27 (1) 51-57 2010年4月

    出版者・発行元:SPRINGER TOKYO

    DOI: 10.1007/s10014-010-0263-y  

    ISSN:1433-7398

    詳細を見る 詳細を閉じる

    We describe a rare case of melanotic neuroectodermal tumor (MNT) of the brain recurring 12 years after complete remission. An 11-year-old girl initially presented with exotropia and bilateral papilledema. Magnetic resonance (MR) imaging revealed an intracranial extraaxial large tumor at the midfrontal region. T(1)-weighted MR imaging showed the tumor to be well delineated with homogeneous enhancement by gadolinium. The tumor was subtotally removed, and the histological diagnosis was MNT. The residual tumor became enlarged, so gamma knife radiosurgery was performed 5 months after initial surgery. The enhanced lesion disappeared, but another lesion emerged 3 years later. A second gamma knife radiosurgery was performed for this local recurrence. The enhanced lesion disappeared once again. Twelve years after the second gamma knife radiosurgery, another local recurrence was detected. This tumor was subtotally removed. Histological examination confi rmed the same diagnosis of MNT. This case suggests that MNTs not completely resected need long-term follow up, even if complete remission was achieved after adjuvant therapy.

  387. Insulo-opercular Gliomas: Four Different Natural Progression Patterns and Implications for Surgical Indications 査読有り

    Ryuta Saito, Toshihiro Kumabe, Masayuki Kanamori, Yukihiko Sonoda, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 50 (4) 286-290 2010年4月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.50.286  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    The insular cortex is circumscribed with three limiting sulci, so progression patterns of insulo-opercular gliomas can be categorized into tumor progression limited to the insular cortex, tumor progression via the anterior limiting sulcus, tumor progression via the inferior limiting sulcus, and tumor progression via the superior limiting sulcus. Recent improvements in clinical accessibility and imaging devices have identified more patients harboring small tumors in the insulo-opercular regions. Therefore, the natural progression patterns of insulo-opercular gliomas and the implications for surgical indications are important. Among 36 patients who suffered glioma at insulo-opercular regions and underwent radical resection at our institute between February 2002 and August 2008, cases that showed four different development patterns were retrospectively reviewed. In our series of patients, 7 patients were followed up for more than 100 days after detection of the diseases until surgery. Among these patients, there existed cases that represent four different progression patterns of insulo-opercular gliomas. Surgical complications associated with insulo-opercular gliomas often result from damage to surrounding structures, especially the perforating arteries. Resection of tumors invading medially to the putamen can result in damage to the lenticulostriate arteries, and resection higher than the superior limiting sulcus can result in injury to the long insular arteries. Consequently, the surgical indications for insulo-opercular gliomas should be limited to small tumors within the insular cortex or progressing via the anterior or inferior limiting sulcus. Tumors that progress via the superior limiting sulcus carry a high risk of injuring the long insular arteries.

  388. Asymptomatic Moyamoya Disease Subsequently Manifesting as Transient Ischemic Attack, Intra cerebral Hemorrhage, and Subarachnoid Hemorrhage in a Short Period-Case Report 査読有り

    Miki Fujimura, Shunji Mugikura, Hiroaki Shimizu, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 50 (4) 316-319 2010年4月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.50.316  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 59-year-old man, who had incidentally been found to have asymptomatic moyamoya disease 4 months previously, suffered transient ischemic attack (TIA) in the left extremities. Three weeks later, he again suffered TIA, and neuroimaging examination revealed fresh subarachnoid hemorrhage in the interhemispheric cistern as well as an asymptomatic thalamic hemorrhage in the contralateral hemisphere, which was not evident at the first onset of TIA. Digital subtraction angiography confirmed the diagnosis of moyamoya disease, and single-photon emission computed tomography demonstrated significant hemodynamic compromise in the right hemisphere. He underwent superficial temporal artery-middle cerebral artery anastomosis with indirect pial synangiosis without complication one month later. The TIA completely disappeared after surgery, and no further cerebrovascular event occurred during the follow-up period of 2 years. Asymptomatic moyamoya disease may manifest with a dynamic course, so careful follow up is necessary. Simultaneous manifestation of ischemic attack, subarachnoid hemorrhage, and intracerebral hemorrhage in a short period in the present case may indicate the underlying mechanism of the cerebrovascular events in this rare entity.

  389. De Novo Formation of Orbital Cavernous Malformation 9 Years After Surgical Management of Dural Arteriovenous Fistula in the Anterior Middle Fossa-Case Report 査読有り

    Shunsuke Omodaka, Miki Fujimura, Toshiki Endo, Takashi Inoue, Hiroaki Shimizu, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 50 (4) 324-327 2010年4月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.50.324  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 30-year-old man presented with recurrent dural arteriovenous fistula (dAVF) associated with de nova orbital cavernous malformation (CM), manifesting as progressive left visual disturbance. He had undergone transarterial embolization and subsequent surgical management for a left anterior middle fossa dAVF 9 years previously. External carotid angiography showed recurrence of the dAVF. Magnetic resonance imaging revealed a well delineated intraorbital mass lesion with hypointense signal rim by T(2)-weighted imaging, adjacent to the shunting point of the recurrent dAVF. Transcranial subtotal removal of the intraorbital mass lesion through the orbitopterional approach revealed continuity between the mass lesion and the draining vein of the recurrent dAVF. The histological diagnosis was CM. His symptom was relieved postoperatively, and no regrowth was seen during the follow-up period of one year. The coexistence of recurrent dAVF with newly formed orbital CM is extremely rare, but may indicate the underlying mechanism of the formation of CMs and recurrent dAVF.

  390. Non-saccular aneurysms of the supraclinoid internal carotid artery trunk causing subarachnoid hemorrhage: acute surgical treatments and review of literatures. 査読有り

    Shimizu H, Matsumoto Y, Tominaga T

    Neurosurgical review 33 (2) 205-216 2010年4月

    DOI: 10.1007/s10143-009-0234-0  

    ISSN:0344-5607

  391. Long-term Outcome of Cervical and Thoracolumbar Dural Arteriovenous Fistulas With Emphasis on Sensory Disturbance and Neuropathic Pain 査読有り

    Mizuya Shinoyama, Toshiki Endo, Toshiyuki Takahash, Hiroaki Shimizu, Akira Takahashi, Michiyasu Suzuki, Teiji Tominaga

    WORLD NEUROSURGERY 73 (4) 401-408 2010年4月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.wneu.2010.01.003  

    ISSN:1878-8750

    詳細を見る 詳細を閉じる

    BACKGROUND: Clinical features and prognosis of sensory disturbance in spinal dural arteriovenous fistula (SDAVF) have not been well documented. Here we report long-term outcomes and detailed sensory evaluations of surgically treated SDAVF, including 14 patients with the craniocervical fistulas. METHODS: Thirty-four consecutive patients with SDAVF treated at our institute during a period of 14 years were reviewed (mean age, 64.6 years; 67.6% men). Fistulas were located at the craniocervical junction in 14 patients (CC group) and in the thoracolumbar spine in 20 patients (TL group). In the CC group, six patients presented with subarachnoid hemorrhage. Fistulas were found incidentally in seven patients. One patient in the CC group and all patients in the TL group presented with progressive myelopathy. Most patients underwent microsurgery either alone (30 patients) or combined with embolization (3 patients). One patient was treated by embolization only. The follow-up ranged from 12 to 145 months (mean, 57 months). RESULTS: All but one patient in the CC group had excellent surgical outcome. Most patients in the TL group stabilized or improved neurologically. Shorter duration before treatment indicated better gait recovery. Important, a few patients in the TL group suffered worsening or development of new pain, as well as lesser degree of improvement in gait and micturition. Spinal cord atrophy was correlated with clinical deterioration. CONCLUSIONS: In craniocervical SDAVF, surgical treatment provides favorable long-term outcomes without risk of recurrence. In the thoracolumbar SDAVF, irreversible structural changes, such as spinal cord atrophy, may lead to poor recovery. Early diagnosis and treatment are thus warranted.

  392. Effect of olmesartan and pravastatin on experimental cerebral aneurysms in rats 査読有り

    Naoto Kimura, Hiroaki Shimizu, Hany Eldawoody, Toshio Nakayama, Atsushi Saito, Teiji Tominaga, Akira Takahashi

    BRAIN RESEARCH 1322 144-152 2010年3月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.brainres.2010.01.044  

    ISSN:0006-8993

    詳細を見る 詳細を閉じる

    The major initiation process of intracranial aneurysms is thought to involve endothelial dysfunction due to hemodynamic stress. Angiotensin II type 1 receptor blockers and statins improve vascular endothelium function. The effects of olmesartan and pravastatin were investigated on the development of experimental aneurysms in rats. Eighty-three rats underwent aneurysm induction. Seven groups of 10-14 rats were treated with low or high dose olmesartan, low or high dose pravastatin, low doses of olmesartan and pravastatin, hydralazine, or no drug (control) for 12 weeks, when rats were sacrificed for vascular corrosion casting and scanning electron microscopy. Aneurysmal changes at the anterior cerebral-olfactory artery bifurcation were divided into stages 0 (no abnormality) to III (saccular aneurysm). Systolic arterial blood pressure was elevated over 170 mm Hg in the control, low dose pravastatin, and high dose pravastatin groups, but not in the other groups. The control group demonstrated aneurysmal changes in 100% and stage III in 50% of rats. Aneurysmal changes were observed in most rats in the other groups, but the incidence of stage III was 10% or less. The staging pattern showed significant differences between the groups (P=0.028). Pravastatin reduced both stages III and II + III and olmesartan ameliorated stage III, implying that these may prevent aneurysmal formation through acting on different steps. (209 words) (C) 2010 Elsevier B.V. All rights reserved.

  393. Fasudil, a Rho-kinase inhibitor, attenuates induction and progression of cerebral aneurysms: Experimental study in rats using vascular corrosion casts 査読有り

    Hany Eldawoody, Hiroaki Shimizu, Naoto Kimura, Atsushi Saito, Toshio Nakayama, Akira Takahashi, Teiji Tominaga

    NEUROSCIENCE LETTERS 470 (1) 76-80 2010年2月

    出版者・発行元:ELSEVIER IRELAND LTD

    DOI: 10.1016/j.neulet.2009.12.061  

    ISSN:0304-3940

    詳細を見る 詳細を閉じる

    Fasudil (a Rho-kinase inhibitor) has been shown to attenuate abdominal aortic aneurysm development, but any preventive effect against development of cerebral aneurysms is unclear. The effect of fasudil on the development of cerebral aneurysms was investigated in 55 female Sprague-Dawley rats divided into 4 groups: Group 1 (n = 10) was the control group without treatment. Groups 2-4 (n = 15 each) were subjected to cerebral aneurysm induction procedures plus 1% NaCl in the drinking water. Groups 3 and 4 were also treated with 0.5 or 1.0 mg/mL of fasudil in the drinking water, respectively. Vascular corrosion casts of the cerebral arteries were prepared and examined using a scanning electron microscope after 2 months. No significant differences were observed in the degree of induced hypertension between Groups 2, 3 and 4. No aneurysms were found in Group 1. Examination of the left anterior cerebral-olfactory artery junction, which is the most susceptible site for aneurysm development, found significantly fewer aneurysmal lesions in Groups 3 (60%) and 4 (53%) compared to Group 2 (100%) (P&lt;0.02). This study suggests that fasudil attenuated induction of cerebral aneurysms in the rat model. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

  394. Extracranial Metastasis of Anaplastic Oligodendroglioma With 1p19q Loss of Heterozygosity -Case Report- 査読有り

    Nobuo Noshita, Shoji Mashiyama, Osamu Fukawa, Shigeyuki Asano, Mika Watanabe, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 50 (2) 161-164 2010年2月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.50.161  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    We report a rare case of anaplastic oligodendroglioma with extracranial metastasis, showing 1p19q co-deletion in both the brain tissue and the metastatic site. A 53-year-old man first presented with a left frontal tumor. The tumor was subtotally removed and irradiation was performed for the residual tumor and tumor bed. Two years after the initial treatment, several tumors appeared on his neck and one was resected. Histological examination revealed anaplastic oligodendroglioma, proved to be the same as the previous brain tumor. The patient refused further treatment, and died 30 months after the initial treatment. Autopsy demonstrated multiple extracranial metastases in the vertebrae, lymph nodes, spinal dura mater, thymus gland, and chest wall. We confirmed 1p19q loss of heterozygosity in both lesions, suggesting that 1p19q co-deletion might important to extracranial metastasis of oligodendroglioma.

  395. Parent artery occlusion with bypass surgery for the treatment of internal carotid artery aneurysms: Clinical and hemodynamic results 査読有り

    Hiroaki Shimizu, Yasushi Matsumoto, Teiji Tominaga

    CLINICAL NEUROLOGY AND NEUROSURGERY 112 (1) 32-39 2010年1月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.clineuro.2009.10.002  

    ISSN:0303-8467

    詳細を見る 詳細を閉じる

    Objective: Parent artery occlusion with/without bypass surgery is one of the treatment choices for the internal carotid artery (ICA) aneurysm difficult to treat by clipping or coiling. There have been few reports regarding postoperative cerebral blood flow (CBF) changes after surgery. This study evaluated the present bypass selection strategy based on balloon test occlusion (BTO) in terms of clinical and hemodynamic outcomes. Methods: Twenty-one consecutive patients with ICA aneurysms underwent parent artery occlusion. High flow bypass (n = 9), superficial temporal artery-middle cerebral artery bypass (n = 10), or no bypass (n = 2) was performed depending on the changes in clinical symptoms and CBF during BTO. Quantitative CBF measurement with acetazolamide challenge was performed in the chronic stage. Results: Overall outcome at discharge was good recovery 18, moderate disability 2, and severe disability 1. Two patients suffered symptomatic embolic or perforator infarction associated with the surgical manipulations. Preoperative cranial nerve pareses improved completely or partially in all patients except one. CBF in the chronic stage (n = 18) demonstrated no significant difference between the surgical and non-surgical cerebral hemispheres. No cerebral ischemic event was observed during the follow-up period (mean 2.9 years). Conclusion: The present surgical strategy based on preoperative BTO provides a reliable tool to achieve acceptable clinical and hemodynamic outcomes in patients with complex ICA aneurysms to be treated by parent artery occlusion. (C) 2009 Elsevier B.V. All rights reserved.

  396. Simultaneous occurrence of subarachnoid hemorrhage and cerebral infarction caused by anterior cerebral artery dissection treated by endovascular trapping. 査読有り

    Inoue T, Fujimura M, Matsumoto Y, Kondo R, Inoue T, Shimizu H, Tominaga T

    Neurologia medico-chirurgica 50 (7) 574-577 2010年

    DOI: 10.2176/nmc.50.574  

    ISSN:0470-8105

  397. Cushing's disease associated with unruptured large internal carotid artery aneurysm. Case report. 査読有り

    Nishijima Y, Ogawa Y, Sato K, Matsumoto Y, Tominaga T

    Neurologia medico-chirurgica 50 (8) 665-668 2010年

    DOI: 10.2176/nmc.50.665  

    ISSN:0470-8105

  398. Subependymoma in the lateral ventricle manifesting as intraventricular hemorrhage. 査読有り

    Akamatsu Y, Utsunomiya A, Suzuki S, Endo T, Suzuki I, Nishimura S, Ezura M, Suzuki H, Uenohara H, Tominaga T

    Neurologia medico-chirurgica 50 (11) 1020-1023 2010年

    DOI: 10.2176/nmc.50.1020  

    ISSN:0470-8105

  399. Minimum apparent diffusion coefficient for the differential diagnosis of ganglioglioma 査読有り

    Toshio Kikuchi, Toshihiro Kumabe, Shuichi Higano, Mika Watanabe, Teiji Tominaga

    NEUROLOGICAL RESEARCH 31 (10) 1102-1107 2009年12月

    出版者・発行元:MANEY PUBLISHING

    DOI: 10.1179/174313209X382539  

    ISSN:0161-6412

    詳細を見る 詳細を閉じる

    Objectives: The utility of apparent diffusion coefficient (ADC) values was evaluated for the differential diagnosis of ganglioglioma. Methods: Ten consecutive patients, five men and five women, aged from 14 to 67 years, with histologically proven supratentorial gangliogliomas, underwent diffusion-weighted magnetic resonance imaging with echo planar imaging technique. The minimum ADC (minADC) of each tumor was pre-operatively determined from several regions of interest. The minADC of ganglioglioma was compared with that of low-or high-grade astrocytomas (astrocytoma, anaplastic astrocytoma and glioblastoma). Tumor cellularity of gangliogliomas was compared with the minADC. Results: The mean minADC of the gangliogliomas (1.45 +/- 0.20 x 10(-3) mm(2)/s) was significantly higher than that of the low-or high-grade astrocytomas. Tumor cellularity of ganglioglioma was inversely correlated with the minADC value. Discussion: The minADC value reflects in the low tumor cellularity of gangliogliomas and may provide a method for the differential diagnosis of ganglioglioma. [Neurol Res 2009; 31: 1102-1107]

  400. Clinical implications of intraoperative infrared brain surface monitoring during superficial temporal artery-middle cerebral artery anastomosis in patients with moyamoya disease Clinical article 査読有り

    Atsuhiro Nakagawa, Miki Fujimura, Tatsuhiko Arafune, Ichiro Sakuma, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 111 (6) 1158-1164 2009年12月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2009.4.JNS08585  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Object. Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). Symptomatic cerebral hyperperfusion is a potential complication of this procedure, but its treatment is contradictory to that for ischemia. Because intraoperative techniques to detect hyperperfusion are still lacking, the authors performed intraoperative infrared monitoring in moyamoya disease using a novel infrared imaging system. Methods. During superficial temporal artery-middle cerebral artery anastomosis in 25 patients (26 hemispheres) with moyamoya disease, the authors monitored the brain surface temperature intraoperatively with the IRIS-V infrared imaging system. The average gradation value change (indicating temperature change) was calculated using commercial software. Magnetic resonance imaging, MR angiography, and N-isopropyl-p-[(123)I] iodoamphetamine SPECT studies were performed routinely before and within 10 days after surgery. Results. Patency of bypass, detailed local hemodynamics, and changes in cortical surface temperature around the anastomosis site were well recognized by the IRIS-V infrared imaging system in all cases. In the present study, 10 patients suffered transient neurological symptoms accompanied by an increase in CBF around the anastomosis site, recognized as symptomatic hyperperfusion. The increase in temperature was significantly higher in these patients. Intensive blood pressure control was undertaken, and free-radical scavengers were administered. No patient in the present study suffered a permanent neurological deficit. Conclusions. Although the present method does not directly monitor surface CBF, temperature rise around the anastomosis site during surgery might be an indicator of postoperative hyperperfusion. Prospective evaluation with a larger number of patients is necessary to validate this technique. (DOI: 10.3171/2009.4.JNS08585)

  401. Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis Clinical article 査読有り

    Masayuki Kanamori, Toshihiro Kumabe, Ryuta Saito, Yoji Yamashita, Yukihiko Sonoda, Hisanori Ariga, Yoshihiro Takai, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-PEDIATRICS 4 (6) 506-514 2009年12月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2009.7.PEDS08288  

    ISSN:1933-0707

    詳細を見る 詳細を閉じる

    Object. This study retrospectively analyzed the long-term outcomes of 108 consecutive patients to establish the classification and optimal treatment strategy for each subgroup of newly diagnosed germ cell tumors (GCTs). Methods. A retrospective review of medical records from the authors&apos; department between April 1989 and March 2007 identified 108 patients with newly diagnosed intracranial GCT. The diagnoses were germinoma in 83 patients, and nongerminomatous GCT (NGGCT) in 25 patients. Results. In patients with germinoma, the 10-year overall and progression-free survival (PFS) rates at a median follow-up period of 99 months were 86 and 74%. respectively. Recurrences developed during a range of 6 to 153 months (median 26 months) after starting the initial therapy. Patients treated only with chemotherapy demonstrated a shorter PFS rate, and patients treated with chemotherapy followed by reduced-dose radiation therapy to the whole ventricle, whole brain, or craniospinal axis showed significantly better PFS than patients treated with only radiation or reduced-dose radiation therapy to the focal field. Nongerminomatous GCTs were divided into good, intermediate, and poor prognosis groups as proposed by the Japanese Pediatric Brain Tumor Study Group. In the good and intermediate prognosis groups, the 10-year overall and PFS rates were 100 and 93%, respectively. In the poor prognosis group, the 3-year overall and PFS rates were 56 and 29%. respectively. All patients with NGGCTs. in whom the lesions on MR imaging disappeared after combination therapies consisting of resection. radiation therapy, and chemotherapy, remained alive. Conclusions. Chemotherapy followed by reduced-dose radiation therapy covering the whole ventricle improves the prognosis for patients with germinoma. Combined therapy of radiation therapy, chemotherapy, and radical resection as an initial or salvage treatment achieved excellent tumor control in the intermediate prognosis NGGCT group. The outcomes were still dismal in the poor prognosis NGGCT group, so initial therapy should target complete disappearance of all lesions on MR imaging. (DOI: 10.3171/2009.7.PEDS08288)

  402. [Intraoperative neuronavigation system without rigid pin fixation]. 査読有り

    Akamatsu Y, Kumabe T, Kanamori M, Nagamatsu K, Saito R, Sonoda Y, Sato K, Tominaga T

    No shinkei geka. Neurological surgery 37 (12) 1193-1199 2009年12月

    ISSN:0301-2603

  403. Differentiation of Clear Cell Ependymoma of the Cerebellum From Hemangioblastoma by Thallium-201 Single Photon Emission Computed Tomography-Case Report 査読有り

    Ken-ichi Nagamatsu, Toshihiro Kumabe, Mika Watanabe, Yoichi Nakazato, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 49 (12) 608-611 2009年12月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.49.608  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 57-year-old man suffered from dizziness for about one year and truncal ataxia for about one month. Magnetic resonance imaging demonstrated a cystic tumor with a homogeneously enhanced mural nodule located in the cerebellar vermis. Computed tomography angiography revealed a hypervascular nodule. These findings were compatible with hemangioblastoma. Thallium-201 single photon emission computed tomography ((201)Tl-SPECT) showed moderately high uptake in the early phase and moderately high retention in the delayed phase, whereas hemangioblastoma shows almost no retention in the delayed phase. The patient underwent total removal of the tumor. The histological diagnosis was clear cell ependymoma (CCE). CCE is a rare subtype of ependymoma, which resembles hemangioblastoma in histological and neuroimaging findings, but is considerably more aggressive. (201)Tl-SPECT can provide useful information for the preoperative differential diagnosis of infratentorial CCE and hemangioblastoma.

  404. Hypophysitis Presenting With Atypical Rapid Deterioration: With Special Reference to Immunoglobulin G4-Related Disease-Case Report 査読有り

    Shinichiro Osawa, Yoshikazu Ogawa, Mika Watanabe, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 49 (12) 622-625 2009年12月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.49.622  

    ISSN:0470-8105

    eISSN:1349-8029

    詳細を見る 詳細を閉じる

    Primary hypophysitis is believed to be a chronic inflammation of the pituitary tissue caused by the autoimmune mechanism. The disease can be classified based on morphology and histology simultaneously, but the relationships between these subtypes remain unclarified. Moreover, hypophysitis may occur as a part of systemic immunoglobulin G4 (IgG4)-related plasmacytic disease. A 74-year-old woman was initially diagnosed with infundibulo-hypophysitis. After a long period of stability, she suffered rapid deterioration with evolving endocrinopathies and visual symptoms. Biopsy specimen established the diagnosis as granulomatous hypophysitis with positive reaction for IgG4 in infiltrating plasma cells. Postoperative glucocorticoid administration improved her condition dramatically. This case illustrates two interesting points: The rapid deterioration after a long stable clinical course, and the presence of IgG4-positive tissue in the pituitary gland, which can be considered as "primary" hypophysitis with no systemic IgG4-related disease in other organs.

  405. Minimum apparent diffusion coefficient is significantly correlated with cellularity in medulloblastomas 査読有り

    Yoji Yamashita, Toshihiro Kumabe, Shuichi Higano, Mika Watanabe, Teiji Tominaga

    NEUROLOGICAL RESEARCH 31 (9) 940-946 2009年11月

    出版者・発行元:MANEY PUBLISHING

    DOI: 10.1179/174313209X382520  

    ISSN:0161-6412

    詳細を見る 詳細を閉じる

    Objective: On diffusion-weighted magnetic resonance (MR) images, posterior fossa tumors may exhibit the various signal intensity and apparent diffusion coefficient (ADC) reflecting their histology and cellularity. The purpose of this study was to evaluate the relationship between ADC and tumor cellularity in medulloblastoma and other posterior fossa tumors. Methods: Pre-operative diffusion-weighted MR images were retrospectively reviewed in 26 patients with posterior fossa neoplasms: 11 medulloblastomas, one atypical teratoid/rhabdoid tumor (AT/RT), four glioblastomas, four ependymomas, three pilocytic astrocytomas and three hemangioblastomas. The minimum ADC (minADC) value of each tumor was determined on ADC maps derived from isotropic diffusion-weighted MR images. The minADC values were compared by a two-tailed t-test. Tumor cellularity measured in surgical specimens was compared with the minADC value by simple linear regression analysis. Results: The mean minADC value of the medulloblastoma was significantly lower than those of ependymoma, pilocytic astrocytoma and hemangioblastoma without overlap in the range of minADC values. Therefore, medulloblastomas could be clearly differentiated by absolute minADC values. AT/RT and glioblastoma had similar minADC values to medulloblastoma. Tumor cellularity was negatively correlated with the minADC value in medulloblastomas and other posterior fossa tumors. Discussion: The low minADC value of medulloblastomas reflects the high tumor cellularity. Analysis of ADC values has high predictive value for the differentiation of medulloblastoma from other posterior fossa tumors. [Neurol Res 2009; 31: 940-946]

  406. Increased expression of serum matrix metalloproteinase-9 in patients with moyamoya disease 査読有り

    Miki Fujimura, Mika Watanabe, Ayumi Narisawa, Hiroaki Shimizu, Teiji Tominaga

    SURGICAL NEUROLOGY 72 (5) 476-480 2009年11月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.surneu.2008.10.009  

    ISSN:0090-3019

    詳細を見る 詳細を閉じる

    Background: Moyamoya disease is a chronic occlusive cerebrovascular disease with unknown etiology characterized by an abnormal vascular network at the base of the brain, which can manifest both as ischemic stroke and as cerebral hemorrhage. It was also reported that the patients with moyamoya disease are more vulnerable to cerebral hyperperfusion such as postoperative hemorrhagic complication after extracranial-intracranial bypass surgery despite its low flow revascularization. However, the underlying mechanisms of its pathologic angiogenesis and the occurrence of hemorrhage are undetermined. Excessive degradation of the vascular matrix by MMPs, proteolytic enzymes that degrade all the components of extracellular matrix, can lead to instability of the vascular structure and can thereby cause bleeding. The MMPs also play an important role in tissue remodeling including angiogenesis in both physiologic and pathologic condition. Methods: We examined the serum levels of MMP-2 and MMP-9 in 16 cases with definitive moyamoya disease by enzyme-linked immunosorbent assay and compared them with those from healthy controls. Results: The serum MMP-9 level was significantly higher in moyamoya disease (40.18 ng/mL) than in healthy controls (13.75 ng/mL, P=.0372). There was no difference in serum MMP-2 level between moyamoya disease (646.65 ng/mL) and healthy control (677.60 ng/mL). Immunohistochemistry on the surgical specimens showed significant increase in MMP-9 expression within the arachnoid membrane of moyamoya disease. Conclusion: The increased expression of MMP-9 may contribute to pathologic angiogenesis and/or to the instability of the vascular structure and could thereby cause hemorrhage in moyamoya disease. (C) 2009 Elsevier Inc. All rights reserved.

  407. Long-term survivors of glioblastoma: clinical features and molecular analysis 査読有り

    Yukihiko Sonoda, Toshihiro Kumabe, Mika Watanabe, Yoichi Nakazato, Tomoo Inoue, Masayuki Kanamori, Teiji Tominaga

    ACTA NEUROCHIRURGICA 151 (11) 1349-1358 2009年11月

    出版者・発行元:SPRINGER WIEN

    DOI: 10.1007/s00701-009-0387-1  

    ISSN:0001-6268

    詳細を見る 詳細を閉じる

    Glioblastoma is a highly lethal neoplasm with a median survival of 12-14 months; only 2-5% of patients survive &gt; 3 years. At our institute, patients with glioblastoma are initially treated with maximum tumor resection followed by radiation and the intravenous injection of nimustine hydrochloride (ACNU). Using this strategy, 18 of 123 (14.6%) patients treated at our hospital survived &gt; 3 years; 7 manifested no recurrence, and the other 11 had early recurrence and received additional therapies. To identify factors associated with prolonged survival, we compared these patients with 21 short-term (&lt; 1.5 years) glioblastoma survivors. In the long-term survivors, the MGMT promoter methylation was significantly more frequent. The rate of p53 mutation was lower, and the rate of PTEN mutations and the proliferation index were slightly higher in short-term survivors. By multivariate analysis, we found that a younger age and MGMT promoter methylation were significant favorable factors in patients with glioblastoma.

  408. Simplified experimental cerebral aneurysm model in rats: Comprehensive evaluation of induced aneurysms and arterial changes in the circle of Willis 査読有り

    Hany Eldawoody, Hiroaki Shimizu, Naoto Kimura, Atsushi Saito, Toshio Nakayama, Akira Takahashi, Teiji Tominaga

    BRAIN RESEARCH 1300 159-168 2009年11月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.brainres.2009.08.099  

    ISSN:0006-8993

    詳細を見る 詳細を閉じる

    Establishing a simple and comprehensive experimental model is one of the most important issues in the study of cerebral aneurysms. Previous models in the rat required two stage surgeries and observations were limited to a few branching sites. The present study aimed to introduce a simplified model in rats and to provide a comprehensive evaluation of induced arterial changes in the circle of Willis. Sprague-Dawley rats underwent ligation of the right common carotid artery, and posterior and inferior (group 2, n = 9) or only posterior (group 3, n = 12) branches of the bilateral renal arteries, and bilateral oophorectomy. Dahl salt-sensitive rats underwent only carotid ligation and bilateral oophorectomy (group 5, n = 11). All surgical procedures were completed in one procedure instead of two in the original method. Salt loading was started after the surgery. Five rats of each strain without treatment served as controls (groups 1 and 4, respectively). Three months later, vascular corrosion casts of the cerebral arteries were examined by scanning electron microscopy. Experimental rats in groups 2, 3, and 5 developed 43 aneurysmal lesions at branching sites. Forty-eight arterial changes including dilatation, tortuosity, and fusiform or lateral wall aneurysms were observed at non-branching sites. Group 3 appeared to be superior to the other groups for experimental studies. The frequency and degree of the induced lesions were comparable with previous studies even after the surgical simplification. The present model may be more practical for the study of experimental cerebral aneurysms. (C) 2009 Elsevier B.V. All rights reserved.

  409. Neuroendoscopic management of symptomatic septum pellucidum cavum vergae cyst using a high-definition flexible endoscopic system. 査読有り

    Nishijima Y, Fujimura M, Nagamatsu K, Kohama M, Tominaga T

    Neurologia medico-chirurgica 49 (11) 549-552 2009年11月

    DOI: 10.2176/nmc.49.549  

    ISSN:0470-8105

  410. Analysis of IDH1 and IDH2 mutations in Japanese glioma patients 査読有り

    Yukihiko Sonoda, Toshihiro Kumabe, Taigen Nakamura, Ryuta Saito, Masayuki Kanamori, Yoji Yamashita, Hiroyoshi Suzuki, Teiji Tominaga

    CANCER SCIENCE 100 (10) 1996-1998 2009年10月

    出版者・発行元:WILEY-BLACKWELL PUBLISHING, INC

    DOI: 10.1111/j.1349-7006.2009.01270.x  

    ISSN:1347-9032

    詳細を見る 詳細を閉じる

    A recent study reported on mutations in the active site of the isocitrate dehydrogenase 1 (IDH1) gene in several types of gliomas. All mutations detected resulted in an amino acid exchange at position 132. We analyzed the genomic region spanning wild-type R132 of IDH1 by direct sequencing in 125 glial tumors. A total of 39 IDH1 mutations were observed. Mutations of the IDH2 gene, homologous to IDH1, were often detected in gliomas without IDH1 mutations. In the present study, R172 mutation of the IDH2 gene was detected in one anaplastic astrocytoma. IDH1 or IDH2 mutations were frequently in oligodendrogliomas (67%), anaplastic astrocytomas (62%), anaplastic oligoastrocytomas (75%), anaplastic oligodendrogliomas (50%), secondary glioblastomas (67%), gangliogliomas (38%), and anaplastic gangliogliomas (60%). Primary glioblastomas were characterized by a low frequency of mutations (5%) at amino acid position 132 of IDH1. Mutations of the IDH1 or IDH2 genes were significantly associated with improved outcome in patients with anaplastic astrocytomas. Our data suggest that IDH1 or IDH2 mutation plays a role in early tumor progression of several types of glioma and might arise from a common glial precursor. The infrequency of IDH1 mutation in primary glioblastomas revealed that these subtypes are genetically distinct entities from other glial tumors. (Cancer Sci 2009; 100: 1996-1998).

  411. Collision tumor of anaplastic oligodendroglioma and gangliocytoma: a case report 査読有り

    Yoichi Takeuchi, Masayuki Kanamori, Toshihiro Kumabe, Ryuta Saito, Yukihiko Sonoda, Mika Watanabe, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 26 (2) 89-93 2009年10月

    出版者・発行元:SPRINGER TOKYO

    DOI: 10.1007/s10014-009-0255-y  

    ISSN:1433-7398

    詳細を見る 詳細を閉じる

    A 53-year-old woman presented with a rare case of coexistence of anaplastic oligodendroglioma with gangliocytoma manifesting as progressive disturbance of consciousness and left hemiparesis. Magnetic resonance imaging with gadolinium demonstrated the mass lesion consisted of a strongly enhanced area around the middle cerebral artery and less enhanced areas in the right temporal lobe, insula, and basal ganglia. She underwent subtotal resection of the tumor, resulting in improvement of her symptoms. Macroscopic and histological examination showed the tumor consisted of two distinct components, grayish soft tissue and yellowish hard tissue. The former consisted of cells with equal-sized round-to-oval hyperchromatic nuclei and perinuclear halo with microvascular proliferation and necrosis, and the diagnosis was anaplastic oligodendroglioma. The latter consisted of large and dysplastic neurons with marked nucleoli and basophilic cytoplasm containing Nissl bodies, with nonneoplastic glial cells in the stroma, and the diagnosis was gangliocytoma. Both lesions were distinct, but intermingled at the border. These two tumors apparently occurred as a collision tumor.

  412. [C2 neurinoma with intracranial extension: a case report]. 査読有り

    Sonobe S, Murakami K, Kohama M, Watanabe M, Kumabe T, Tominaga T

    No shinkei geka. Neurological surgery 37 (9) 893-897 2009年9月

    ISSN:0301-2603

  413. Differential Diagnosis Between Radiation Necrosis and Glioma Progression Using Sequential Proton Magnetic Resonance Spectroscopy and Methionine Positron Emission Tomography 査読有り

    Takeshi Nakajima, Toshihiro Kumabe, Masayuki Kanamori, Ryuta Saito, Manabu Tashiro, Mika Watanabe, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 49 (9) 394-401 2009年9月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.49.394  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    Differential diagnosis between radiation necrosis and tumor recurrence is important in the clinical management of glioma. Multi-modality imaging including proton magnetic resonance spectroscopy ((1)H-MRS) and positron emission tomography (PET) with L-[methyl-(11)C]methionine (MET) was evaluated. Eighteen patients underwent sequential (1)H-MRS and MET-PET. The expressions of metabolites including choline-containing compounds (Cho), creatine phosphate (Cre), and lactate (Lac) were calculated as the ratios of Cho to Cre (Cho/Cre) and Lac to Cho (Lac/Cho). The uptake of MET was determined as the ratio of the lesion to the contralateral reference region (L/R). The final diagnoses were determined by histological examination and/or follow-up MR imaging and clinical course. The Lac/Cho ratio was 0.63 +/- 0.25 (mean standard deviation) in recurrence (7 cases) and 2.35 +/- 1.81 in necrosis (11 cases). The Lac/Cho ratio was significantly different between the two groups (p &lt; 0.01). Consecutive investigation of 1H-MRS revealed temporary elevation of Cho in 4 of 9 cases of necrosis, which could be identified as false positive findings for recurrence. Including those cases, MET-PET demonstrated significant difference in the L/R ratio between the two groups (2.18 +/- 0.42 vs. 1.49 +/- 0.35, p &lt; 0.01). According to a 2 x 2 factorial table analysis, the borderline values of Lac/Cho and L/R to differentiate recurrence from necrosis were 1.05 and 2.00, respectively. (1)H-MRS is reliable and accessible for the differentiation of recurrence and necrosis, although the temporary elevation of Cho in the course of necrosis should be recognized. Additional MET-PET imaging can establish the diagnosis.

  414. Magnetic resonance imaging for preoperative identification of the lenticulostriate arteries in insular glioma surgery Technical note 査読有り

    Ryuta Saito, Toshihiro Kumabe, Takashi Inoue, Shihomi Takada, Yoji Yamashita, Masayuki Kanamori, Yukihiko Sonoda, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 111 (2) 278-281 2009年8月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2008.11.JNS08858  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Aggressive resection of insular tumors is possible using a meticulous surgical approach based on the regional insular anatomy, with high rates of gross-total resection and low rates of permanent neurological deficits. However, the risk of postoperative morbidities remains high, often caused by disruption of the vascular supply to the surrounding eloquent structures, especially the lenticulostriate arteries (LSAs) that supply the internal capsule. Three-dimensional 3-T time-of-flight (TOF) MR imaging was performed pre- and postoperatively in patients with insuloopercular gliomas. This 3D 3-T TOF MR imaging clearly visualized the LSAs and the relationships with the tumor margins. These findings were confirmed intraoperatively. Three-dimensional 3-T TOF MR imaging of the LSAs in patients with insuloopercular gliomas can help to maximize the extent of resection without neurological complications, preserve the LSAs during Surgery, and assist in patient selection. (DOI: 10.3171/2008.11.JNS08858)

  415. Temporo-parietal theta activity correlates with misery perfusion in arterial occlusive disease 査読有り

    Satoru Ohtomo, Nobukazu Nakasato, Hiroaki Shimizu, Shintarou Seki, Akitake Kanno, Toshihiro Kumabe, Teiji Tominaga

    CLINICAL NEUROPHYSIOLOGY 120 (7) 1227-1234 2009年7月

    出版者・発行元:ELSEVIER IRELAND LTD

    DOI: 10.1016/j.clinph.2009.05.015  

    ISSN:1388-2457

    eISSN:1872-8952

    詳細を見る 詳細を閉じる

    Objective: Temporo-parietal theta activity (TPTA), often detected in hemispheres with internal carotid (ICA) or middle cerebral artery (MCA) occlusive lesions, is more clearly separated from occipital alpha activity by magnetoencephalography (MEG) than electroencephalography. The present study investigated whether TPTA is correlated with misery perfusion, a surgically correctable type of hemodynamic impairment. Methods: Awake MEG was measured in 56 patients with ICA or MCA occlusive lesions. Regional cerebral blood flow (rCBF) and regional cerebrovascular reactivity (rCVR) to acetazolamide were measured in the MCA territory by xenon-133 single-photon emission computed tomography. MEG was repeated in 10 patients after vascular reconstruction surgery. Results: Fourteen patients showed TPTA in the lesion hemisphere (n = 13) or bilaterally (n = I). The presence of TPTA was significantly correlated with both reduced rCBF and reduced rCVR (P = 0.0009). After surgery, TPTA disappeared in 7 of the 10 studied patients. Conclusions: The presence of TPTA suggests misery perfusion, which is characterized by reduced rCBF and reduced rCVR. Significance: MEG can detect the presence of reversible and surgically remediable cerebral ischemia before the development of complete infarction. (C) 2009 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  416. [Surgery of internal carotid--posterior communicating artery aneurysms]. 査読有り

    Shimizu H, Tominaga T

    No shinkei geka. Neurological surgery 37 (7) 633-642 2009年7月

    ISSN:0301-2603

  417. Predictive factors for overall and progression-free survival, and dissemination in oligodendroglial tumors 査読有り

    Masayuki Kanamori, Toshihiro Kumabe, Yukihiko Sonoda, Yoshikazu Nishino, Mika Watanabe, Teiji Tominaga

    JOURNAL OF NEURO-ONCOLOGY 93 (2) 219-228 2009年6月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s11060-008-9762-7  

    ISSN:0167-594X

    詳細を見る 詳細を閉じる

    The pattern of recurrence and predictive factors for tumor progression, dissemination and survival in oligodendroglial tumors were investigated. 56 consecutive patients with oligodendroglial tumors were retrospectively analyzed to determine the predictive significance of various factors, including World Health Organization grade, loss of chromosomes 1p and 19q, and immunohistochemical features of TP53, O(6)-methylguanine-deoxyribonucleic-acid-methyltransferase, CD44H, nestin, and Ki-67. Eleven patients developed dissemination, and had significantly shorter post-progression survival compared to ten patients with local recurrence. Univariate analysis showed that retention of chromosome 1p or 19q, Ki-67 labeling index a parts per thousand yen 25%, diffuse expression of nestin, and p53 labeling index a parts per thousand yen 10% were unfavorable factors for overall, progression-free, and dissemination-free survival. Multivariate analysis showed that Ki-67 labeling index a parts per thousand yen 25% and diffuse expression of nestin were significant for dissemination-free survival. In conclusion, post-progression survival shows significant differences between patients with local and disseminated recurrence. Ki-67 labeling index and nestin expression pattern are useful markers to predict dissemination.

  418. Endfolium sclerosis in temporal lobe epilepsy diagnosed preoperatively by 3-tesla magnetic resonance imaging Case report 査読有り

    Masaki Iwasaki, Nobukazu Nakasato, Hiroyoshi Suzuki, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 110 (6) 1124-1126 2009年6月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2008.11.JNS081109  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    A 34-year-old man presented with intractable temporal lobe epilepsy. Three-tesla magnetic resonance imaging revealed increased T2 signal intensity and volume loss limited to the CA4 region of the right hippocampus. A right anterior temporal lobectomy and amygdalohippocampectomy were performed. Histological examination of the hippocampus disclosed severe neuron loss limited to the CA4 region, consistent with the preoperative imaging, which is a pattern known as endfolium sclerosis. Close inspection of the internal hippocampal anatomy with high-field MR imaging is useful in patients with temporal lobe epilepsy, because endfolium sclerosis may be associated with less chance of seizure freedom after temporal lobectomy. (DOI: 10.3171/2008.11.JNS081109)

  419. Cortical Changes Following Spinal Cord Injury with Emphasis on the Nogo Signaling System 査読有り

    Toshiki Endo, Teiji Tominaga, Lars Olson

    NEUROSCIENTIST 15 (3) 291-299 2009年6月

    出版者・発行元:SAGE PUBLICATIONS INC

    DOI: 10.1177/1073858408329508  

    ISSN:1073-8584

    詳細を見る 詳細を閉じる

    After spinal cord injury, structural as well as functional modifications occur to the adult CNS. Sites of plastic changes include the injured spinal cord itself as well as cortical and subcortical structures. Previously, cortical reorganization in response to sensory deprivation has mainly been studied using peripheral nerve injury models, and has led to a degree of understanding of mechanisms underlying reorganization and plastic changes. Deprivation or damage-induced CNS plasticity is not always beneficial for patients, and may underlie the development of conditions such as neuropathic pain and phantom sensations. Therefore, efforts not only to enhance, but also to control the capacity of plastic changes in the CAS, are of clinical relevance. Novel methods to stimulate plasticity as well its to monitor it, such as transcranial magnetic stimulation and functional magnetic resonance imaging, respectively, may be useful in diverse clinical situations such as spinal cord injury and stroke. Here, human and animal studies of spinal cord injury are reviewed, with special emphasis on the contribution of the Nogo signaling system to cortical plasticity.

  420. [A case report of cerebellar pleomorphic xanthoastrocytoma]. 査読有り

    Mano Y, Kanamori M, Sonoda Y, Kumabe T, Watanabe M, Tominaga T

    No shinkei geka. Neurological surgery 37 (6) 586-590 2009年6月

    ISSN:0301-2603

  421. [Surgery of glioma]. 査読有り

    Kumabe T, Tominaga T

    Gan to kagaku ryoho. Cancer & chemotherapy 36 (6) 928-931 2009年6月

    ISSN:0385-0684

  422. Clock genes regulate neurogenic transcription factors, including NeuroD1, and the neuronal differentiation of adult neural stem/progenitor cells 査読有り

    Tomomi Kimiwada, Mikako Sakurai, Hiroki Ohashi, Shunsuke Aoki, Teiji Tominaga, Keiji Wada

    NEUROCHEMISTRY INTERNATIONAL 54 (5-6) 277-285 2009年5月

    出版者・発行元:PERGAMON-ELSEVIER SCIENCE LTD

    DOI: 10.1016/j.neuint.2008.12.005  

    ISSN:0197-0186

    詳細を見る 詳細を閉じる

    The circadian clock system plays multiple roles in our bodies, and clock genes are expressed in various brain regions, including the lateral subventricular zone (SVZ) where neural stem/progenitor cells (NSPCs) persist and postnatal neurogenesis continues. However, the functions of clock genes in adult NSPCs are not well understood. Here, we first investigated the expression patterns of Clock and Bmal1 in the SVZ by immunohistochemistry and then verified how the expression levels of 17 clock and clock-related genes changed during differentiation of cultured adult NSPCs using quantitative RT-PCR. Finally, we used RNAi to observe the effects of Clock and Bmal1 on neuronal differentiation. Our results revealed that Clock and Bmal1 were expressed in the SVZ and double-stained with the neural progenitor marker Nestin and neural stem marker GFAP. In cultured adult NSPCs, the clock genes changed their expression patterns during differentiation, and interestingly, Bmal1 started endogenous oscillation. Moreover, gene silencing of Clock or Bmal1 by RNAi decreased the percentages of neuronal marker Map2-positive cells and expression levels of NeuroD1 mRNA. These findings suggest that clock genes are involved in the neuronal differentiation of adult NSPCs and may extend our understanding of various neurological/psychological disorders linked to adult neurogenesis and circadian rhythm. (C) 2008 Elsevier Ltd. All rights reserved.

  423. Surgical and Histological Observations of Trochlear Neurinoma -Case Report- 査読有り

    Misaki Kohama, Kensuke Murakami, Toshiki Endo, Mika Watanabe, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 49 (5) 217-220 2009年5月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.49.217  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 47-year-old woman presented with an extremely rare case of trochlear nerve neurinoma manifesting as left hemiparesis. Magnetic resonance imaging demonstrated a cystic tumor, 4 cm in diameter, in the right ambient and cerebellopontine cisterns, compressing the midbrain and upper pons. The preoperative diagnosis was trigeminal neurinoma. However, the tumor was identified arising from the trochlear nerve, and was totally removed via the posterior transpetrosal approach. The histological diagnosis was neurinoma. The patient&apos;s hemiparesis improved postoperatively. Preoperative diagnosis of trochlear neurinoma must distinguish the neurological presentations of trochlear and trigeminal neurinomas and to analyze the microanatomy of the tumor and skull base structures on neuroimaging.

  424. Standardizing the diagnosis of acute ischemic stroke - The concept of an institutional manual and its clinical impact 査読有り

    Hiroaki Shimizu, Eisuke Furui, Hiroshi Shamoto, Akira Itabashi, Yasushi Matsumoto, Teiji Tominaga

    Brain and Nerve 61 (5) 581-589 2009年5月

    ISSN:1881-6096

    詳細を見る 詳細を閉じる

    In the management of acute ischemic stroke, a diagnostic procedure is critically important. However, till date, no guideline or consensus regarding a standard diagnosis procedure has been established. We hereby report an institutional manual for the consistent diagnosis of acute ischemic stroke. Methods: The institutional manual was based on the National Institute of Neurological Disorders and Stroke III classification however, the criteria for each stroke subtype were clearly defined using a rating system that included the representative observations specific to each subtype. The present manual was prepared in order to clearly define the characteristics of the stroke subtypes, which are often ambiguous in the clinical settings, and to design a diagnostic procedure within the institute with more emphasis on standardization rather than achieving complete accuracy. Several characteristic points were considered while doing this: lacunar infarctions should be clearly differentiated from other small infarctions, subtypes of "suspicious cardioembolism," "atherothrombotic infarction (embolic mechanism)," and "infarction due to arterial dissection" should be determined separately in order to identify the causal mechanism to the extent possible. For a final diagnosis, the patients were examined 3 time points during: at admission, during the subacute stage (day 4-7), and at discharge or more than 2 weeks after the onset of stroke. The current version of the manual has been used since 2006 after a transitional phase from 2004 to 2005. Retrospective comparisons on stroke diagnoses and clinical outcomes were performed between the periods during which the present manual was used and those during which it was not. Results: The present manual was retrospectively applied for diagnosing 311 consecutive ischemic stroke patients who were admitted to our institute within 7 days after the onset in 2003 in the case of 85 patients (29%), the diagnosis was different from that made in 2003. Of all the lacunar infections reported in 2003, 17 were diagnosed as other conditions when the manual was used. Similarly, 45% of the cases of atherothrombotic infarction (thrombotic mechanism) and 24% of those of cardiac embolism in 2003 were diagnosed differently when the present manual was applied. The mean modified Rankin scale at discharge was 2.63 ± 0.07 (mean ± standard error of the mean) in patients in 2002 and 2003 (n=491), which was significantly different from 2.32 ± 0.06 in patients in 2006 through March of 2008 (n=903 p=0.01). Conclusion: The present manual appears to be helpful to improve the uniformity of the diagnoses and the clinical results. It may also assist residents and their mentors in the educational field. The manual will require periodical evaluation and version upgrade in order to maintain its efficacy.

  425. Incidence and risk factors for symptomatic cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with moyamoya disease 査読有り

    Miki Fujimura, Shun Mugikura, Tomohiro Kaneta, Hiroaki Shimizu, Teiji Tominaga

    SURGICAL NEUROLOGY 71 (4) 442-447 2009年4月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.surneu.2008.02.031  

    ISSN:0090-3019

    詳細を見る 詳細を閉じる

    Background: Superficial temporal artery-middle cerebral artery anastomosis for moyamoya disease prevents cerebral ischemic attack by improving CBE, whereas recent evidence suggests that the temporary neurologic deterioration because of postoperative cerebral hyperfusion could occur despite its low-flow revascularization. The present study investigates the incidence and the risk factors for symptomatic hyperfusion after STA-MCA anastomosis in patients with moyamoya disease. Methods: We prospectively performed N-isopropyl-p-(sic) iodoamphetamine single-photon emission computed tomography 1 and 7 days after STA-MCA anastomosis on 80 hemispheres of 58 consecutive patients with moyamoya disease (approximately 2-62 years old, 34.4 years old in average). Mean follow-up period was 22.7 months. Symptomatic cerebral hyperperfusion was defined as the presence of the significant increase in CBF at the site of the anastomosis that is responsible for the apparent neurologic sign. Results: Twenty-one patients (22 sides, 27.5%) temporarily had symptomatic cerebral hyperfusion, who were subjected of intensive blood pressure control. Postoperative magnetic resonance imaging/angiography showed the thiek high signal of bypass without ischemic changes in all 21 patients. Adult-onset (P = .013) or hemorrhagic-onset patients (P = .027) had significantly higher risk for symptomatic hyperfusion. There was no difference in intraoperative temporary occlusion time between each group. No patients had permanent neurologic deficit because of hyperperfusion. Conclusion: The STA-MCA anastomosis is a safe and effective treatment of moyamoya disease, although adult-onset and/or hemorrhagic-onset patients had higher risk for symptomatic hyperperfusion. We recommend routine CBF measurement especially for these patients because the management of hyperperfusion is contradictory to that of ischemia. (c) 2009 Elsevier Inc. All rights reserved.

  426. Acute ischemic complications after therapeutic parent artery occlusion with revascularization for complex internal carotid artery aneurysms 査読有り

    Kensuke Murakami, Hiroaki Shimizu, Yasushi Matsumoto, Teiji Tominaga

    SURGICAL NEUROLOGY 71 (4) 434-441 2009年4月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.surneu.2008.03.036  

    ISSN:0090-3019

    詳細を見る 詳細を閉じる

    Background: Parent artery occlusion (PAO) is an alternative surgical strategy for complex internal carotid artery (ICA) aneurysma, which are unclippable because of their anatomical structures, including a broad neck, fragile dome, critical branch, and c sinus location. Despite revascularization, ischemic complications occur after the PAO because of several factors, such as hypoperfusion, embolism, and perforator impairment. Methods: Acute ischemic complications and their mechanisms were analyzed in a consecutive series of 32 patients presenting with complex ICA aneurysms treated by PAO. Results: Fourteen ruptured and 18 unruptured aneurysms were located in the carvernous sinus (n = 16) and paraclinoid portion (n = 16). Preoperative balloon test occlusion was performed to investigate ischemic tolerance and to select the bypass method in 24 cases. An extracranial-intraeranial bypass was constructed using the superficial temporal artery in 17, and saphenous vein graft was done in 12 cases. Although postoperative hypoperfusion was prevented by revascularization based on the balloon test occlusion, acute ischemic complications due to perforator occlusion and thromboembolism were observed in 10 cases after the surgery. Five cases presented with impairment of perforating branches adjacent to the occluded parent artery, resulting in prolonged neurologic deterioration. Conclusion: The distal location of ICA aneurysms is a risk factor for the perforator impairment, when treated by PAO, and PAO by clip placement is preferred to endovascular coiling to prevent of perforator impairment. (c) 2009 Elsevier Inc. All rights reserved.

  427. Therapeutic efficacy of a polymeric micellar doxorubicin infused by convection-enhanced delivery against intracranial 9L brain tumor models 査読有り

    Tomoo Inoue, Yoji Yamashita, Masamichi Nishihara, Shinichiro Sugiyama, Yukihiko Sonoda, Toshihiro Kumabe, Masayuki Yokoyama, Teiji Tominaga

    NEURO-ONCOLOGY 11 (2) 151-157 2009年4月

    出版者・発行元:DUKE UNIV PRESS

    DOI: 10.1215/15228517-2008-068  

    ISSN:1522-8517

    詳細を見る 詳細を閉じる

    Convection-enhanced delivery (CED) with various drug carrier systems has recently emerged as a novel chemotherapeutic method to overcome the problems of current chemotherapies against brain tumors. Polymeric micelle systems have exhibited dramatically higher in vivo antitumor activity in systemic administration. This study investigated the effectiveness of CED with polymeric micellar doxorubicin (DOX) in a 9L syngeneic rat model. Distribution, toxicity, and efficacy of free, liposomal, and micellar DOX infused by CED were evaluated. Micellar DOX achieved much wider distribution in brain tumor tissue and surrounding normal brain tissue than free DOX. Tissue toxicity increased at higher doses, but rats treated with micellar DOX showed no abnormal neurological symptoms at any dose tested (0.1-1.0 mg/ml). Micellar DOX infused by CED resulted in prolonged median survival (36 days) compared with free DOX (19.6 days; p = 0.0173) and liposomal DOX (16.6 days; p = 0.0007) at the same dose (0.2 mg/ml). This study indicates the potential of CED with the polymeric micelle drug carrier system for the treatment of brain tumors. Neuro-Oncology 11, 151-157, 2009 (Posted to Neuro-Oncology [serial online], Doc. D08-00039, August 28, 2008. URL http://neuro-oncology.dukejournals.org; DOI: 10.1215/15228517-2008-068)

  428. Cerebral ischemia owing to compression of the brain by swollen temporal muscle used for encephalo-myo-synangiosis in moyamoya disease 査読有り

    Miki Fujimura, Tomohiro Kaneta, Hiroaki Shimizu, Teiji Tominaga

    NEUROSURGICAL REVIEW 32 (2) 245-249 2009年4月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s10143-009-0184-6  

    ISSN:0344-5607

    詳細を見る 詳細を閉じる

    Compression of the brain by swollen temporal muscle used for indirect pial synangiosis is a rare complication after the revascularization surgery for moyamoya disease, and its mechanism and clinical presentation are undetermined. A 26-year-old woman, who had been suffering transient ischemic attack (TIA), underwent superficial temporal artery-middle cerebral artery anastomosis with encephalo-myo-synangiosis (EMS) on the affected hemisphere. The (123)I-IMP-SPECT 1 day after surgery demonstrated an improvement of cerebral blood flow (CBF) on the operated hemisphere. Two days later, however, she suffered fluctuating aphasia when computed tomography scan revealed marked swelling of the temporal muscle used for EMS. The (123)I-IMP-SPECT 4 days after surgery showed significant decrease in CBF by the compression of the brain. Then, we performed revision of EMS. The base of the temporal muscle was markedly compressed by the edge of the free bone flap, which resulted in swelling of the entire temporal muscle used for EMS. We drilled out the edge of the free bone flap for decompression. Her aphasia disappeared postoperatively, and CBF normalized 7 days after the initial surgery. Her TIA disappeared, and there was no deterioration during the follow-up period. The STA-MCA bypass has been patent since the initial surgery. Surgical revascularization including EMS has a substantial risk for cerebral ischemia owing to compression of the brain by temporal muscle swelling. Relative wide bone window for temporal muscle insertion is necessary to avoid this rare complication. Once the flow compromise is confirmed, we recommend early decompression by the revision of EMS.

  429. Hemorrhagic onset of pilocytic astrocytoma and pilomyxoid astrocytoma 査読有り

    Ichiyo Shibahara, Masayuki Kanamori, Toshihiro Kumabe, Hidenori Endo, Yukihiko Sonoda, Yoshikazu Ogawa, Mika Watanabe, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 26 (1) 1-5 2009年4月

    出版者・発行元:SPRINGER TOKYO

    DOI: 10.1007/s10014-008-0243-7  

    ISSN:1433-7398

    詳細を見る 詳細を閉じる

    The incidence of hemorrhagic onset in pilocytic astrocytoma and pilomyxoid astrocytoma, and the clinical and histological characteristics, were compared to other types of neuroepithelial tumors or nonhemorrhagic pilocytic astrocytoma by retrospective review of 445 consecutive neuroepithelial tumors treated at our institute. Hemorrhagic onset was observed in 4 of 35 (11.4%) patients with pilocytic astrocytoma and pilomyxoid astrocytoma, with higher incidence than in glioblastoma (3.9%), anaplastic oligodendroglioma (7.7%), and anaplastic ependymoma (7.1%). The hemorrhagic onset occurred in 2 patients with sporadic pilocytic astrocytoma, 1 with pilocytic astrocytoma associated with neurofibromatosis type 1, and 1 with pilomyxoid astrocytoma. There was no correlation between hemorrhagic onset and clinical features, including age, sex, tumor location, proliferative activity, or microvascular proliferation. Hemorrhagic onset of pilocytic astrocytoma and pilomyxoid astrocytoma is not as uncommon as was previously thought, so pilocytic astrocytoma or pilomyxoid astrocytoma should be considered in the differential diagnosis of patients with brain tumors manifesting as hemorrhagic onset.

  430. Application of high-definition flexible neuroendoscopic system to the treatment of primary pineal malignant B-cell lymphoma 査読有り

    Hidenori Endo, Miki Fujimura, Toshihiro Kumabe, Masayuki Kanamori, Mika Watanabe, Teiji Tominaga

    SURGICAL NEUROLOGY 71 (3) 344-348 2009年3月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.surneu.2007.08.029  

    ISSN:0090-3019

    詳細を見る 詳細を閉じる

    Background: Endoscopic procedure for pineal region tumors and associated hydrocephalus has been getting more standard. We applied high-definition flexible neuroendoscopic system to the initial management of primary pineal malignant B-cell lymphoma. Efficacy of this new technology as an initial treatment of pineal region tumors is discussed. Case Description: A 31-year-old man presented with progressive left abducens nerve palsy with headache and nausea. Magnetic resonance imaging showed multiple enhanced lesions in several cranial nerves and obstructive hydrocephalus due to a pineal cystic lesion with nodular enhancement on its roof. Diagnostic endoscopic biopsy of the pineal region tumor and ETV were performed using new flexible endoscopic system, in which a small CCD camera is implanted at the tip of the flexible scope, without complications. The thin cyst membrane was perforated and then opened with endoscopic forceps. A biopsy of the solid nodule on the cyst wall was carefully performed without injuring the surrounding venous system. We found a lot of small wartlike lesions along the third ventricular wall and fish egg-like abnormal lesions adhered to the colloid plexus around the pineal region, which were considered to be associated with dissemination. These lesions were not apparent in initial MRI. Histopathologic diagnosis of the pineal region tumor was malignant B-cell lymphoma. Conclusion: Endoscopic biopsy and ETV for pineal region tumors can be safely achieved using a high-definition flexible neuroendoscopic system. Moreover, this system allowed us to observe disseminated lesions that are not revealed by preoperative neuroradiologic studies, which might enable us to make staging diagnosis of the disease. (C) 2009 Elsevier Inc. All rights reserved.

  431. Syringomyelia with obstructive hydrocephalus at the foramens of Luschka and Magendie successfully treated by endoscopic third ventriculostomy 査読有り

    Tomohiro Kawaguchi, Miki Fujimura, Teiji Tominaga

    SURGICAL NEUROLOGY 71 (3) 349-352 2009年3月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.surneu.2007.08.015  

    ISSN:0090-3019

    詳細を見る 詳細を閉じる

    Background: Syringomyelia rarely accompanies hydrocephalus except for the cases with Chiari malformation, and the efficacy of endoscopic third ventriculostomy for this entity is undetermined. Case Report: A 55-year-old man developed sensory disturbance and discrete movement disturbance on the bilateral upper limb during the past 3 years. On admission, he presented with slight tetraparesis and hyperreflection on his lower limbs with rectovesical dysfunction. Preoperative MR imaging demonstrated marked enlargement of the lateral ventricles as well as the third and fourth ventricle due to obstruction of the foramens of Luschka and Magendie. Spine MR imaging showed longitudinal dilatation of the central canal from the cerebrospinal junction toward the thoracic level with communication to the fourth ventricle, whereas Chiari malformation and tight cisterna magna were absent. He was successfully treated by ETV. The patient significantly recovered from his symptoms postoperatively, and MR imaging after surgery showed apparent shrinkage of the syrinx as well as the ventricles. Conclusion: The efficacy of the normalization of cerebrospinal fluid circulation and subsequent improvement of the syringomyelia in the present case may suggest that ETV could be a therapeutic choice for syringomyelia associated with hydrocephalus due to the obstruction of the foramens of Luschka and Magendie, especially when the connection between the ventricular system and the dilated central canal is evident, and may give a clue to the explanation for Gardner&apos;s hydrodynamic theory. (c) 2009 Elsevier Inc. All rights reserved.

  432. [Neuroendoscopic management of a colloid cyst at the third ventricle using the high-definition flexible neuroendoscopic system: report of two cases]. 査読有り

    Kohama M, Fujimura M, Nagamatsu K, Murakami K, Tominaga T

    No shinkei geka. Neurological surgery 37 (3) 261-267 2009年3月

    ISSN:0301-2603

  433. [Preoperative evaluation of the aneurismal wall by using high-resolution MRI: report of 3 cases]. 査読有り

    Sadahiro H, Shimizu H, Inoue T, Tominaga T

    No shinkei geka. Neurological surgery 37 (3) 269-275 2009年3月

    ISSN:0301-2603

  434. [Surgical treatment of non-lesional supplementary motor area epilepsy: two case reports]. 査読有り

    Iwasaki M, Nakasato N, Shamoto H, Tominaga T

    No shinkei geka. Neurological surgery 37 (3) 293-298 2009年3月

    ISSN:0301-2603

  435. Delayed intracerebral hemorrhage after superficial temporal artery-middle cerebral artery anastomosis in a patient with moyamoya disease: possible involvement of cerebral hyperperfusion and increased vascular permeability 査読有り

    Miki Fujimura, Hiroaki Shimizu, Shunji Mugikura, Teiji Tominaga

    SURGICAL NEUROLOGY 71 (2) 223-227 2009年2月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.surneu.2007.07.077  

    ISSN:0090-3019

    詳細を見る 詳細を閉じる

    Background: Postoperative intracerebral hemorrhage is a rare complication after surgical revascularization for moyamoya disease, and its mechanism is totally undetermined. Case Description: A 47-year-old woman with moyamoya disease, experiencing crescendo transient ischemic attack on her tell hand, underwent STA-MCA anastomosis on the right hemisphere. Postoperative MR imaging 1 day after Surgery demonstrated asymptomatic vasogenic edema without ischemic change at the subcortex under the site of the anastomosis that expanded the next day, and STA-MCA bypass was apparently patent with the strong high signal by MR angiography. N-isopropyl-p-[(123)I]iodo-amphetamine single-photon emission CT showed marked increase in the CBF on the hemisphere operated oil. Four days after surgery, the patient complained of sudden headache and experienced severe monoparesis in her left hand due to the intracerebral hemorrhage at the corresponding lesion to the prior vasogenic edema. Edema around hematoma was prolonged for as long as a month; while intensive blood pressure control and the use of adrenocorticosteroid gradually relieved her symptoms, The patient completely recovered from her symptoms 2 months later, and she was discharged without neurologic deficit. tier transient ischemic attacks completely disappeared postoperatively. Conclusion: Early increase in CBF associated with vasogenic edema formation at the site of the anastomosis could be the warning sign for subsequent hemorrhagic complication, and intensive blood pressure control is warranted in Such patients. Alternatively, it would be necessary to elucidate the biochemical mechanism of the deleterious cascade during reperfusion in moyamoya disease to avoid this rare complication. (C) 2009 Elsevier Inc. All rights reserved.

  436. Efficacy of the revascularization surgery for adult-onset moyamoya disease with the progression of cerebrovascular lesions 査読有り

    Ayumi Narisawa, Miki Fujimura, Teiji Tominaga

    CLINICAL NEUROLOGY AND NEUROSURGERY 111 (2) 123-126 2009年2月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.clineuro.2008.09.022  

    ISSN:0303-8467

    詳細を見る 詳細を閉じる

    Object: In moyamoya disease, despite its progressive nature of the occlusive lesions in pediatric patients, the prevalence of the progression in adult patients is undetermined. Furthermore, the optimal timing of the revascularization surgery for progressive cases is controversial. To address these issues, we retrospectively investigate four cases with the adult-onset moyamoya disease manifesting as progression before revascularization surgery. Methods: From March 2004 to May 2007, 49 patients with adult-onset moyamoya disease aged from 19 to 62 years old (mean 40.5) underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis on 63 hemispheres. All patients were strictly followed up by magnetic resonance (MR) imaging/angiography postoperatively. Twenty-seven hemispheres of 15 adult patients without surgery were also followed up at outpatient service during the same period. If the patients manifest as the progression of the steno-occlusive lesion on the hemisphere without surgery, they undergo revascularization surgery after the confirmation of hemodynamic compromise. Results: During this period, 47 hemispheres including those of outpatient cases were conservatively followed up after initial diagnosis. Among them, six hemispheres (12.8%) of four patients had been proven to show apparent progression of steno-occlusive lesion and were subjected to revascularization surgery. Postoperative courses were uneventful in all four cases, and no patient suffered cerebrovascular event on the operated hemisphere after surgery. Conclusion: Adult-onset moyamoya disease, either bilateral or unilateral, has a substantial risk for progression, and careful follow-up is necessary for asymptomatic hemisphere. Once the patient manifests as the progression of cerebrovascular occlusive lesions or ischemic symptoms, we recommend revascularization surgery after the confirmation of the hemodynamic compromise. (c) 2008 Elsevier B.V. All rights reserved.

  437. [Primary yolk sac tumor in the cerebellar vermis. Case report]. 査読有り

    Nakamura T, Kanamori M, Sonoda Y, Watanabe M, Kumabe T, Tominaga T

    No shinkei geka. Neurological surgery 37 (2) 173-177 2009年2月

    ISSN:0301-2603

  438. Neuro-endoscopic management of mesencephalic intraparenchymal cyst: a case report 査読有り

    Hidenori Endo, Miki Fujimura, Mika Watanabe, Teji Tominaga

    SURGICAL NEUROLOGY 71 (1) 107-110 2009年1月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.surneu.2007.07.037  

    ISSN:0090-3019

    詳細を見る 詳細を閉じる

    Background: Intraparenchymal cyst of the mesencephalon is rare. and its natural course is unclear. The optimal treatment tor this entity is Still undetermined. Case Description: A 54-year-old woman Was found to have asymptomatic multilobulated mesencephalic cysts. Two),cars after the initial diagnosis, she experienced headache and double vision, when MRI showed the enlargement of the multilobulated Cystic lesions Which Markedly compressed the mesencephalon and the aqueduct. resulting in noncommunicating hydrocephalus. She undervent diagnostic endoscopic biopsy and ETV by flexible endoscopic system, which revealed the mesensephalic cyst wall at the dorsal part of the third ventricle floor. A part of the cyst membrane was carefully excised by endoscopic forceps without injuring the surrounding Structures. Histopathological examination revealed that the cyst wall was exclusively neuroglial tissue, and the presence of neoplasm was ruled out. Her Symptoms were relieved immediately after surgery and postoperative MRI showed both the shrinkage of mesencephalic cysts and the improvement of hydrocephalus. There is no recurrence of her symptoms. and MRI findings have been stable during the 3 year follow-up period. Conclusion: Intraparenchymal cysts of the mesencephalon have all expanding nature. Once those cysts become symptomatic, we recommend endoscopic procedure including decompression and biopsy of the cyst with ETV (C) 2009 Elsevier Inc. All rights reserved.

  439. ADDITIONAL SURGERY FOR POSTOPERATIVE ISCHEMIC SYMPTOMS IN PATIENTS WITH MOYAMOYA DISEASE: THE EFFECTIVENESS OF OCCIPITAL ARTERY POSTERIOR CEREBRAL ARTERY BYPASS WITH AN INDIRECT PROCEDURE: TECHNICAL CASE REPORT 査読有り

    Toshiaki Hayashi, Reizo Shirane, Teiji Tominaga

    NEUROSURGERY 64 (1) 195-196 2009年1月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1227/01.NEU.0000336311.60660.26  

    ISSN:0148-396X

    詳細を見る 詳細を閉じる

    OBJECTIVE: In patients with moyamoya disease, surgery to revascularize the ischemic brain is a recommended treatment. However, there are a few patients who require additional revascularization surgery because of progression of the disease. Even patients who show no postoperative ischemic symptoms at first may experience late deterioration. We performed additional surgery for such lesions using occipital artery (OA)-posterior cerebral artery (PCA) bypass with indirect revascularization. The efficacy of the procedure is reported. METHODS: We treated 3 patients with moyamoya disease who showed a transient ischemic attack after revascularization surgery. Three female patients, ranging in age from 6:0 to 35.2 years (mean age, 23.8 years) at the time of surgery, with ischemic symptoms (leg monoparesis in 2, visual impairment in 1) underwent the additional revascularization procedure. Preoperatively, all patients underwent indirect and/or direct revascularization surgery for initial treatment. All patients showed progression of the disease, especially in the PCA. OA-PCA bypass with encephalogaleodurosynangiosis and burr hole surgery were performed for postoperative ischemic symptoms. RESULTS: All patients showed clinical and radiological improvement. The transient ischemic attack was improved in all 3 patients. They did not complain of transient ischemic attack in the recent follow-up period. Follow-up magnetic resonance imaging showed no additional cerebral infarction. Magnetic resonance angiography showed widening of the OA and development of peripheral collateral vessels. Postoperative single-photon emission computed tomographic studies showed marked increase of uptake in both anterior cerebral artery and PCA territories. Cerebral vasodilatory capacity evaluated by an acetazolamide test also showed marked improvement. One patient showed postoperative cerebral edema as a result of focal cerebral hyperperfusion. CONCLUSION: OA-PCA anastomosis with indirect revascularization was effective for postoperative ischemia that showed symptoms in the anterior cerebral artery and PCA territories as a result of progression of a PCA lesion.

  440. Intraoperative infrared brain surface blood flow monitoring during superficial temporal artery-middle cerebral artery anastomosis in patients with childhood moyamoya disease 査読有り

    Atsuhiro Nakagawa, Miki Fujimura, Tatsuhiko Arafune, Ichiro Sakuma, Teiji Tominaga

    CHILDS NERVOUS SYSTEM 24 (11) 1299-1305 2008年11月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00381-008-0682-9  

    ISSN:0256-7040

    詳細を見る 詳細を閉じる

    Objective To monitor patency of the bypass and to accomplish comprehensive visualized evaluation of brain surface hemodynamics in childhood moyamoya patients, we performed intraoperative monitoring using novel infrared imaging system. Materials and methods Intraoperative monitoring of brain surface blood flow by IRIS V infrared imaging system has been conducted during superficial temporal artery-middle cerebral artery anastomosis on seven sides of five pediatric patients with moyamoya disease (man/woman=2:3, 7-8 years old). The range of recipient artery was 0.7-0.8 mm (average 0.75 mm). Magnetic resonance imaging and magnetic resonance angiography were performed routinely before and after surgery. Conclusions In all cases, patency of bypass, as well as detailed local hemodynamics and changes of brain surface temperature distribution could be evaluated. Intraoperative infrared system will be a feasible monitoring not only for noninvasive intraoperative evaluation of bypass patency but also for local hemodynamics even in patients with childhood moyamoya disease.

  441. Enhanced antitumor effect of combined-modality treatment using convection-enhanced delivery of hydrophilic nitrosourea with irradiation or systemic administration of temozolomide in intracranial brain tumor xenografts 査読有り

    Shin-Ichiro Sugiyama, Yoji Yamashita, Toshio Kikuchi, Yukihiko Sonoda, Toshihiro Kumabe, Teiji Tominaga

    NEUROLOGICAL RESEARCH 30 (9) 960-967 2008年11月

    出版者・発行元:MANEY PUBLISHING

    DOI: 10.1179/174313208X331581  

    ISSN:0161-6412

    詳細を見る 詳細を閉じる

    Objective: Convection-enhanced delivery (CED) is a local infusion technique that delivers chemotherapeutic agents directly to the central nervous system, circumventing the blood-brain barrier and reducing systemic side effects. We previously reported the safety and efficacy of CED of ACNU (nimustine hydrochloride: 3-[(4-amino-2-methyl-5-pyrimidinyl) methyl]-1-(2chloroethyl)- 1-nitrosourea hydrochloride), a hydrophilic nitrosourea, in rat brain tumor models. This study evaluated the efficacy of combined-modality treatments using CED of ACNU with irradiation or systemic administration of temozolomide. Methods: Antitumor efficacy and toxicity of the treatment were evaluated using rat 9L intracranial brain tumor models. Results: Combined treatment using CED of ACNU with irradiation produced significantly longer survival time than each treatment alone (versus CED: p &lt; 0.001, versus irradiation: p &lt; 0.05, logrank test) or systemic administration of ACNU with irradiation (p &lt; 0.001). Long-term survival (120 days) and eradication of tumor occurred only in this combined-treatment group. We also showed that CED of ACNU plus systemic administration of temozolomide significantly enhanced survival rate compared with each treatment alone (versus CED: p &lt; 0.001, versus systemic temozolomide: p &lt; 0.05). Discussion: Multimodality treatment using CED of ACNU, radiotherapy and systemic chemotherapy with temozolomide is a promising strategy for treatment of brain tumors. [Neurol Res 2008; 30: 960-967]

  442. Convection-enhanced delivery of polyethylene glycol-coated liposomal doxorubicin: characterization and efficacy in rat intracranial glioma models 査読有り

    Toshio Kikuchi, Ryuta Saito, Shin-ichirou Sugiyama, Yoji Yamashita, Toshihiro Kumabe, Michal Krauze, Krystof Bankiewicz, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 109 (5) 867-873 2008年11月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/JNS/2008/109/11/0867  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Object. The characteristics of polyethylene glycol-coated liposomal doxorubicin (PLD), the only liposomal drug now clinically available for intravenous injection, were investigated after convection-enhanced delivery (CED) into the rat brain parenchyma. Methods. The distribution, tissue retention, and toxicity profile were evaluated after CED into the rat brain parenchyma. The antitumor efficacy was also determined in rodent intracranial U-251MG and U-87MG glioma models. Results. Convection-enhanced delivery of PLD achieved wider distributions and delayed onset of toxicity in the brain parenchyma compared with CED of free doxorubicin infusion. Fluorescence generated from doxorubicin infused as PLD was detected until at least 30 days after infusion. Local toxicity was not observed when a 10% dilution of the commercially available PLD solution was used (0.2 mg/ml doxorubicin), but was significant at higher concentrations. Results after 10% PLD was delivered locally with CED demonstrated significant survival prolongation in both intracranial U-251MG and U-87MG xenograft models. Conclusions. Convection-enhanced delivery of PLD achieved extensive tissue distribution and sustained drug release. Convection-enhanced delivery of PLD is a promising chemotherapy for the treatment of malignant gliomas.

  443. Papillary tumor of the pineal region: a case report 査読有り

    Tomoo Inoue, Toshihiro Kumabe, Masayuki Kanamori, Yukihiko Sonoda, Mika Watanabe, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 25 (2) 85-90 2008年11月

    出版者・発行元:SPRINGER TOKYO

    DOI: 10.1007/s10014-008-0231-y  

    ISSN:1433-7398

    詳細を見る 詳細を閉じる

    We report a case of papillary tumor of the pineal region (PTPR) and describe the morphological, immunohistochemical, and neuroimaging findings. A 43-year-old man presented with signs of increased intracranial pressure and upward gaze palsy. Magnetic resonance (MR) imaging demonstrated a heterogeneously enhanced mass in the pineal region and obstructive hydrocephalus. Proton MR spectroscopy revealed increased choline and decreased N-acetyl aspartate peaks with a slightly increased lactate peak. Minimum apparent diffusion coefficient value was 0.60 x 103 mm2/s. Positron emission tomography showed significantly increased [18F]fluorodeoxyglucose uptake at the site of the lesion. He underwent total resection of the pineal region mass, resulting in resolution of the symptoms. The tumor consisted of columnar and cuboidal cells, with papillary growth pattern. Immunohistochemical staining showed positive reaction for neuron-specific enolase, S-100 protein, and vimentin. Ki-67 labeling index (LI) was 13.1%. These features were consistent with PTPR. Postoperatively, the patient received radiochemotherapy, and maintenance chemotherapy at our outpatient clinic, and was doing well without tumor recurrence 1 year after the surgery. Although the morphological features agree with those in the original description of the PTPR, the Ki-67 LI and radiologic findings suggest the malignant nature and the necessity for adjuvant therapy.

  444. [Clinical application of pulsed laser-induced liquid jet: preliminary report in glioma surgery]. 査読有り

    Nakagawa A, Kumabe T, Kanamori M, Saito R, Hirano T, Takayama K, Tominaga T

    No shinkei geka. Neurological surgery 36 (11) 1005-1010 2008年11月

    ISSN:0301-2603

  445. Cerebral cavernous malformation - Its genetic and biological background 査読有り

    Miki Fujimura, Teiji Tominaga

    Brain and Nerve 60 (11) 1271-1274 2008年11月

    ISSN:1881-6096

    詳細を見る 詳細を閉じる

    Cerebral cavernous malformations (CCMs) are vascular lesions of the central nervous system that consisit of enlarged vascular channels without intervening normal parenchyma. The CCMs can occur as sporadic or autosomal-dominant inherited condition. Linkage analysis of the familial CCMs has identified three different loci at 7q21.2 (CCM1), 7q13 (CCM2), and 3q25.2-q27 (CCM3). The genes at these loci have been identified as Krev1 Interaction Trapped 1 KRIT1 (CCM1), MGC4607 malcavernin (CCM2), and PDCD10 (CCM3), respectively. Recent investigations on these genes suggest that there are interactions between each gene, although the exact pathway of the formation of CCMs is still undetermined. In this review, the authors summarize the currently available knowledge on the molecular events associated with CCMs.

  446. Temporal change of 3-T magnetic resonance imaging/angiography during symptomatic cerebral hyperperfusion following superficial temporal artery-middle cerebral artery anastomosis in a patient with adult-onset moyamoya disease 査読有り

    Misaki Kohama, Miki Fujimura, Shunji Mugikura, Teiji Tominaga

    NEUROSURGICAL REVIEW 31 (4) 451-455 2008年10月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s10143-008-0147-3  

    ISSN:0344-5607

    詳細を見る 詳細を閉じる

    Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is a safe and effective treatment for moyamoya disease, although recent evidence suggests its substantial risk for symptomatic cerebral hyperperfusion. The diagnostic value of single-photon emission computed tomography (SPECT) for postoperative hyperperfusion in moyamoya patients is well established, but that of magnetic resonance (MR) imaging/angiography is undetermined. A 22-year-old woman with hemorrhagic-onset moyamoya disease underwent STA-MCA anastomosis on the right hemisphere, but she suffered from transient left hemiparesis and facial paresis owing to cerebral hyperperfusion from 3 to 11 days after surgery as delineated by SPECT. The time-sequential 3-T MR angiography revealed intense high signal of donor STA and dilated branches of MCA around the site of the anastomosis. These findings were most prominent at 8 days after surgery, when her neurologic signs were most apparent. Intensive blood pressure control relieved her symptom and she was discharged without neurologic deficit. MR findings normalized 3 months later. The characteristic findings of 3-T MR angiography, which was not evident by 1.5-T MR angiography in the previous studies, may reflect intrinsic pathology of postoperative cerebral hyperperfusion. It could be a useful diagnostic tool after revascularization surgery for moyamoya disease.

  447. Middle cerebral artery plaque imaging using 3-Tesla high-resolution MRI 査読有り

    Kuniyasu Nlizuma, Hiroaki Shimizu, Shihomi Takada, Teiji Tominaga

    JOURNAL OF CLINICAL NEUROSCIENCE 15 (10) 1137-1141 2008年10月

    出版者・発行元:CHURCHILL LIVINGSTONE

    DOI: 10.1016/j.jocn.2007.09.024  

    ISSN:0967-5868

    詳細を見る 詳細を閉じる

    Diagnosis of deep subcortical infarcts based on atherosclerosis of the middle cerebral artery (MCA) is important because this type of infarct is usually more aggressive than typical lacunar infarcts. However. current imaging techniques are of limited utility in the diagnosis of MCA plaques. Here, we report the use of 3-Tesla (3T) high-resolution moderate T-weighted imaging (HRT2WI) to detect MCA plaques in three patients with acute MCA perforator territory infarcts. MCA plaques were seen with HRT2WI in a patient with MCA stenosis, which was observed by magnetic resonance angiography (M RA). OF the two patients Without MCA stenosis (also confirmed by MRA), one had thin MCA plaques and the other had normal walls based on HRT2WI. Progression of symptoms occurred ill the patients with plaques. We conclude that 3T HRT2WI call identify plaque On MCA walls and has the potential to identify patients at risk for stroke progression or recurrence. (c) 2007 Elsevier Ltd. All rights reserved.

  448. Is histological diagnosis necessary to start treatment for germ cell tumours in the pineal region? 査読有り

    Masayuki Kanamori, Toshihiro Kumabe, Teiji Tominaga

    JOURNAL OF CLINICAL NEUROSCIENCE 15 (9) 978-987 2008年9月

    出版者・発行元:ELSEVIER SCI LTD

    DOI: 10.1016/j.jocn.2007.08.004  

    ISSN:0967-5868

    詳細を見る 詳細を閉じる

    The significance of histological diagnosis was retrospectively investigated in the treatment of 79 consecutive patients with pineal region tumours. Histological diagnoses were consistent with clinical diagnoses in 38 out of 39 patients with germ cell tumours and in all eight patients with non-germ cell tumours. The single exception was pineoblastoma. Forty-one patients were treated under a clinical diagnosis of pineal germ cell tumour using neoadjuvant chemotherapy and radiation therapy without histological veri. cation. Of the 41 patients, 32 achieved an excellent response, whereas nine required the delayed resection of a residual tumour. Of these nine tumours, seven were mature or immature teratomas or scars. These patients had elevated levels of tumour markers. Most cases of pineal germ cell tumour could be identified on the basis of clinical findings only, and could be treated appropriately using neoadjuvant chemotherapy and radiation therapy without histological diagnosis. However, second-look surgery should be considered in cases with residual teratomatous components or unusual responses. (C) 2007 Elsevier Ltd. All rights reserved.

  449. Functional MRI of the brain detects neuropathic pain in experimental spinal cord injury 査読有り

    Toshiki Endo, Christian Spenger, Jingxia Hao, Teiji Tominaga, Zsuzsanna Wiesenfeld-Hallin, Lars Olson, Xiao-Jun Xu

    PAIN 138 (2) 292-300 2008年8月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.pain.2007.12.017  

    ISSN:0304-3959

    詳細を見る 詳細を閉じる

    Functional magnetic resonance imaging (fMRI) has been used to map cerebral activations related to nociceptive Stimuli in rodents. Here, we used fMRI to investigate abnormally increased responses to noxious or innocuous stimuli. in a well-established rat model of chronic neuropathic pain induced by photochemical lumbar spinal cord injury. In this model, a subpopulation of rats exhibits allodynia-like hypersensitivity to mechanical and cold stimulation of the trunk area. In those rats that do not develop overt hypersensitivity after identical spinal cord injury (i.e. non-hypersensitive rats). touch evoked pain can be triggered by the opioid receptor antagonist, naloxone. We show that cerebral activations in contralateral primary somatosensory cortex (S1) are markedly correlated with different behavioural characteristics of these animals. Identical electrical stimulation, applied on trunks of spinally injured hypersensitive and non-hypersensitive rats, evoked significantly higher responses in S1 of the former than the latter. Although levels of FM RI signals in SI of the trunk territory were not significantly different between normal and spinally injured non-hypersensitive rats, the administration of naloxone significantly increased fMRI signals in the non-hypersensitive rats, but not in the normal rats. We conclude that increased activation of contralateral SI is a key feature of behavioural neuropathic pain in spinally injured rats and that fMRI is an effective method to monitor experimental neuropathic pain in small animals. (C) 2008 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  450. Germ cell tumors in the basal ganglia: problems of early diagnosis and treatment 査読有り

    Yukihiko Sonoda, Toshihiro Kumabe, Shin-Ichiro Sugiyama, Masayuki Kanamori, Yoji Yamashita, Ryuta Saito, Hisanori Ariga, Yoshihiro Takai, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-PEDIATRICS 2 (2) 118-124 2008年8月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/PED/2008/2/8/118  

    ISSN:1933-0707

    詳細を見る 詳細を閉じる

    Object. Intracranial germ cell tumors (GCTs) originating in the basal ganglia are rare. The authors investigated factors related to the diagnosis of these lesions as well as outcome in order to help decrease the time to diagnosis and improve treatment efficacy. Methods. The authors reviewed the clinical features of 142 cases of intracranial GCT in their institute. Fourteen cases of basal ganglia GCT were identified. The symptoms, neuroimaging findings, delay between symptom onset and diagnosis or treatment, initial and further treatment, and outcome were investigated. Results. Major symptoms were motor weakness and precocious puberty. Gadolinium-enhanced T1-weighted MR images showed enhancement in 8 of 11 patients examined, but only slight hyperintensity without enhancement in 2 patients. Ipsilateral peduncle and hemispheric atrophy were found in 3 and 4 patients, respectively. Cases of basal ganglia GCT were characterized by a longer delay from the initial neuroimaging examination to diagnosis compared with GCT in other regions. Five patients had aggravated hemiparesis in the extremities due to the delay in diagnosis. Despite good response to the initial therapy, 5 patients experienced recurrence; 2 of these 5 had malignant GCTs, and 3 had been treated only with chemotherapy or radiochemotherapy with insufficient radiation dose and field. Finally, the 2 patients with malignant GCTs died of the disease, and 1 died of aspiration pneumonia due to dissemination around the brainstem. Conclusions. Early diagnosis requires MR imaging with administration of contrast medium in young patients presenting with motor weakness and/or precocious puberty. Serial neuroimaging studies should be performed if any tiny lesion is detected in the basal ganglia. Since insufficient treatment resulted in early recurrence, radiation therapy with adequate dose and field is essential.

  451. [Usefulness of human atrial natriuretic peptide in neurosurgical perioperative management]. 査読有り

    Kamii H, Sato K, Shimizu H, Fujiwara S, Tominaga T

    No shinkei geka. Neurological surgery 36 (8) 687-692 2008年8月

    ISSN:0301-2603

  452. [Clinical features and significance of negative motor response in intraoperative language mapping during awake craniotomy]. 査読有り

    Nagamatsu K, Kumabe T, Suzuki K, Nakasato N, Sato K, Iizuka O, Kanamori M, Sonoda Y, Tominaga T

    No shinkei geka. Neurological surgery 36 (8) 693-700 2008年8月

    ISSN:0301-2603

  453. [Glioblastoma multiforme developing separately from the initial lesion 9 years after successful treatment for gliomatosis cerebri: a case report]. 査読有り

    Inoue T, Kanamori M, Sonoda Y, Watanabe M, Sasajima T, Kamisato N, Kumabe T, Tominaga T

    No shinkei geka. Neurological surgery 36 (8) 709-715 2008年8月

    ISSN:0301-2603

  454. Efficacy of superficial temporal artery-middle cerebral artery anastomosis with routine postoperative cerebral blood flow measurement during the acute stage in childhood moyamoya disease 査読有り

    Miki Fujimura, Tomohiro Kaneta, Teiji Tominaga

    CHILDS NERVOUS SYSTEM 24 (7) 827-832 2008年7月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00381-007-0551-y  

    ISSN:0256-7040

    詳細を見る 詳細を閉じる

    Object Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). It is undetermined, however, how rapid increase in CBF affects chronic ischemic brain during the acute stage in childhood moyamoya disease. Materials and methods The present study includes nine consecutive cases of patients with childhood moyamoya disease (2 similar to 8 years old, 6.2 in average), who underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis on 17 hemispheres. We prospectively performed single-photon emission computed tomography 1 and 7 days after 17 surgeries. The follow-up period ranged from 12 to 37 months (24.9 in average). Results The outcome of 17 surgeries was excellent (disappearance of transient ischemic attack) in 14 hemispheres (82.4%) and good (reduction of transient ischemic attack) in three hemispheres (17.6%). No patient suffered peri-operative infarction, except for one (5.9%) manifesting as pseudolaminar necrosis in a part of the cerebral cortex supplied by STA-MCA bypass at the subacute stage, which did not affect his long-term neurological status. One patient (5.9%) presented with transient facial palsy due to hyperperfusion, which resolved within several days. No patient manifested permanent neurological deterioration during the follow-up period. Conclusion The STA-MCA anastomosis is a safe and effective treatment for childhood moyamoya disease. We recommend routine CBF measurement for avoiding surgical complications including both cerebral ischemia and hyperperfusion.

  455. Efficacy of intraoperative wound irrigation for preventing shunt infection 査読有り

    Toshiaki Hayashi, Reizo Shirane, Takahiro Kato, Teiji Tominaga

    JOURNAL OF NEUROSURGERY-PEDIATRICS 2 (1) 25-28 2008年7月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3777/PED/2008/2/7/025  

    ISSN:1933-0707

    詳細を見る 詳細を閉じる

    Object. Although a cerebrospinal fluid shunt procedure is one of the most frequently performed operations in pediatric neurosurgery, the infection rate due to the procedure is not low. The authors have hypothesized that the key to reducing surgical shunt infections is to reduce bacteria from the operating field and wound. This hypothesis has been tested in a prospective nonrandomized controlled study at the authors' department. Methods. Beginning in August 2006, during shunt procedures the authors began routinely irrigating the operating field and wound with amikacin containing saline, using a jet of fluid from a syringe. Prior to this new routine no irrigation techniques were used, providing an adequate control group for comparing the effect of the irrigation technique. Data obtained in all patients undergoing shunt insertions or revisions for hydrocephalus performed between October 1, 2003, and November 30, 2007, were reviewed. Results. A total of 101 shunt procedures were performed in 63 patients (34 females and 29 males) during the study period. The mean age of all patients was 48.2 +/- 61.8 months. A total of 61 shunt procedures were performed before August 2006 and 40 were performed after August 2006. There was no statistical difference between the ages of patients in the 2 groups (p = 0.64). Eight total infections occurred during the 90 days of the postoperative period (7.9% overall infection rate). All 8 infections occurred before implementation of the irrigation technique (13.1 % infection rate), but no infections were noted after beginning use of the irrigation procedure (0% infection rate). There was a statistically significant difference in the infection rate between the 2 groups (p = 0.021). Conclusions. Use of an irrigation strategy aimed at reducing bacteria from the operating field and wound can be considered an effective procedure for preventing shunt infection.

  456. [Multiple intracerebral enhanced lesions strongly suspected to be microsporidiosis. A case report]. 査読有り

    Okuyama H, Kanamori M, Watanabe M, Kumabe T, Tominaga T

    No shinkei geka. Neurological surgery 36 (7) 645-650 2008年7月

    ISSN:0301-2603

  457. Neurosarcoidosis manifesting as tremor of the extremities and severe hypopituitarism: case report. 査読有り

    Ogawa Y, Tominaga T, Ikeda H

    Neurologia medico-chirurgica 48 (7) 314-317 2008年7月

    DOI: 10.2176/nmc.48.314  

    ISSN:0470-8105

  458. Ischemic stroke due to dissection of intracranial internal carotid artery: implications for early surgical treatment 査読有り

    Funuaki Oka, Hiroaki Shimizu, Yasushi Matsumoto, Mika Watanabe, Teiji Tominaga

    SURGICAL NEUROLOGY 69 (6) 578-585 2008年6月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.surneu.2007.04.002  

    ISSN:0090-3019

    詳細を見る 詳細を閉じる

    Background: Intracranial ICA dissection is a rare pathology that frequently results in severe morbidity or mortality in young patients. This study examined the suitability of early surgical treatment. Methods: We present and analyze 6 of our own cases and 39 other cases reported after 1980. The clinical courses were classified into 3 types: A, single attack and severe outcome; 13, single attack and mild to moderate outcome; and C, recurrent attacks and various outcomes, Results: Type A patients (n = 11) usually deteriorated quickly and severely so that early surgical treatment was not possible. Most type B patients (n = 12) did not require surgical intervention because of relatively stable courses. Only some type C patients (n = 10) are candidates for early surgery to prevent progressive deterioration. Twelve cases were unclassified because of insufficient information. We encountered 3 cases of type C, and emergency bypass surgery with parent ICA occlusion was planned in 2 patients. The surgery was successful with good prognosis in I patient; but the ICA and its branches were already occluded in the other patient, which precluded completion of bypass surgery and resulted in severe hemiparesis. Intraoperative findings and histologic examination of the MCA confirmed arterial dissection. Conclusion: Young patients with intracranial ICA dissection manifesting as mild ischemic stroke should be considered for early bypass surgery with occlusion of the dissected ICA if any sign of progression or recurrence occurs after the onset. (C) 2008 Elsevier Inc. All rights reserved.

  459. Surgical treatment for choroid plexus tumors in the fourth ventricle: brain stem infiltration hinders total extirpation 査読有り

    Toshihiro Kumabe, Miki Fujimura, Hidefumi Jokura, Teiji Tominaga

    NEUROSURGICAL REVIEW 31 (2) 165-172 2008年4月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s10143-007-0103-7  

    ISSN:0344-5607

    詳細を見る 詳細を閉じる

    The significance of surgery for choroid plexus tumors is well established, but surgical resection of those in the fourth ventricle has not been evaluated. This study reviewed five consecutive patients with choroid plexus tumors in the fourth ventricle treated in our institute between 1996 and 2005, focusing on the factors that hindered total extirpation. Two cases were choroid plexus papillomas, and three cases were choroid plexus carcinomas. Preoperative T2-weighted magnetic resonance imaging showed a diffuse high-intensity lesion in the brain stem in four patients. Infiltration into the fourth ventricle floor was apparent in all five patients during surgery, which hindered total resection of the tumors without neurological deterioration. Intraoperative bleeding was well controlled in all five patients by cauterizing the feeding arteries at the early stage of surgery through the telovelar approach. Performance status was improved in all patients postoperatively. All patients with choroid plexus carcinomas underwent radiation therapy after the surgical removal. No patient suffered tumor progression within the follow-up of 24-129 months (mean 64 months). Total resection of choroid plexus tumors in the fourth ventricle is difficult because of invasion into the fourth ventricle floor. Adjuvant therapy for choroid plexus tumors with brain stem infiltration must be established.

  460. Progressive moyamoya syndrome associated with de novo formation of the ipsilateral venous and contralateral cavernous malformations: case report 査読有り

    Elke Januschek, Miki Fujimura, Shunji Mugikura, Teiji Tominaga

    SURGICAL NEUROLOGY 69 (4) 423-427 2008年4月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.sunreu.2007.01.078  

    ISSN:0090-3019

    詳細を見る 詳細を閉じる

    Background: Association of moyamoya disease with multiple vascular malformations is extremely rare. Case Presentation: A 33-year-old man, who had been affected with moyamoya syndrome with TIA during the past 3 years, was admitted to our hospital because of crescendo TlAs with numbness in his right hand and dysarthria. Magnetic resonance angiography showed apparent progression of the steno-occlusive changes bilaterally. We then planned surgical revascularization on the symptomatic side. At the time of readmission for surgery, an asymptomatic small intracerebral hemorrhage in the right frontal cortex was found, which presented on MRI as a CCM. Cerebral angiogram showed avascular lesion corresponding to the location of CCM as well as a newly formed venous malformation on the left side. One month later, STA-MCA anastomosis with pial synangiosis was performed without complications. Significant improvement in CBF on the left hemisphere was confirmed by postoperative single-photon emission CT. There were no ischemic changes on a postoperative MRI, and STA-MCA bypass was apparently patent by MRA. The TIA completely disappeared after surgery, and the patient was discharged without neurologic deficit. Persistence of the CCM and venous malformation were confirmed by T2*-weighted image and 3-dimensional contrast-enhanced gradient echo/SWI 4 months after surgery, respectively. Conclusion: The association of moyamoya syndrome with CCM and venous malformation is extremely rare. The coincidence of the progressive moyamoya syndrome with these newly formed vascular malformations may give a clue to the underlying mechanism of the progression of this rare entity. (C) 2008 Elsevier Inc. All rights reserved.

  461. Low-grade fibromyxoid sarcoma of intracranial origin 査読有り

    Ryuta Saito, Toshihiro Kumabe, Mika Watanabe, Hidefumi Jokura, Makoto Shibuya, Yoichi Nakazato, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 108 (4) 798-802 2008年4月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/JNS/2008/108/4/0798  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    The authors report on a 21-year-old man who presented with a low-grade fibromyxoid sarcoma primarily located in the right parietal lobe with diffuse infiltration. The low-grade fibromyxoid sarcoma is a rare sarcoma of the deep soft tissue that is characterized as an indolent but metastasizing soft-tissue neoplasm with a deceptively benign histological appearance. Only one case of intracranial origin has been previously reported in the literature. A high rate of local recurrence and eventual metastasis has been demonstrated for this tumor in deep soft tissue. Similarly, the patient in the present case suffered recurrence 6 times; he underwent treatment by surgical removal 4 times, Gamma Knife surgery twice, and local radiation therapy once during the 7-year follow-up period. The tumor is still under control without any evidence of extracranial metastasis. To the authors' knowledge, this is the first case report that discusses the clinical course of this rare disease in detail.

  462. Medulloblastoma demonstrating multipotent differentiation: case report 査読有り

    Hiroyuki Sakata, Masayuki Kanamori, Mika Watanabe, Toshihiro Kumabe, Teiji Tominaga

    BRAIN TUMOR PATHOLOGY 25 (1) 39-43 2008年4月

    出版者・発行元:SPRINGER TOKYO

    DOI: 10.1007/s10014-007-0228-y  

    ISSN:1433-7398

    詳細を見る 詳細を閉じる

    We report a 6-year-old boy who presented with a medulloblastoma demonstrating classic, myoblastic, neuronal, glial, and melanotic differentiation and manifesting as severe morning headache. Magnetic resonance imaging revealed a mass lesion with cystic components in the cerebellar vermis. He underwent suboccipital craniotomy and total resection of the tumor. The specimen consisted of three morphologically distinct components. The first component consisted of densely packed cells with round-to-oval highly hyperchromatic nuclei surrounded by scanty cytoplasm. Immunohistochemical staining revealed diffuse expression of neurofilament protein and focal expression of desmin and myoglobin. The second component consisted of long spindle-shaped cells with elongated nuclei and eosinophilic cytoplasm. Immunohistochemical staining revealed diffuse expression of neurofilament protein, desmin, and myoglobin. The third component consisted of cells with small, densely hyperchromatic nuclei and scanty cytoplasm in a fine fibrillary background. Mature ganglion cells and melanotic tumor cells were also observed. Immunohistochemical staining revealed diffuse expression of synaptophysin and neurofilament protein, and focal expression of glial fibrillary acidic protein, S-100 protein, desmin, and myoglobin. The diagnosis was medulloblastoma with myoblastic, neuronal, astrocytic, and melanotic differentiation. Medulloblastoma demonstrating multipotent differentiation is rare, but the features observed in this case support the idea that medulloblastoma originates from multipotent stem cells.

  463. A case of atypical thyrotroph cell adenoma, which re-grew within 3 months after surgery and required multimodal treatment 査読有り

    Yoshikazu Ogawa, Teiji Tominaga

    JOURNAL OF NEURO-ONCOLOGY 87 (1) 91-95 2008年3月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s11060-007-9492-2  

    ISSN:0167-594X

    eISSN:1573-7373

    詳細を見る 詳細を閉じる

    Objective and importance Thyrotroph cell adenoma accounts for only 1% of all pituitary adenomas. This tumor is tough and firm because of significant interstitial fibrosis, and is difficult to remove. Atypical adenoma has an aggressive biological character, invades the surrounding structures, and grows rapidly. Atypical thyrotroph cell adenoma is extremely rare. Clinical presentation A 32-year-old man presented with hyperthyroidism and bitemporal hemianopsia. Head magnetic resonance imaging revealed a large sellar tumor compressing the optic chiasma and invading the left cavernous sinus. Intervention Transsphenoidal surgery was performed and subtotal removal was achieved. Histological examination showed atypical thyrotroph cell adenoma. Gamma knife surgery was planned, but the tumor re-grew within 3 months, and reattached to the optic chiasma. Second transcranial surgery failed to remove residual tumor behind the pituitary stalk. Conventional irradiation followed by octreotide administration resulted in decreased tumor size and stable euthyroidism. The tumor has been controlled for 22 months since first surgery and diagnosis. Conclusion Atypical thyrotroph cell adenoma has an aggressive biological character and grows rapidly. Multimodal treatment including medication and radiotherapy is required.

  464. Spinal granulocytic sarcoma manifesting as radiculopathy in a nonleukemic patient 査読有り

    Tomoo Inoue, Toshiyuki Takahashi, Hiroaki Shimizu, Masayuki Kanamori, Toshihiro Kumabe, Mika Watanabe, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 48 (3) 131-136 2008年3月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.48.131  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 26-year-old nonleukemic woman presented with lumbosacral granulocytic sarcoma manifesting as progressive low back pain and numbness of her left lower leg persisting for 3 months. Physical examination revealed hypesthesia within the left S1 area of the sensory dermatome, decreased Achilles tendon reflex in the left lower extremity, and walking impairment due to severe pain in her left hip and leg. Magnetic resonance imaging confirmed an extradural mass in the spinal canal at the L5-S2 levels with invasion to the pelvis from the left sacral foramen. Positron emission tomography with [F-18]fluorodeoxyglucose (FDG-PET) showed hyperaccumulation indicating malignant tumor. Baseline laboratory data were normal. Decompressive laminectomy and tumor removal were performed. Histological examination identified granulocytic sarcoma. Bone marrow involvement was absent. She underwent adjuvant chemotherapy and radiotherapy, resulting in reduced residual lesion and neurological improvement. Immediate diagnosis and adequate systematic treatment are recommended for spinal granulocytic sarcoma in nonleukemic patients to prevent or delay progression to leukemia. The importance of immunohistochemical staining in the differential diagnosis from other types of spinal tumor, and the efficacy of FDG-PET for evaluation of the treatment are also emphasized.

  465. Neurenteric cyst of the craniocervical junction in an infant 査読有り

    Hiroyuki Sakata, Miki Fujimura, Masaki Iwasaki, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 48 (2) 86-89 2008年2月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.48.86  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 1-year-old boy presented with an extremely rare neurenteric cyst of the craniocervical junction manifesting as weakness in all extremities, slowly progressing over 2 months with rapid deterioration during the last few days. Neurological examination on admission showed tetraparesis with hyper-reflexia in the extremities. Magnetic resonance imaging demonstrated an intradural extramedullary cystic lesion located ventrally to the cord, extending from the craniocervical junction to the C3 level. The cyst wall was not enhanced with contrast medium, and the cyst content was isointense to the cerebrospinal fluid. He underwent total removal of the cyst through a left suboccipital craniectomy with C1 hemilaminectomy. The lesion had not adhered to the surrounding structures except for attachment to the left C2 nerve root outlet. Histological examination of the surgical specimen revealed typical neurenteric cyst with single layer epithelium. His symptoms improved significantly after the surgery, and he suffered no recurrence during the 2-year follow-up period. Neurenteric cyst should be considered in the differential diagnosis of intradural extramedullary cystic lesion located ventrally to the cord at the craniocervical junction in infants. Early surgical removal is recommended.

  466. Reorganization of sensory processing below the level of spinal cord injury as revealed by fMRl 査読有り

    Toshiki Endo, Christian Spenger, Eric Westman, Teiji Tominaga, Lars Olson

    EXPERIMENTAL NEUROLOGY 209 (1) 155-160 2008年1月

    出版者・発行元:ACADEMIC PRESS INC ELSEVIER SCIENCE

    DOI: 10.1016/j.expneurol.2007.09.017  

    ISSN:0014-4886

    詳細を見る 詳細を閉じる

    The adult mammalian CNS undergoes plastic changes in response to injury. To investigate such changes in spinal cord, functional magnetic resonance imaging (fMRI) was applied in rats subjected to complete transection of the mid-thoracic spinal cord. Blood oxygenation level-dependent (BOLD) contrasts were recorded in the distal spinal cord different times after injury (3, 7, and 14 days, and 1, 3, and 6 months) in response to electrical hind limb stimulation. Functional MRI demonstrated a substantial increase of neuronal activation in the ipsilateral dorsal horn after injury. Notably, 0.5 mA, which did not evoke activation in the normal spinal cord and was considered a non-painful stimulus, induced significant BOLD responses in the dorsal horn after injury. Increased sensitivity was also seen in response to 1.0 m-A stimulation. Our results suggest exaggerated responsiveness of spinal neurons after spinal cord injury. Reorganization in the injured spinal cord has been shown to involve the amplification of peripheral inputs and implicated as one underlying mechanism causing neuropathic pain and autonomic dysreflexia. Since BOLD signals can demonstrate such plastic changes in spinal cord parenchyma, we propose fMRI as a method to monitor functional reorganization in the spinal cord after injury. Combining brain and spinal cord fMRI allows the visualization of neuronal activities along the entire neuroaxis and thereby an evaluation of the different plastic responses to CNS injuries that occur in the brain and the spinal cord. (c) 2007 Elsevier Inc. All rights reserved.

  467. Intraoperative infrared brain surface blood flow monitoring during superficial temporal artery-middle cerebral artery anastomosis in a patient with moyamoya disease: clinical implication of the gradation value in postoperative clinical course--a case repo 査読有り

    Nakagawa A, Fujimura M, Arafune T, Suzuki H, Sakuma I, Tominaga T

    Acta neurochirurgica. Supplement 102 159-163 2008年

    DOI: 10.1007/978-3-211-85578-2-32  

    ISSN:0065-1419

  468. Shock wave-induced brain injury in rat: novel traumatic brain injury animal model. 査読有り

    Nakagawa A, Fujimura M, Kato K, Okuyama H, Hashimoto T, Takayama K, Tominaga T

    Acta neurochirurgica. Supplement 102 421-424 2008年

    DOI: 10.1007/978-3-211-85578-2-82  

    ISSN:0065-1419

  469. [Magnetic resonance angiographic occlusion of the cervical carotid artery at 3 tesla: its pitfalls]. 査読有り

    Mano Y, Shimizu H, Inoue T, Tominaga T

    No shinkei geka. Neurological surgery 36 (1) 51-58 2008年1月

    ISSN:0301-2603

  470. Rapid revascularization after therapeutic parent artery occlusion for a large intracavernous carotid artery aneurysm. 査読有り

    Kagawa K, Shimizu H, Matsumoto Y, Watanabe M, Tominaga T

    Neurologia medico-chirurgica 47 (12) 559-563 2007年12月

    DOI: 10.2176/nmc.47.559  

    ISSN:0470-8105

  471. Neuromagnetic localization of spike sources in perilesional, contralateral mirror, and ipsilateral remote areas in patients with cavernoma 査読有り

    Kazutaka Jin, Nobukazu Nakasato, Hiroshi Shamoto, Akitake Kanno, Yasuto Itoyama, Teiji Tominaga

    EPILEPSIA 48 (11) 2160-2166 2007年11月

    出版者・発行元:BLACKWELL PUBLISHING

    DOI: 10.1111/j.1528-1167.2007.01228.x  

    ISSN:0013-9580

    eISSN:1528-1167

    詳細を見る 詳細を閉じる

    Purpose: To assess neuromagnetic spike localization as an indication for extended lesionectomy of cavernoma. Methods: Electroencephalography (EEG) and magnetoencephalography (MEG) was simultaneously recorded in 17 patients (8 men, mean age 29.7 years) with single cavernoma. The location of the equivalent current dipole (ECD) of the interictal spikes was correlated with the lesion shown by magnetic resonance imaging. Results: Preoperative ECD localization was classified into four types: perilesional, adjacent to the cavernoma only (n = 6); mirror, adjacent to the lesion and at the contralateral homologous site (n = 5); remote, mainly at a remote site in the ipsilateral hemisphere (n = 3); and no spikes (n = 3). The spikes were detected by only MEG in two of five "mirror" and all three "remote" patients. In the mirror group, contralateral spikes were synchronized with the ipsilateral spikes, or also occurred independently. Two "perilesional" and two "mirror" patients became seizure-free and spike-free after extended lesionectomy. In contrast, the other two "mirror" patients had residual seizures and spikes after pure lesionectomy. Conclusion: The detectability of mirror and remote spikes was higher by MEG than by EEG, whereas the detectability of perilesional spikes was similar by MEG and EEG. Therefore, the use of both EEG and MEG will provide the maximum information about spike distribution and propagation. Residual seizures and spikes after pure lesionectomy, but not after extended lesionectomy, in the "mirror" patients suggest the importance of resection of the perilesional irritable zone. Extended resection of the irritable cortex surrounding cavernoma is recommended for better seizure control, particularly in "mirror" patients.

  472. Cortical sensory map rearrangement after spinal cord injury: fMRI responses linked to Nogo signalling 査読有り

    Toshiki Endo, Christian Spenger, Teiji Tominaga, Stefan Brene, Lars Olson

    BRAIN 130 (Pt 11) 2951-2961 2007年11月

    出版者・発行元:OXFORD UNIV PRESS

    DOI: 10.1093/brain/awm237  

    ISSN:0006-8950

    詳細を見る 詳細を閉じる

    Cortical sensory maps can reorganize in the adult brain in an experience-dependent manner. We monitored somatosensory cortical reorganization after sensory deafferentation using functional magnetic resonance imaging (fMRI) in rats subjected to complete transection of the mid-thoracic spinal cord. Cortical representation in response to spared forelimb stimulation was observed to enlarge and invade adjacent sensory-deprived hind limb territory in the primary somatosensory cortex as early as 3 days after injury. Functional MRI also demonstrated long-term cortical plasticity accompanied by increased thalamic activation. To support the notion that alterations of cortical neuronal circuitry after spinal cord injury may underlie the fMRI changes, we quantified transcriptional activities of several genes related to cortical plasticity including the Nogo receptor (NgR), its co-receptor LINGO-1 and brain derived neurotrophic factor (BDNF), using in situ hybridization. We demonstrate that NgR and LINGO-1 are down-regulated specifically in cortical areas deprived of sensory input and in adjacent cortex from 1 day after injury, while BDNF is up-regulated. Our results demonstrate that cortical neurons react to sensory deprivation by decreasing transcriptional activities of genes encoding the Nogo receptor components in the sensory deprived and the anatomically adjacent non-deprived area. Combined with the BDNF up-regulation, these changes presumably allow structural changes in the neuropil. Our observations therefore suggest an involvement of Nogo signalling in cortical activity-dependent plasticity in the somatosensory system. In spinal cord injury, cortical reorganization as shown here can become a disadvantage, much like the situation in amblyopia or phantom sensation. Successful strategies to repair sensory pathways at the spinal cord level may not lead to proper reestablishment of cortical connections, once deprived hind limb cortical areas have been reallocated to forelimb use. In such situations, methods to control cortical plasticity, possibly by targeting Nogo signalling, may become helpful.

  473. Association of cavernous malformation within vestibular schwannoma: immunohistochemical analysis of matrix metalloproteinase-2 and -9. 査読有り

    Sakata H, Fujimura M, Watanabe M, Tominaga T

    Neurologia medico-chirurgica 47 (11) 509-512 2007年11月

    DOI: 10.2176/nmc.47.509  

    ISSN:0470-8105

  474. Symptomatic hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in a child with moyamoya disease 査読有り

    Miki Fujimura, Tomohiro Kaneta, Hiroaki Shimizu, Teiji Tominaga

    CHILDS NERVOUS SYSTEM 23 (10) 1195-1198 2007年10月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00381-007-0361-2  

    ISSN:0256-7040

    詳細を見る 詳細を閉じる

    Object Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). It is undetermined, however, how rapid increase in CBF affects ischemic brain at acute stage, especially in children. Case report A 4-year-old girl with moyamoya disease underwent right superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. She suffered temporary left facial palsy 5 days after surgery. Postoperative N-isopropyl-p-[I-123]iodoamphetamine single-photon emission computed tomography (I-123-IMP-SPECT) revealed focal intense increase in CBF at the sites of anastomosis. Magnetic resonance imaging/angiography showed the apparently patent STA-MCA anastomosis as a thick high signal without ischemic changes. Her symptom improved 9 days after surgery, and single-photon emission computed tomography (SPECT) 2 months later showed normalization of CBF. Surgical revascularization completely relieved the transient ischemic attack on her left hand that was seen before surgery. Conclusion We demonstrated, for the first time, that delayed focal neurological deficit after STA-MCA anastomosis can be caused by focal hyperperfusion in childhood moyamoya disease.

  475. Delayed cerebrospinal fluid leakage 10 years after transsphenoidal surgery and gamma knife surgery - case report - . 査読有り

    Ogawa Y, Tominaga T

    Neurologia medico-chirurgica 47 (10) 483-485 2007年10月

    DOI: 10.2176/nmc.47.483  

    ISSN:0470-8105

  476. Intercostal arteriovenous fistula associated with neurofibromatosis manifesting as congestive myelopathy: case report. 査読有り

    Saito A, Takahashi T, Ezura M, Tominaga T

    Neurosurgery 61 (3) E656-7; discussion E657 2007年9月

    DOI: 10.1227/01.NEU.0000290918.47847.9E  

    ISSN:0148-396X

  477. A Randomized controlled trial of hydrocortisone against hyponatremia in patients with aneurysmal subarachnoid hemorrhage 査読有り

    Yoichi Katayama, Jo Haraoka, Hidehiro Hirabayashi, Tatsuro Kawamata, Keiji Kawamoto, Takao Kitahara, Jun Kojima, Toshihiko Kuroiwa, Tatsuro Mori, Nobuhiro Moro, Izumi Nagata, Akira Ogawa, Kikuo Ohno, Yoshikatsu Seiki, Yoshiaki Shiokawa, Akira Teramoto, Teiji Tominaga, Toshiki Yoshimine

    STROKE 38 (8) 2373-2375 2007年8月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1161/STROKEAHA.106.480038  

    ISSN:0039-2499

    詳細を見る 詳細を閉じる

    Background and Purpose - Hyponatremia is common after aneurysmal subarachnoid hemorrhage ( SAH). It is caused by natriuresis, which induces osmotic diuresis and decreases blood volume, contributing to symptomatic cerebral vasospasm ( SCV). Hypervolemic therapy to prevent SCV will not be efficient under this condition. We conducted a randomized controlled trial to assess the efficacy of hydrocortisone, which promotes sodium retention in the kidneys. Methods - Seventy-one SAH patients were randomly assigned after surgery to treatment with either a placebo ( n = 36) or 1200 mg/d of hydrocortisone ( n = 35) for 10 days and tapered thereafter. Both groups underwent hypervolemic therapy. The primary end point was the prevention of hyponatremia. Results - Hydrocortisone prevented excess sodium excretion ( P = 0.04) and urine volume ( P = 0.04). Hydrocortisone maintained the targeted serum sodium level throughout the 14 days ( P &lt; 0.001), and achieved the management protocol with lower sodium and fluid ( P = 0.007) supplementation. Hydrocortisone kept the normal plasma osmolarity ( P &lt; 0.001). SCV occurred in 9 patients ( 25%) in the placebo group and in 5 ( 14%) in the hydrocortisone group. No significant difference in the overall outcome was observed between the 2 groups. Conclusions - Hydrocortisone overcame excess natriuresis and prevented hyponatremia. Although there was no difference in outcome, hydrocortisone supported efficient hypervolemic therapy.

  478. [Parent artery occlusion with bypass surgery for the treatment of aneurysms of the internal carotid artery]. 査読有り

    Shimizu H, Tominaga T

    No shinkei geka. Neurological surgery 35 (8) 763-770 2007年8月

    ISSN:0301-2603

  479. [Intrasellar small TSH secreting pituitary adenomas, 2 case reports]. 査読有り

    Ogawa Y, Tominaga T, Ikeda H

    No shinkei geka. Neurological surgery 35 (7) 679-684 2007年7月

    ISSN:0301-2603

  480. Anaplastic astrocytoma and anaplastic oligodendroglioma occurring 6 years after subtotal resection of a central neurocytoma - Case report 査読有り

    Masayuki Kanamori, Toshihiro Kumabe, Mika Watanabe, Teji Tominaga

    JOURNAL OF NEUROSURGERY 107 (1) 185-189 2007年7月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/JNS-07/07/0185  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    The authors present the case of a 5 1 -year-old man who presented with all anaplastic astrocytoma and anaplastic oligodendroglioma that developed 6 years after Subtotal resection of a central neurocytoma in his right lateral ventricle. He had received neither radiation therapy nor chemotherapy after the original resection. Oil readmission, neuroimaging revealed a mass in the right parietal lobe and a diffuse lesion in the right temporal lobe, insula, and corolla radiata. Because both lesions extended to the right lateral ventricle wall, they were regarded as recurrent rather than metachronous tumors. Histological examination revealed anaplastic oligodendroglioma in the parietal lobe and anaplastic astrocytoma in the insula. One year later, the anaplastic astrocytoma Was found to have transformed into a glioblastoma multiforme. Fluorescence in situ hybridization analysis and immunohistochemical examinations detected deletions of the 1p36 and 19q13 loci, and nuclear accumulation of TP53 protein in the anaplastic oligodendroglioma but not in the glioblastoma multiforme. These findings Suggest that central neurocytoma or progenitor cells have the potential for oligodendrocytic and astrocytic transformation with different genetic aberrations.

  481. [Seizure following superficial temporal-middle cerebral artery anastomosis in patients with moyamoya disease: possible contribution of postoperative cerebral hyperperfusion]. 査読有り

    Narisawa A, Fujimura M, Shimizu H, Tominaga T

    No shinkei geka. Neurological surgery 35 (5) 467-474 2007年5月

    ISSN:0301-2603

  482. Total resection of a hemorrhagic tectal pilocytic astrocytoma - Case report 査読有り

    Fumiaki Oka, Yoji Yamashita, Toshihiro Kumabe, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 47 (5) 219-221 2007年5月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.47.219  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 21-year-old man presented with a hemorrhagic pilocytic astrocytoma of the tectal plate manifesting as sudden onset of severe headache, vertigo, nausea, and vomiting. Computed tomography demonstrated acute hydrocephalus and hemorrhage within the brain stem and fourth ventricle. Magnetic resonance (MR) imaging revealed a dorsally exophytic tectal tumor as hypointense on the Tl-weighted image and hyperintense on the T-2-weighted image with contrast enhancement. Radical resection of the tumor was selected because of the unusual aggressive clinical course with hemorrhage and suspicion of malignant components. The tumor was totally resected via an occipital transtentorial approach using a neuronavigation system without surgical complications. The histological diagnosis was pilocytic astrocytoma. The patient was discharged home without neurological deficits on the 9th postoperative day. Twenty-three months after the surgery, follow-up MR imaging demonstrated no recurrence. Tectal plate pilocytic astrocytoma is rarely associated with hemorrhage but should be considered in the differential diagnosis of intracranial hemorrhage with acute presentation. Such exceptional tectal tumors should be resected radically and undergo histological examination to decide on further appropriate treatment.

  483. Pressure-dependent effect of shock waves on rat brain: induction of neuronal apoptosis mediated by a caspase-dependent pathway 査読有り

    Kaoruko Kato, Miki Fujimura, Atsuhiro Nakagawa, Atsushi Saito, Tomohiro Ohki, Kazuyoshi Takayama, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 106 (4) 667-676 2007年4月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/jns.2007.106.4.667  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Object. Shock waves have been experimentally applied to various neurosurgical treatments including fragmentation of cerebral emboli, perforation of cyst walls or tissue, and delivery of drugs into cells. Nevertheless, the application of shock waves to clinical neurosurgery remains challenging because the threshold for shock wave-induced brain injury has not been determined. The authors investigated the pressure-dependent effect of shock waves on histological changes of rat brain, focusing especially on apoptosis. Methods. Adult male rats were exposed to a single shot of shock waves (produced by silver azide explosion) at over-pressures of 1 or 10 MPa after craniotomy. Histological changes were evaluated sequentially by H & E staining and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL). The expression of active caspase-3 and the effect of the nonselective caspase inhibitor N-benzyloxyc irbonyl-Val-Ala-Asp-fluoromethylketone (Z-VAD-FMK) were examined to evaluate the contribution of a caspase-dependent pathway to shock wave-induced brain injury. High-overpressure (&gt; 10 MPa) shock wave exposure resulted in contusional hemorrhage associated with a significant increase in TUNEL-positive neurons exhibiting chromatin condensation, nuclear segmentation, and apoptotic bodies. The maximum increase was seen at 24 hours after shock wave application. Low-overpressure (I MPa) shock wave exposure resulted in spindle-shaped changes in neurons and elongation of nuclei without marked neuronal injury. The administration of Z-VAD-PAK significantly reduced the number of TUNEL-positive cells observed 24 hours after high-overpressure shock wave exposure (p &lt; 0.01). A significant increase in the cytosolic expression of active caspase-3 was evident 24 hours after high-overpressure shock wave application; this increase was prevented by Z-VAD-FMK administration. Double immunofluorescence staining showed that TUNEL-positive cells were exclusively neurons. Conclusions. The threshold for shock wave-induced brain injury is speculated to be under 1 MPa, a level that is lower than the threshold for other organs. High-overpressure shock wave exposure results in brain injury, including neuronal apoptosis mediated by a caspase-dependent pathway. This is the first report in which the pressure-dependent effect of shock wave on the histological characteristics of brain tissue is demonstrated.

  484. Safety and efficacy of convection-enhanced delivery of ACNU, a hydrophilic nitrosourea, in intracranial brain tumor models 査読有り

    Shin-ichiro Sugiyama, Yoji Yamashita, Toshio Kikuchi, Ryuta Saito, Toshihiro Kumabe, Teiji Tominaga

    JOURNAL OF NEURO-ONCOLOGY 82 (1) 41-47 2007年3月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s11060-006-9247-5  

    ISSN:0167-594X

    詳細を見る 詳細を閉じる

    Convection-enhanced delivery (CED) is a local infusion technique, which delivers chemotherapeutic agents directly to the central nervous system, circumventing the blood-brain barrier and reducing systemic side effects. CED distribution is significantly increased if the infusate is hydrophilic. This study evaluated the safety and efficacy of CED of nimustine hydrochloride: 3-[(4-amino-2-methyl-5-pyrimidinyl) methyl]-1-(2-chloroethyl)-1-nitrosourea hydrochloride (ACNU), a hydrophilic nitrosourea, in rat 9 L brain tumor models. The local neurotoxicity of ACNU delivered via CED was examined in normal rat brains, and the maximum tolerated dose (MTD) was estimated at 0.02 mg/rat. CED of ACNU at the MTD produced significantly longer survival time than systemic administration (P &lt; 0.05, log-rank test). Long-term survival (80 days) and eradication of the tumor occurred only in the CED-treated rats. The tissue concentration of ACNU was measured by high-performance liquid chromatography, which revealed that CED of ACNU at the dose of 100-fold less total drug than intravenous injection carried almost equivalent concentrations of ACNU into rat brain tissue. CED of hydrophilic ACNU is a promising strategy for treating brain tumors.

  485. Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease 査読有り

    Miki Fujimura, Tomohiro Kaneta, Shunji Mugikura, Hiroaki Shimizu, Teiji Tominaga

    SURGICAL NEUROLOGY 67 (3) 273-282 2007年3月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.surneu.2006.07.017  

    ISSN:0090-3019

    詳細を見る 詳細を閉じる

    Background: Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving CBF, but little is known about the change in CBF and its effect on neurologic status during the acute stage after revascularization. Methods: I-123-IMP-SPECT was performed 1 and 7 days after STA-MCA anastomosis on 34 sides of 27 consecutive patients with adult-onset moyamoya disease (6 men, 21 women; 22-62 years old). The follow-up period ranged from 5 to 28 months (mean, 17.6 months). Results: Thirteen patients (13 sides, 38.2%) suffered temporary neurologic deterioration due to hyperperfusion several days after surgery, which was sustained for several days (7.4 days in average). Postoperative magnetic resonance imaging/angiography showed the STA as a higher intensity signal than the preoperative finding without ischemic changes in all 13 patients. Postoperative SPECT revealed focal intense increase in CBF at the sites of anastomosis in all 13 patients. Eleven patients (32.4%) had transient focal neurologic deficit mimicking ischemic attack. Two patients (5.9%) had cerebral hyperperfusion syndrome associated with subarachnoid hemorrhage extending to the ipsilateral sylvian cistern. Symptoms were relieved by intensive blood pressure control, and no patients had permanent neurologic deficit or delayed neurologic deterioration during the follow-up period. Conclusions: Surgical revascularization including STA-MCA anastomosis is a safe and effective treatment for moyamoya disease, although temporary neurologic deterioration due to hyperperfusion could occur at a substantial rate. Routine CBF measurement is recommended for accurate diagnosis of postoperative hyperperfusion in moyamoya disease because its treatment is contradictory to that for ischemia. (c) 2007 Elsevier Inc. All rights reserved.

  486. Clinicopathological and endocrinological study of Rathke's cleft cyst manifesting as hyponatremia. 査読有り

    Ogawa Y, Tominaga T, Ikeda H

    Neurologia medico-chirurgica 47 (2) 58-63; discussion 63 2007年2月

    DOI: 10.2176/nmc.47.58  

    ISSN:0470-8105

  487. Ischemic complications associated with resection of opercular glioma 査読有り

    Toshihiro Kumabe, Shuichi Higano, Shoki Takahashi, Teiji Tominaga

    JOURNAL OF NEUROSURGERY 106 (2) 263-269 2007年2月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/jns.2007.106.2.263  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Object. Opercular glioma inferolateral to the hand/digit sensorimotor area can be resected safely using a neuronavigation system and functional brain mapping techniques. However, the surgery can still sometimes cause postoperative ischemic complications, the character of which remains unclear. The authors of this study investigated the occurrence of infarction associated with resection of opercular glioma and the arterial supply to this region. Methods. The study involved 11 consecutive patients with gliomas located in the opercular region around the orofacial primary motor and somatosensory cortices but not involving either the hand/digit area or the insula, who had been treated in their department after 1997. Both pre- and postoperative diffusion-weighted magnetic resonance (MR) imagin. was performed in the nine consecutive patients after 1998 to detect ischemic complications. All patients underwent open surgery for maximum tumor resection. Postoperative MR imaging identified infarction beneath the resection cavity in all patients. Permanent motor deficits associated with infarction involving the descending motor pathway developed in two patients. Cadaveric angiography showed that the distributing arteries to the corona radiata were the long insular arteries and/or medullary arteries from the opercular and cortical segments of the middle cerebral artery. Conclusions. Subcortical resection around the upper limiting sulcus of the posterior region of the insula and wide resection in the anteroposterior and cephalocaudal directions of the opercular region were considered to be risk factors of the critical infarction. Surgeons should be aware that resection of opercular glioma can disrupt the blood supply of the corona radiata, and carries the risk of permanent motor deficits.

  488. Spinal intramedullary metastasis of medulloblastoma at initial diagnosis 査読有り

    Tomoo Inoue, Toshihiro Kumabe, Toshiyuki Takahashi, Takeshi Nakajima, Mika Watanabe, Teiji Tominaga

    CHILDS NERVOUS SYSTEM 23 (1) 113-116 2007年1月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00381-006-0167-7  

    ISSN:0256-7040

    詳細を見る 詳細を閉じる

    Case report Spinal magnetic resonance imaging of a 4-year-old boy with medulloblastoma at the initial presentation showed intramedullary lesion without enhancement effect and slight cord swelling from C-5 to T-1. After complete response to the initial therapy, this lesion recurred and slowly expanded. Cervical C-11-methionine-positron emission tomography could establish the diagnosis of intramedullary metastasis. Conclusion Spinal intramedullary metastasis of medulloblastoma at initial diagnosis is extremely rare, but must be considered.

  489. [A case of cavernous angioma at the septum pellucidum]. 査読有り

    Narisawa A, Kumabe T, Anzai T, Utsumi Y, Tominaga T

    No shinkei geka. Neurological surgery 35 (1) 53-58 2007年1月

    ISSN:0301-2603

  490. Surgical treatment of paraventricular cavernous angioma: fibre tracking for visualizing the corticospinal tract and determining surgical approach. 査読有り

    Niizuma K, Fujimura M, Kumabe T, Higano S, Tominaga T

    Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 13 (10) 1028-1032 2006年12月

    DOI: 10.1016/j.jocn.2004.11.025  

    ISSN:0967-5868

  491. ["Disease targeting therapy" for neurosurgical disorders: molecular targeting and drug delivery]. 査読有り

    Saito R, Kumabe T, Tominaga T

    No shinkei geka. Neurological surgery 34 (11) 1157-1165 2006年11月

    ISSN:0301-2603

  492. Congestive myelopathy due to cervical perimedullary arteriovenous fistula evaluated by apparent diffusion coefficient values - Case report 査読有り

    Tomoo Inoue, Toshiyuki Takahashi, Hiroaki Shimizu, Yasushi Matsumoto, Akira Takahashi, Teiji Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 46 (11) 559-562 2006年11月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.46.559  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 22-year-old woman presented with a cervical perimedullary arteriovenous fistula (AVF) manifesting as right upper and lower extremity weakness. T-2-weighted magnetic resonance (MR) imaging showed intramedullary hyperintensity believed to be caused by venous congestion. Preoperative diffusion-weighted MR imaging showed increased apparent diffusion coefficient (ADC) value. Spinal angiography demonstrated an AVF fed mainly by the right C-5 radicular artery. Complete obliteration of AVF was achieved by endovascular embolization and microsurgical shunt occlusion. The ADC value was normalized and her neurological deficits improved after endovascular surgery, whereas T,-weighted MR imaging still demonstrated the lesion. The high preoperative ADC value probably indicated reversible vasogenic edema and immediate normalization of the ADC value suggests a good clinical outcome.

  493. [Diagnosis and various grading systems of subarachnoid hemorrhage]. 査読有り

    Shimizu H, Tominaga T

    Nihon rinsho. Japanese journal of clinical medicine 64 Suppl 8 559-565 2006年11月

    ISSN:0047-1852

  494. [Delayed ischemic neurological deficit in patients with aneurysmal subarachnoid hemorrhage: its pathogenesis, prevention and treatment]. 査読有り

    Tominaga T, Fujimura M

    Nihon rinsho. Japanese journal of clinical medicine 64 Suppl 8 650-653 2006年11月

    ISSN:0047-1852

  495. [Cerebral cavernous malformation]. 査読有り

    Fujimura M, Tominaga T

    Nihon rinsho. Japanese journal of clinical medicine 64 Suppl 8 691-694 2006年11月

    ISSN:0047-1852

  496. [Intraoperative brain surface blood flow monitoring using IRIS V thermographic imaging system in patients with Moyamoya disease]. 査読有り

    Nakagawa A, Fujimura M, Ohki T, Suzuki H, Takayama K, Tominaga T

    No shinkei geka. Neurological surgery 34 (10) 1017-1025 2006年10月

    ISSN:0301-2603

  497. Penetrating atheroma in cervical carotid artery stenosis. 査読有り

    Narisawa A, Shimizu H, Watanabe M, Tominaga T

    Neurologia medico-chirurgica 46 (9) 434-437 2006年9月

    DOI: 10.2176/nmc.46.434  

    ISSN:0470-8105

  498. [Diagnostic value of perfusion-weighted MRI for evaluating postoperative alteration of cerebral hemodynamics following STA-MCA anastomosis in patients with moyamoya disease]. 査読有り

    Fujimura M, Mugikura S, Shimizu H, Tominaga T

    No shinkei geka. Neurological surgery 34 (8) 801-809 2006年8月

    ISSN:0301-2603

  499. [Usefulness of regional cerebral oxygen saturation monitoring in balloon test occlusion]. 査読有り

    Niizuma K, Kamii H, Matsumoto Y, Kondoh R, Shimizu H, Tominaga T

    No shinkei geka. Neurological surgery 34 (7) 695-702 2006年7月

    ISSN:0301-2603

  500. [Precocious puberty caused by hCG-producing germinoma involving the bilateral basal ganglia and cerebral white matter without 1ypical radiologic findings: case report]. 査読有り

    Sugiyama S, Kumabe T, Mino M, Fujimura M, Fujiwara I, Tominaga T

    No shinkei geka. Neurological surgery 34 (6) 619-624 2006年6月

    ISSN:0301-2603

  501. [Intracerebral intravascular papillary endothelial hyperplasia mimicking a metastatic brain tumor: a case report]. 査読有り

    Yamashita Y, Kumabe T, Tominaga T, Watanabe M

    No to shinkei = Brain and nerve 58 (4) 344-345 2006年4月

    ISSN:0006-8969

  502. Evaluation of interhemispheric time difference by magnetoencephalography before and after total callosotomy - Two case reports 査読有り

    KA Salayev, N Nakasato, M Ishitobi, H Shamoto, A Kanno, T Tominaga, K Iinuma

    NEUROLOGIA MEDICO-CHIRURGICA 46 (3) 136-142 2006年3月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.46.136  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    Interhemispheric time difference (ITD) measured by electroencephalography (EEG) and magnetoencephalography (MEG) was compared to seizure outcome after callosotomy. Two patients with frequent drop attacks underwent simultaneous EEG and MEG before and after total callosotomy. ITDs in 30 bilateral synchronized (BS) discharges were calculated independently by EEG and MEG. As minimum transcallosal conduction time was suggested to be approximately 20 msec, BS discharges were classified into five categories according to ITD and side: left- or right-leading long (300 to 80 msec), left- or right-leading moderate (80 to 20 msec), and negligible (&lt; 20 msec). In Case I before callosotomy, EEG detected 77% negligible and 23% right-leading moderate BS discharges, whereas MEG detected 30% and 63%, respectively. After callosotomy, drop attacks reduced remarkably and EEG and MEG detected no BS discharges. In Case 2 before callosotomy, EEG detected 77% negligible and 23% moderate BS discharges, whereas MEG detected 80% and 20%, respectively. After callosotomy, drop attacks recurred 2 months later and EEG and MEG detected left- and right-leading long BS discharges (63% by EEG and 56% by MEG). MEG detected a large number of BS discharges with moderate ITD before surgery in Case 1, suggesting that the transcallosal pathway was the main pathway for the synchronization, whereas the negligible ITD in Case 2 excludes transcallosal propagation. BS discharges with longer ITD after surgery in Case 2 suggest a persistent poly-synaptic non-transcallosal pathway. MEG with higher spatial resolution than EEG may provide surgical indications for callosotomy.

  503. De novo and salvage pathways of DNA synthesis non primary cultured neurall stem cells 査読有り

    K Sato, J Kanno, T Tominaga, Y Matsubara, S Kure

    BRAIN RESEARCH 1071 (1) 24-33 2006年2月

    出版者・発行元:ELSEVIER SCIENCE BV

    DOI: 10.1016/j.brainres.2005.11.039  

    ISSN:0006-8993

    詳細を見る 詳細を閉じる

    We studied the de novo and salvage pathways of DNA synthesis in sphere-forming neural stem cells obtained from mouse embryos by a neurosphere method. The former pathway needs folic acid (FA) for nucleotide biosynthesis, while the latter requires deoxyribonucleosides (dNS). We examined the proliferative activity of sphere-forming cells in E14.5 embryos by counting the number of spheres formed in media that lacked FA and/or dNS. Proliferation failure and apoptosis occurred in a deficient medium lacking of both FA and dNS. Spheres formed in the deficient medium supplemented with dNS, without FA, did not produce neuron, but rather only seem to generate astrocytes and oligodendrocytes when plated under differentiation condition in culture. On the other hand, a subpopulation of cultured cells formed spheres in the deficient medium supplemented with FA alone in an appropriate concentration, and did possess the self-renewing and multipotential characteristics of neural stem cells. Spheres formed in the media containing low dose Azathioprine and methotrexate, inhibitors of de novo DNA synthesis, were selectively prevented from producing neurons even in the presence of FA. These results suggested that activating de novo DNA synthesis was needed for neural stem cells to proliferate with multipotentiality. (C) 2005 Elsevier B.V. All rights reserved.

  504. [Choroid plexus tumors: report of 7 cases in a single institution]. 査読有り

    Noshita N, Kumabe T, Kayama T, Tominaga T

    No shinkei geka. Neurological surgery 34 (1) 73-81 2006年1月

    ISSN:0301-2603

  505. Attenuation of fluctuating striatal synaptic dopamine levels in patients with Parkinson disease in response to subthalamic nucleus stimulation: a positron emission tomography study 査読有り

    T Nimura, K Yamaguchi, T Ando, S Shibuya, T Oikawa, A Nakagawa, R Shirane, M Itoh, T Tominaga

    JOURNAL OF NEUROSURGERY 103 (6) 968-973 2005年12月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/jns.2005.103.6.0968  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Object. The "wearing-off" phenomenon often hampers the treatment of Parkinson disease (PD). Although deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known to ameliorate the wearing-off phenomenon, the mechanism by which it does this remains unclear. As part of an inquiry into the mechanism of STN DBS, the authors measured synaptic dopamine levels in the striatum by performing positron emission tomography (PET) with [C-11]raclopride. Methods. Three patients with PD who were experiencing the wearing-off phenomenon underwent PET scanning before and after DBS of the STN. The clinical features in these patients were evaluated by applying the Hoehn and Yahr, United Parkinson's Disease Rating, and Schwab and England Activities of Daily Living Scales. Before and after surgery, PET scans were obtained using [C-11]raclopride prior to and 1 hour following an oral administration of levodopa. Regions of interest for the [C-11]raclopride binding potential (RacloBP) were set in the bilateral putamen and the caudate nucleus. All clinical scores were dramatically improved postoperatively. Deep brain stimulation of the STN reduced the baseline RacloBP in both the putamen and caudate nucleus, but the differences between the pre- and postoperative levels were insianificant. Before DBS of the STN, the levodopa administration significantly reduced RacloBP in the putamen (p &lt; 0.0001). Postoperatively the drug-induced reduction in RacloBP became statistically insignificant. The drug-induced increase in synaptic dopamine concentrations in the putamen preoperatively was estimated to be approximately four times higher than that after surgery (p &lt; 0.01). The drug-induced RacloBP change in the caudate nucleus was similar to that in the putamen, although the magnitude of the change was lower (p &lt; 0.005). The drug-induced increase in the caudate nucleus was also reduced postoperatively (p &lt; 0.05). Conclusions. Deep brain stimulation of the STN induces the stabilization of synaptic dopamine concentrations in the striatum and may attribute to the alleviation of levodopa-related motor fluctuations.

  506. The relationship among p53 oligomer formation, structure and transcriptional activity using a comprehensive missense mutation library 査読有り

    T Kawaguchi, S Kato, K Otsuka, G Watanabe, T Kumabe, T Tominaga, T Yoshimoto, C Ishioka

    ONCOGENE 24 (46) 6976-6981 2005年10月

    出版者・発行元:NATURE PUBLISHING GROUP

    DOI: 10.1038/sj.onc.1208839  

    ISSN:0950-9232

    詳細を見る 詳細を閉じる

    Tumor suppressor p53 forms a homo-tetramer through its COOH-terminal oligomerization domain and acts as a sequence-specific transcription factor. We have analysed the interrelation among the transcriptional activities, the structure and the cancer-related mutations in the oligomerization domain by using a comprehensive missense mutation library. Here, we examined the ability of 184 mutant p53s in the domain to form an oligomer by expressing these mutant p53s in yeast, and compared the data with the previous information. We showed that specific residues in the alpha-helix and the beta-strand of the oligomerization domain were critical for both oligomer formation and sequence-specific transactivation, and the activities were closely related. In particular, the alpha-helix was more sensitive to amino-acid substitutions than the beta-strand. We found identity in the interrelation between the two activities, that is, monomer mutants were transcriptionally inactive whereas dimer and tetramer mutants retained their transcriptional activities. In TP53 mutation databases, a small number of mutations have been reported in this domain. Surprisingly, most do not encode p53s defective in functional properties. These results indicate that, although oligomer formation is essential for p53 transactivation function, the inactivation of oligomer formation and therefore the inactivation of transactivation may not be essential for tumor suppression by p53 because they do not lead to oncogenic proteins.

  507. [Preoperative functional brain mapping using magnetoencephalography for brain tumors]. 査読有り

    Nobukazu Nakasato, Toshihiro Kumabe, Teiji Tominaga

    Nihon rinsho. Japanese journal of clinical medicine 63 Suppl 9 228-35 2005年9月

    ISSN:0047-1852

  508. [Progress in prognosis for patients with gliomas]. 査読有り

    Kumabe T, Tominaga T

    Nihon rinsho. Japanese journal of clinical medicine 63 Suppl 9 293-297 2005年9月

    ISSN:0047-1852

  509. [Relationship between intraoperative brain mapping and pre- or post-operative functional MRI in patients with glioma]. 査読有り

    Karibe H, Kumabe T, Tominaga T

    Nihon rinsho. Japanese journal of clinical medicine 63 Suppl 9 395-400 2005年9月

    ISSN:0047-1852

  510. Fronto-basal interhemispheric approach for craniopharyngiomas extending outside the suprasellar cistern 査読有り

    R Shirane, T Hayashi, T Tominaga

    CHILDS NERVOUS SYSTEM 21 (8-9) 669-678 2005年8月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00381-005-1206-5  

    ISSN:0256-7040

    詳細を見る 詳細を閉じる

    Objective: The aim of the present study was to establish the usefulness of the fronto-basal approach with a relatively small craniotomy window for the removal of tumors protruding from the sellar-suprasellar region to the third and basal cistern. Method: Forty-two patients who were surgically treated for craniopharyngiomas extending outside the sellar-suprasellar region were evaluated. All the patients were operated on by the fronto-basal interhemispheric approach, and the average follow-up period was 5 years. Results: Gross total resection of the lesion was achieved in 30 cases. Eight patients underwent subtotal resection and four patients underwent partial removal due to recurrence after previous surgeries with or without radiotherapy. In the immediate postoperative period, major complications, including impairment of the cranial nerves, were observed in two cases. One patient exhibited transient memory disturbance due to infarction of the perforator; after 3 months, this symptom was ameliorated. Three of the patients died during follow-up; however, 6 of the 30 undergoing gross total removal and 10 of the 12 patients undergoing subtotal or partial removal suffered regrowth. Ultimately, a total of 12 patients underwent re-operation with the same approach or combined with the orbito-zygomatic approach. Conclusion: In our experience, the fronto-basal interhemispheric approach, even through a small craniotomy window, is a valid choice for the removal of craniopharyngiomas extending outside the sellar-suprasellar region. Using this approach, tumors can be removed without significant sequelae related to surgical technique due to easy preservation of the pituitary stalk, hypothalamic structures, and perforators. This approach offers a safe and minimally invasive means of treating craniopharyngiomas.

  511. Paraparesis associated with ruptured anterior cerebral artery territory aneurysms 査読有り

    H Endo, H Shimizu, T Tominaga

    SURGICAL NEUROLOGY 64 (2) 135-139 2005年8月

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.surneu.2004.12.019  

    ISSN:0090-3019

    詳細を見る 詳細を閉じる

    Background: Paraparesis is a rare but characteristic manifestation of ruptured anterior communicating artery or anterior cerebral artery (ACA) aneurysms, but the pathogenesis remains unclear. This study investigated the neuroimaging and clinical features of patients with such paraparesis to evaluate possible causes. Methods: Nine of 178 patients with ruptured anterior communicating artery or ACA aneurysms presented with paraparesis among 462 patients with subarachnoid hemorrhage (SAH) admitted between May 1996 and November 2001. Diffusion-weighted magnetic resonance (MR) imaging was performed within 48 hours of the onset of SAH in 4 of these 9 patients. The clinical course and neuroimaging studies of these 4 patients were retrospectively reviewed. Results: Diffusion-weighted MR imaging revealed -intensity areas in the medial aspects of the bilateral frontal lobes, which were supplied by the ACAs and distal to the aneurysms, in all 4 patients. These high-intensity lesions had normal to subnormal values of apparent diffusion coefficient (ADC). Most of the high-intensity lesions recovered and did not result in the final lesions regardless of the ADC values, but some lesions with subnormal ADC values resulted in cerebral infarction. Paraparesis was transient and almost completely resolved in 3 patients. Conclusions: Diffusion-weighted MR imaging detected primary brain damage in the ACA territories caused by acute SAH, which was compatible with the clinical paraparesis. Primary brain damage caused by SAH may include 3 types of lesions: reversible with normal ADC value, reversible with subnormal ADC value, and irreversible with subnormal ADC value. (c) 2005 Elsevier Inc. All rights reserved.

  512. Transethmoidal intranasal meningoencephalocele in an adult with recurrent meningitis 査読有り

    T Hasegawa, N Sugeno, Y Shiga, A Takeda, H Karibe, T Tominaga, Y Itoyama

    JOURNAL OF CLINICAL NEUROSCIENCE 12 (6) 702-704 2005年8月

    出版者・発行元:CHURCHILL LIVINGSTONE

    DOI: 10.1016/j.jocn.2004.08.027  

    ISSN:0967-5868

    詳細を見る 詳細を閉じる

    Intranasal meningoencephalocele is a rarely encountered congenital malformation. We report a case of transethmoidal intranasal meningoencephalocele in a 52-year old man with recurrent purulent meningitis. After treatment of the acute meningitis, frontal craniotomy followed by the removal of the stalk of the meningoencephalocele and repair of the bony defect was successfully performed. He has had no further meningitis or CSF rhinorrhea post-operatively. Detailed neuroradiological examination and appropriate surgical treatment are important to prevent fatal neurological complications of intranasal meningoencephalocele. (C) 2005 Elsevier Ltd. All rights reserved.

  513. Spinal cord infarction demonstrated by diffusion-weighted magnetic resonance imaging 査読有り

    M Shinoyama, T Takahashi, H Shimizu, T Tominaga, M Suzuki

    JOURNAL OF CLINICAL NEUROSCIENCE 12 (4) 466-468 2005年5月

    出版者・発行元:CHURCHILL LIVINGSTONE

    DOI: 10.1016/j.jocn.2004.01.010  

    ISSN:0967-5868

    詳細を見る 詳細を閉じる

    Spinal cord infarction is a rare entity of varying etiology although most often associated with atherosclerotic aortic disease. Definitive diagnosis of (idiopathic) spinal cord infarction in the acute stage and in the absence of demonstrable predisposing factors is not always possible even with MRI. Diffusion-weighted MRI (dwMRI) may provide valuable information in the evaluation of spinal cord ischemia. A 45-year-old woman presented with idiopathic spinal cord infarction manifesting as sudden onset of paraparesis and sphincter dysfunction. Both T2-weighted and line-scan dwMRI revealed hyperintense signals in the dorsal part of the spinal conus. Apparent diffusion coefficient values were significantly low in the lesion, suggesting cytotoxic edema compatible with acute ischemia. The clinical course and other radiographic findings were also compatible with idiopathic spinal cord infarction. Diffusion-weighted MRI is an important diagnostic tool for examining patients with suspected spinal cord ischemia. (c) 2005 Elsevier Ltd. All rights reserved.

  514. Tl-201-SPECT and H-1-MRS study of benign lateral ventricle tumors: differential diagnosis of subependymoma 査読有り

    T Kawaguchi, T Kumabe, H Shimizu, M Watanabe, T Tominaga

    NEUROSURGICAL REVIEW 28 (2) 96-103 2005年4月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s10143-004-0353-6  

    ISSN:0344-5607

    詳細を見る 詳細を閉じる

    The introduction of computed tomography (CT) and magnetic resonance (MR) imaging has resulted in the detection of increasing numbers of asymptomatic intraventricular tumors. Establishing the correct preoperative diagnosis is important to prevent unnecessary surgical intervention. Our study includes nine cases of benign lateral ventricle tumors including two cases of central neurocytoma, two of subependymal giant cell astrocytoma, two of pilocytic astrocytoma and three of subependymoma treated surgically between 1996 and 2003. MR imaging, proton MR spectroscopy (H-1-MRS) and thallium-201 single photon emission computed tomography (Tl-201-SPECT) were performed in all patients. All three types of tumor demonstrated heterogeneous enhancement on MR imaging with gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) and increased choline (Cho) peak and decreased N-acetyl aspartate (NAA) and creatine (Cre) peaks on H-1-MRS. Tl-201-SPECT showed high uptake of Tl-201 without wash out in all cases of central neurocytoma, subependymal giant cell astrocytoma and pilocytic astrocytoma, but no uptake in cases of subependymoma. Absence of Tl-201 uptake in contrast with enhancement on MR imaging and the H-1-MRS features of modest elevation of the Cho/Cre ratio, reduction of the NAA peak and presence of lactate/lipid peaks are characteristic features of subependymomas and useful to establish a preoperative diagnosis.

  515. Neuromagnetic measurement of unilateral temporo-parietal theta rhythm in patients with internal carotid artery occlusive disease 査読有り

    S Seki, N Nakasato, S Ohtomo, A Kanno, H Shimizu, T Tominaga

    NEUROIMAGE 25 (2) 502-510 2005年4月

    出版者・発行元:ACADEMIC PRESS INC ELSEVIER SCIENCE

    DOI: 10.1016/j.neuroimage.2004.11.025  

    ISSN:1053-8119

    詳細を見る 詳細を閉じる

    Rhythmic theta activity detected by electroencephalography (EEG) may be correlated with cerebrovascular brain diseases. Magnetoencephalography (MEG) has higher sensitivity and spatial resolution than conventional scalp EEG, so may be a better method to detect theta rhythm in patients with internal carotid artery (ICA) occlusive disease. Simultaneous EEG and MEG were performed in the awake state in 48 patients with unilateral (n = 42) or bilateral (n = 6) stenotic lesions (more than 60% occlusion) of the ICA (n = 47) or middle cerebral artery (n = 7), and in 27 age-matched healthy normal subjects. No subject had severe neurological deficits. MEG detected the theta rhythm (6-8 Hz) in 14 of 48 patients: ipsilateral to the stenotic or occluded side in 13 hemispheres and bilaterally in one patient with unilateral lesion. The source of the MEG theta rhythm was estimated in the dorsolateral temporo-parietal area, regardless of the location of infarct foci or the stenotic portion of the ICA system. The temporoparietal theta rhythm was separated from the occipital alpha rhythm by frequency and distribution in MEG. The theta rhythm was found in only two patients by EEG, as well as by MEG. MEG provided better separation of this theta rhythm from the occipital alpha rhythm. Neither MEG nor EEG detected this theta rhythm in the normal subjects. Unilateral temporo-parietal theta rhythm is correlated with the hemisphere with ICA occlusive disease. This rhythm may indicate mild or subclinical abnormalities in the ICA system. MEG is superior to EEG for the detection and localization of theta rhythm. (c) 2004 Elsevier Inc. All rights reserved.

  516. Neuromagnetic evaluation of binaural unmasking 査読有り

    T Sasaki, T Kawase, N Nakasato, A Kanno, M Ogura, T Tominaga, T Kobayashi

    NEUROIMAGE 25 (3) 684-689 2005年4月

    出版者・発行元:ACADEMIC PRESS INC ELSEVIER SCIENCE

    DOI: 10.1016/j.neuroimage.2004.11.030  

    ISSN:1053-8119

    詳細を見る 詳細を閉じる

    Binaural unmasking refers to the improvement in intelligibility under conditions of masking when a tone is presented out of phase rather than in phase. In the present study, binaural unmasking was evaluated using auditory-evoked magnetoencephalography (MEG) in eight healthy right-handed volunteers (7 males and 1 female, mean age 25.9 years). Peak latency and amplitude of the N1m response to tone bursts of 250 Hz (n = 8), 1000 Hz (n = 3), and 4000 Hz (n = 3) were measured under SoNo (binaural phase difference was zero radian (in phase) for both stimulus sound and masker noise) and SpiNo (binaural phase difference was pi radian (out of phase) for stimulus sound and zero radian for masker noise) conditions. The level of tone bursts was swept by 5 or 10 dB steps from the level of 20 dB above the psychophysical threshold under the SoNo condition until no significant auditory-evoked field could be observed. Identical background noise was presented to both ears continuously at 50 dB SPL. N1m responses to stimuli at or above the psychophysical threshold were found bilaterally in all subjects except one who had only right hemispheric N1m. N1m response for the SpiNo stimulus had larger amplitude and shorter latency than that for the SoNo stimulus in each hemisphere and at each sound level. Neuromagnetic binaural unmasking was greatest around the threshold level, corresponding to psychophysical binaural unmasking; became smaller with greater stimuli, indicating the suprathreshold unmasking effect; and disappeared at around 15-20 dB above the threshold. Psychophysical binaural unmasking can be quantitatively evaluated by MEG in the auditory cortex level of the bilateral hemispheres. (c) 2004 Elsevier Inc. All rights reserved.

  517. Ectopic recurrence of craniopharyngioma 査読有り

    T Kawaguchi, M Fujimura, R Shirane, T Shoji, M Watanabe, T Tominaga

    JOURNAL OF CLINICAL NEUROSCIENCE 12 (3) 307-309 2005年4月

    出版者・発行元:CHURCHILL LIVINGSTONE

    DOI: 10.1016/j.jocn.2004.01.009  

    ISSN:0967-5868

    詳細を見る 詳細を閉じる

    50-year-old woman first presented with recurrent craniopharyngioma in the suprasellar region. The recurrent tumor was removed via the frontobasal interhemispheric approach. Two years later, magnetic resonance imaging revealed a further recurrence in the primary suprasellar region and a cystic mass with ring enhancement on the surface of the left frontal lobe. Both lesions were removed via the frontobasal interhemispheric approach. Histological examination showed the left frontal lesion was an ectopic recurrence of craniopharyngioma. Ectopic recurrence of craniopharyngioma is extremely rare. (c) 2004 Elsevier Ltd. All rights reserved.

  518. Delayed lymphocytic infundibuloneurohypo-physitis following successful transsphenoidal treatment of Cushing's disease 査読有り

    T Kawaguchi, H Ikeda, M Fujimura, T Yoshimoto, T Tominaga

    JOURNAL OF CLINICAL NEUROSCIENCE 12 (3) 320-323 2005年4月

    出版者・発行元:CHURCHILL LIVINGSTONE

    DOI: 10.1016/j.jocn.2004.04.007  

    ISSN:0967-5868

    詳細を見る 詳細を閉じる

    Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan Lymphocytic infundibuloneurohypophysitis is a rare disorder in which neurohypophyseal function is impaired by an autoimmune process. Although several etiologies for this rare entity have been suggested, its occurrence following transsphenoidal adenomectomy has not been reported. A 20-year-old man presented with diabetes insipidus - seven years after successful transsphenoidal microadenomectomy for Cushing's disease, first diagnosed at the age of 13. Seven years later, he developed fairly rapid onset of polydipsia and polyuria. Magnetic resonance imaging demonstrated swelling of the posterior pituitary gland with thickening of the pituitary stalk. Endocrinological evaluation revealed neurohypophyseal dysfunction without the adenohypophysis being affected. On the basis of these findings, a diagnosis of lymphocytic infundibuloneurohypophysitis was made. The mass lesion of the posterior pituitary resolved after the administration of corticosteroids for two months and no operation was required. Lymphocytic infundibuloneurohypophysitis should be considered in the differential diagnosis of pituitary mass lesions following transsphenoidal surgery, especially when the mass is confined to the posterior pituitary gland with neurohypophyseal function being compromised. (c) 2004 Elsevier Ltd. All rights reserved.

  519. [MRA volume rendering for surgical planning of unruptured intracranial cerebral aneurysms]. 査読有り

    Narisawa A, Syamoto H, Karibe H, Shimizu H, Fujiwara S, Tominaga T

    No shinkei geka. Neurological surgery 33 (3) 243-248 2005年3月

    ISSN:0301-2603

  520. [Surgical removal of gliomas with attention to preserve vascular structures]. 査読有り

    Kumabe T, Tominaga T

    No shinkei geka. Neurological surgery 33 (1) 19-27 2005年1月

    ISSN:0301-2603

  521. Diagnostic value of super-selective bilateral cavernous sinus sampling with hypothalamic stimulating hormone loading in patients with ACTH-producing pituitary adenoma 査読有り

    M Fujimura, H Ikeda, A Takahashi, M Ezura, T Yoshimoto, T Tominaga

    NEUROLOGICAL RESEARCH 27 (1) 11-15 2005年1月

    出版者・発行元:MANEY PUBLISHING

    DOI: 10.1179/016164105X18106  

    ISSN:0161-6412

    詳細を見る 詳細を閉じる

    Aims: Early diagnosis and early treatment by transsphenoidal surgery is desirable for ACTH-producing pituitary microadenoma, but accurate localization of the functional lesion is not always possible before surgery because magnetic resonance (MR) imaging may provide false negative and/or positive findings. The diagnostic value of super-selective bilateral cavernous sinus sampling with the administration of corticotropin-releasing hormone (CRH) was assessed in patients with functioning ACTH-producing pituitary adenoma. Methods: Fifteen patients with pituitary adenoma (14 with microadenoma) aged from 23 to 74 years (mean 46.7 years) underwent cavernous sinus sampling with or without the CRH loading test and subsequent transsphenoidal surgery in our institute from October 1997 through to November 2002. MR imaging including dynamic scan failed to detect the adenomatous lesion in all patients. To eliminate the bias due to uneven blood flow in the cavernous sinuses and the multi-hormonal response to CRH administration, the ACTH/FSH ratios were evaluated. The inter-cavernous gradient (ICG) was calculated as the higher/lower ACTH venous blood levels in the right and left cavernous sinuses with or without CRH loading. The adjusted ICG was calculated using the ACTH/FSH ratios. The results were compared with the surgical findings. An ICG of 1.4 or greater was considered to indicate the localization of the responsible lesion. Results: Transsphenoidal surgery revealed the functioning lesion on the right in five cases, the left in six, the midline in three and the bilateral lateral wings (double adenoma) in one. Adjusted ICG with CRH loading had a localization accuracy of 93.3% (14/15), which was significantly higher than that of 73.3% (11/15) using ICG without hypothalamic stimulating hormone loading (p=0.0402). Conclusions: Super-selective cavernous sinus sampling or with hypothalamic stimulating hormone administration can provide accurate localization the responsible lesion in patients with ACTH-producing pituitary adenoma.

  522. Neuroprotective role of neurotrophins: Relationship between nerve growth factor and apoptotic cell survival pathway after cerebral ischemia 査読有り

    Atsushi Saito, Teiji Tominaga, Pak H. Chan

    Current Atherosclerosis Reports 7 (4) 268-273 2005年

    出版者・発行元:Current Science Ltd

    DOI: 10.1007/s11883-005-0018-0  

    ISSN:1523-3804

    詳細を見る 詳細を閉じる

    Neurotrophins provide a neuroprotective effect in a variety of brain diseases. Recent reports demonstrate that neurotrophins play an important role in the regulation of apoptotic neuronal cell death and in the relationship between this machinery and activation of cell survival pathways. The cascade reactions of the two major cell survival pathways, mitogen-activated protein kinase and phosphatidylinositol 3-kinase, are known to play a critical role in the regulation of apoptotic neuronal cell survival pathways. Neurotrophins such as nerve growth factor regulate these two cell survival pathways in in vitro studies. However, the role of neurotrophins in cell survival remains unclear in in vivo apoptotic neuronal cell death. We discuss the mechanism of neuroprotection by neurotrophins and also discuss cell survival effect of nerve growth factor on apoptotic neuronal cell death after in vivo cerebral ischemia. Copyright © 2005 by Current Science Inc.

  523. Neuroprotective effect of an antioxidant in ischemic brain injury - Involvement of neuronal apoptosis 査読有り

    M Fujimura, T Tominaga, PH Chan

    NEUROCRITICAL CARE 2 (1) 59-66 2005年

    出版者・発行元:HUMANA PRESS INC

    DOI: 10.1385/NCC:2:1:059  

    ISSN:1541-6933

    詳細を見る 詳細を閉じる

    The production of reactive oxygen species (ROS) has been implicated in reperfusion injury after cerebral ischemia, and antioxidant enzymes are believed to be among the major mechanisms by which the cells counteract the deleterious effect of ROS after cerebral ischemia. ROS also mediate the mitochondrial signaling pathway that may lead to apoptosis following cerebral ischemia. The recent development and availability of transgenic and knockout mutant rodents that either overexpress or are deficient in antioxidant genes have provided powerful tools for dissecting the molecular and cellular mechanisms of signaling pathways, direct oxidative damage, or both that are involved in ischemic brain injury. This article focuses on the contribution of ROS or an antioxidant system to the molecular pathway of postischemic apoptosis following transient focal cerebral ischemia by using transgenic mice that overexpress the cytosolic antioxidant copper/zinc superoxide dismutase.

  524. Thoracic intradural arachnoid cyst associated with surgical removal of epidural hematoma - Case report 査読有り

    H Endo, T Takahashi, H Shimizu, T Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 44 (11) 607-610 2004年11月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.44.607  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 54-year-old woman presented with a very rare association of spinal intradural arachnoid cyst and spinal epidural hematoma manifesting as paraparesis subsequent to severe back pain. Magnetic resonance (MR) imaging disclosed a ventral epidural hematoma extending from the T-4 to T-6 levels and compressing the spinal cord ventrally. Emergent surgical evacuation of the epidural hematoma was carried out 22 hours after the onset. MR imaging obtained 2 days after surgery showed enlargement of the dorsal subarachnoid space at the T-3 to T-8 levels. The patient could walk independently within 6 months after discharge, but paraparesis recurred 3 years after surgery. MR imaging showed formation of an intradural arachnoid cyst, which compressed the spinal cord dorsally. She underwent arachnoid cystectomy, and recovered ambulation postoperatively. This case of intradural arachnoid cyst of the thoracic spine which appeared after surgical removal of an epidural hematoma at the same spinal level indicates some association between the epidural hematoma and the arachnoid cyst.

  525. Computational replicas: Anatomic reconstructions of cerebral vessels as volume numerical grids at three-dimensional angiography 査読有り

    T Hassan, EV Timofeev, T Saito, H Shimizu, M Ezura, T Tominaga, A Takahashi, K Takayama

    AMERICAN JOURNAL OF NEURORADIOLOGY 25 (8) 1356-1365 2004年9月

    出版者・発行元:AMER SOC NEURORADIOLOGY

    ISSN:0195-6108

    詳細を見る 詳細を閉じる

    BACKGROUND AND PURPOSE: We present a relatively simple approach that physicians can use to reconstruct cerebral vessels as 3D numerical grids or computational replicas. The method accurately duplicates their geometry to provide computer simulations of their blood flow. METHODS: Initial images were obtained by using any medical imaging technique, such as MR angiography, CT angiography, or 3D digital subtraction angiography. The data were collected in DICOM format and converted by a DICOM reader into a 3D gray-scale raster image. The image was then processed by using commercial visualization and mesh generation software, which allowed extraction of the luminal surface of the blood vessel (by using the isosurfacing technique). The subsequent final output was an unstructured tetrahedral grid that can be directly used for detailed analysis of cerebral vascular geometry for patient-specific simulations of blood flow. RESULTS: Four examples of grid reconstruction and blood How simulation for patients with ruptured aneurysms were validated with angiographic and operative findings. The ruptured areas were correlated with areas of high fluid-induced wall-shear stress. CONCLUSION: This approach promises to be a practical tool for planning treatment and follow-up of patients after neurosurgical or endovascular interventions with 3D angiography. The proposed commercial packages or conceptually similar ones seem to be relatively simple and suitable for direct use by neurosurgeons or neuroradiologists.

  526. Hydrocephalus due to cerebrospinal fluid overproduction by bilateral choroid plexus papillomas 査読有り

    M Fujimura, T Onuma, M Kameyama, O Motohashi, H Kon, K Yamamoto, K Ishii, T Tominaga

    CHILDS NERVOUS SYSTEM 20 (7) 485-488 2004年7月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00381-003-0889-8  

    ISSN:0256-7040

    詳細を見る 詳細を閉じる

    Case report: A 10-month-old boy, with congenital deafness and blindness associated with chromosomal deletion [46XY, del(13)(q32)], presented with intractable ascites 9 months after ventriculo-peritoneal shunting for congenital hydrocephalus. Revision of the ventriculo-atrial shunt resulted in shunt failure 1 month later. External ventricular drainage revealed cerebrospinal fluid (CSF) overproduction (2,000 ml/day). Magnetic resonance imaging showed marked lobular enlargement of the bilateral choroid plexuses extending from the trigone to the body and inferior horn of the lateral ventricle. Multi-staged resection was performed via bilateral temporo-occipital transcortical approaches, and CSF production significantly decreased to 100 ml/day postoperatively. Histological assessment of the villous surface suggested villous hyperplasia of the choroid plexus and thorough evaluation including the proximal portion of the lobular lesion near the attachment revealed choroid plexus papilloma. He was discharged after ventriculo-peritoneal shunting without additional neurological deficits except for hyperreflexia of the left extremities. Conclusion: CSF overproduction caused by bilateral choroid plexus papillomas can result in hydrocephalus. Radical resection of the bilateral ventricular lesions should be considered for this entity. Thorough evaluation of the surgical specimen is recommended because histological examination of only the lobular surface of the choroid plexus lesion may fail to identify choroid plexus neoplasm.

  527. Comparison of magnetoencephalographic spikes with and without concurrent electroencephalographic spikes in extratemporal epilepsy 査読有り

    HM Park, N Nakasato, M Iwasaki, H Shamoto, T Tominaga, T Yoshimoto

    TOHOKU JOURNAL OF EXPERIMENTAL MEDICINE 203 (3) 165-174 2004年7月

    出版者・発行元:TOHOKU UNIV MEDICAL PRESS

    DOI: 10.1620/tjem.203.165  

    ISSN:0040-8727

    eISSN:1349-3329

    詳細を見る 詳細を閉じる

    Interictal spikes in patients with epilepsy may be detected by either electroencephalography (EEG) (E-spikes) or magnetoencephalography (MEG) (M-spikes), or both MEG and EEG (E/M-spikes). Localization and amplitude were compared between E/M-spikes and M-spikes in 7 adult patients with extratemporal epilepsy to evaluate the clinical significance of MEG spikes. MEG and EEG were simultaneously measured using a helmet-shaped MEG system with planar-type gradiometers and scalp electrodes of the international 10-20 system. Sources of E/M-spikes and M-spikes were estimated by an equivalent current dipole (ECD) model for MEG at peak latency. Each subject showed 9 to 20 (mean 13.4) E/M-spikes and 9 to 31 (mean 16.3) M-spikes. No subjects showed significant differences in the ECD locations between E/M- and M-spikes. ECD moments of the E/M-spikes were significantly larger in 2 patients and not significantly different in the other 5 patients. The similar localizations of E/M-spikes and M-spikes suggest that combination of MEG and EEG is useful to detect more interictal spikes in patients with extratemporal epilepsy. The smaller tendency of ECD amplitude of the M-spikes than E/M-spikes suggests that scalp EEG may overlook small tangential spikes due to background brain noise. Localization value of M-spikes is clinically equivalent to that of E/M-spikes. (C) 2004 Tohoku University Medical Press.

  528. Pulsed holmium : yttrium-aluminum-garnet laser-induced liquid jet as a novel dissection device in neuroendoscopic surgery 査読有り

    A Nakagawa, T Hirano, H Jokura, H Uenohara, T Ohki, T Hashimoto, Menezes, V, Y Sato, Y Kusaka, H Ohyama, T Saito, K Takayama, R Shirane, T Tominaga

    JOURNAL OF NEUROSURGERY 101 (1) 145-150 2004年7月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/jns.2004.101.1.0145  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Object. A pressure-driven continuous jet of water has been reported to be a feasible tool for neuroendoscopic dissection owing to its superiority at selective tissue dissection in the absence of thermal effects. With respect to a safe, accurate dissection, however, continuous water flow may not be suitable for intraventricular use. The authors performed experiments aimed at solving problems associated with continuous flow by using a pulsed holmium:yttrium-aluminum-garnet (Ho:YAG) laser-induced liquid jet (LILJ). They present this candidate neuroendoscopic LILJ dissection system, having examined its mechanical characteristics and evaluated its controllability both in a tissue phantom and in a rabbit cadaveric ventricle wall. Methods. The LILJ generator was incorporated into the tip of a No. 4 French catheter so that the LILJ could be delivered via a neuroendoscope. Briefly, the LILJ was generated by irradiating an internally supplied column of physiological saline with a pulsed Ho:YAG laser (pulse duration time 350 musec; laser energy 250-700 mJ/pulse) within a No. 4 French catheter (internal diameter 1 mm) and ejecting it from a metal nozzle (internal diameter 100 mum). The Ho:YAG laser energy pulses were conveyed by an optical fiber (core diameter 400 mum) at 3 Hz, whereas physiological saline (4degreesC) was supplied at a rate of 40 ml/hour. The mechanical characteristics of the pulsed LILJ were investigated using high-speed photography and pressure measurements; thermal effects and controllability were analyzed using an artificial tissue model (10% gelatin of 1 mm thickness). Finally, the ventricle wall of a rabbit cadaver was dissected using the LILJ. Jet pressure increased in accordance with laser energy from 0.1 to 2 bar; this translated into a penetration depth of 0.08 to 0.9 mm per shot in the ventricle wall of the rabbit cadaver. The gelatin phantom could be cut into the desired shape without significant thermal effects and in the intended manner, with a good surgical view. Conclusions. The present results show that the pulsed LILJ has the potential to become a safe and reliable dissecting method for endoscopic procedures.

  529. Intramedullary spinal tuberculoma - Case report 査読有り

    H Torii, T Takahashi, H Shimizu, M Watanabe, T Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 44 (5) 266-268 2004年5月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.44.266  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A healthy 33-year-old man presented with an intramedullary tuberculoma of the thoracic spinal cord manifesting as a 2-month history of progressive paraparesis and sphincter dysfunction. Magnetic resonance imaging showed ring enhancement of the intramedullary thoracic lesion with perifocal edema. General physical examination was unremarkable with no signs of inflammation except for a positive finding by the tuberculin skin test. Total resection of the intramedullary mass was performed through a posterior myelotomy following T11-12 laminectomy. Histological examination revealed a granulomatous lesion that contained Langhans giant cells, inflammatory cells, and caseating necrosis. Acid-fast bacilli staining of the specimens was positive, and cultures grew Mycobacterium tuberculosis. Postoperatively, the paraparesis and sphincter dysfunction improved sufficiently for the patient to return to his ordinary activities. Intramedullary spinal tuberculoma is rare, but must be considered in the differential diagnosis of spinal cord compression.

  530. The role of sigma-receptors in levodopa-induced dyskinesia in patients with advanced Parkinson disease: a positron emission tomography study 査読有り

    T Nimura, T Ando, K Yamaguchi, T Nakajima, R Shirane, M Itoh, T Tominaga

    JOURNAL OF NEUROSURGERY 100 (4) 606-610 2004年4月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/jns.2004.100.4.0606  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Object. Levodopa-induced dyskinesia (LID) in patients with Parkinson disease (PD) mimics acute dystonic reactionsinduced by antipsychotic agents, possibly mediated by sigma-receptors; however, there are few reports in which the relationship between a-receptors and LID in advanced PD is investigated. The binding potential of cerebellar sigma-receptors before and after a pallidal surgery for dyskinesia in patients with advanced PD is assessed. Methods. Six patients with advanced PD (male/female ratio 3:3, age 56.7 +/- 9.8 years) underwent stereotactic pallidal surgery (two posteroventral pallidotomy procedures and four deep brain stimulation of the globus pallidus internus, including one bilateral case). Clinical features of patients with PD were assessed using Hoehn and Yahr (H & Y) stages, the Unified Parkinson's Disease Rating Scale (UPDRS), and the Schwab and England Activities of Daily Life Scale (S & E). The LID was evaluated by LID severity score. The binding potential of cerebellar sigma-receptors was determined before and after the Surgery by C-11-nemonapride positron emission tomoraphy, a specific radioligand for sigma-receptors in the cerebellum. All clinical scores, especially the LID severity score, were dramatically improved after the surgery (p &lt; 0.05). Preoperatively, contralateral cerebellar binding potential was significantly elevated (p &lt; 0.01), and it was reduced after the surgery, but it was still higher than that of healthy volunteers (p &lt; 0.05). The ipsilateral cerebellar binding potential remained unchanged after the surgery. The level of binding potential did not correlate with H & Y stage, UPDRS, or S & E score, but a strong positive correlation was seen between the binding potential and the preoperative LID severity score when the patients were receiving medication (r = 0.893, p &lt; 0.05). Conclusions. Cerebellar sigma-receptors may potentially involve the genesis of LID in advanced PD.

  531. Exclusively extradural arteriovenous malformation with neurogenic claudication. Case illustration. 査読有り

    Niizuma K, Fujimura M, Takahashi T, Takahashi A, Watanabe M, Tominaga T

    Journal of neurosurgery 100 (4 Suppl Spine) 397 2004年4月

    ISSN:0022-3085

  532. Spontaneous regression of a primary cerebral tumor following vasospasm caused by subarachnoid hemorrhage due to rupture of an intracranial aneurysm - Case report 査読有り

    Y Yamashita, T Kumabe, H Shimizu, M Ezura, T Tominaga

    NEUROLOGIA MEDICO-CHIRURGICA 44 (4) 187-190 2004年4月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.44.187  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 40-year-old man demonstrated spontaneous regression of a malignant glioma following vasospasm caused by subarachnoid hemorrhage due to rupture of an intracranial aneurysm. The patient had been treated under a diagnosis of malignant glioma for 5 years. He presented with a ruptured aneurysm manifesting as subarachnoid hemorrhage. Single photon emission computed tomography with N-isopropyl-p-I-123-iodoamphetamine and diffusion-weighted magnetic resonance (MR) imaging revealed severe flow reduction due to vasospasm in the bilateral temporoparietal cortical regions, including the tumor. MR imaging performed 5 months later showed marked tumor regression. The present case suggests that treatment targeting angiogenesis of malignant gliomas may be effective as a part of multimodality treatment.

  533. [Clinical feature and surgical treatment of spontaneous spinal epidural hematoma]. 査読有り

    Kimiwada T, Takahashi T, Shimizu H, Tominaga T

    No shinkei geka. Neurological surgery 32 (4) 333-338 2004年4月

    ISSN:0301-2603

  534. Dissection of the superior cerebellar artery: a report of two cases and review of the literature 査読有り

    H Gotoh, T Takahashi, H Shimizu, M Ezura, T Tominaga

    JOURNAL OF CLINICAL NEUROSCIENCE 11 (2) 196-199 2004年2月

    出版者・発行元:CHURCHILL LIVINGSTONE

    DOI: 10.1016/S0967-5868(03)00136-X  

    ISSN:0967-5868

    詳細を見る 詳細を閉じる

    Arterial dissections frequently involve the main trunk of the posterior circulation and are recognised as an important cause of stroke in young individuals. However, dissection confined to cerebellar arteries is rare. We encountered two patients with superior cerebellar artery (SCA) dissection. A 37-year-old man presented with dysarthria, right limb ataxia, and severe headache. Magnetic resonance imaging revealed cerebellar infarction in the right SCA territory. Angiography demonstrated stenosis and fusiform dilation of the SCA in the anterior pontine segment. Recovery with antiplatelet treatment was nearly complete. A 45-year-old man was admitted with decreased consciousness after sudden onset of headache. Computed tomography demonstrated subarachnoid haemorrhage with hydrocephalus. Angiography revealed fusiform dilation of the left SCA in the anterior pontine segment. After ventricular drainage, endovascular embolisation was performed without ischaemic complications. The patient's condition improved sufficiently to return to daily life. In our search only four reported cases involved the SCA. Clinical manifestation and treatment for patients with cerebellar arterial dissections are discussed. (C) 2003 Elsevier Ltd. All rights reserved.

  535. Computational simulation of therapeutic parent artery occlusion to treat giant vertebrobasilar aneurysm 査読有り

    T Hassan, M Ezura, EV Timofeev, T Tominaga, T Saito, A Takahashi, K Takayama, T Yoshimoto

    AMERICAN JOURNAL OF NEURORADIOLOGY 25 (1) 63-68 2004年1月

    出版者・発行元:AMER SOC NEURORADIOLOGY

    ISSN:0195-6108

    詳細を見る 詳細を閉じる

    We applied computational fluid dynamics (CFD) analysis to assess 3D digital subtraction angiography findings in a patient with a giant vertebrobasilar aneurysm to simulate and compare the consequences of left and right vertebral artery occlusion. The balloon occlusion test suggested that occlusion of the right vertebral artery is the better way to treat this patient's aneurysm from the point of view of aneurysmal thrombosis and isolation from the circulation. The computer simulation supported this conclusion, at the same time indicating that from the point of view of pressure distribution on the wall of the aneurysm, the right vertebral occlusion may be also accompanied by an undesirable effect. A high-pressure area on the aneurysm wall in systole was revealed. This high pressure potentially could lead to subsequent aneurysmal growth, which indeed occurred, as was revealed by a follow-up examination 6 months later. This study is a good example of possible future applications of CFD in patients with cerebrovascular disease before therapeutic intervention.

  536. Intractable vomiting as an early clinical symptom of cerebrospinal fluid seeding to the fourth ventricle in patients with high-grade astrocytoma 査読有り

    M Fujimura, T Kumabe, H Jokura, R Shirane, T Yoshimoto, T Tominaga

    JOURNAL OF NEURO-ONCOLOGY 66 (1-2) 209-216 2004年1月

    出版者・発行元:KLUWER ACADEMIC PUBL

    DOI: 10.1023/B:NEON.0000013487.71148.5d  

    ISSN:0167-594X

    詳細を見る 詳細を閉じる

    Object. Cerebrospinal fluid (CSF) seeing of high-grade astrocytoma is common, but the early clinical symptoms are not well characterized. Here, we report five patients with disseminated high-grade astrocytoma in the fourth ventricle region who presented with intractable vomiting prior to the detection of the metastatic deposits with enhancement. Patients and methods. From 1994 to 2000, 133 patients of high-grade astrocytoma were treated in our institute and were followed up until December 2002. Follow-up magnetic resonance (MR) imaging was performed in all patients every 2-3 months. The CSF seeding was defined as leptomeningeal enhancement. Signs and symptoms of CSF seeding were checked at the monthly outpatient examination. Results. Among them, 5 patients aged from 27 to 58 years (mean 43.8 years) with one anaplastic astrocytoma and four glioblastomas showed intractable vomiting without signs of high intracranial pressure as evaluated by MR imaging or ocular fundus examination prior to the detection of the fourth ventricle dissemination. Fourth ventricle dissemination appeared 1-3 months after vomiting in five patients. One patient with glioblastoma received gamma knife radiotherapy for a fourth ventricle lesion appearing as a high intensity area on T2-weighted imaging before the appearance of the enhanced nodule, and this lesion was cured. Four patients died of progression of the fourth ventricle lesion. Conclusion. Intractable vomiting may be an early clinical symptom of CSF seeding to the fourth ventricle in patients with high-grade astrocytoma. Early detection and immediate radiotherapy for this lesion are recommended to control fourth ventricle dissemination.

  537. Experimental application of pulsed Ho : YAG laser-induced liquid jet as a novel rigid neuroendoscopic dissection device 査読有り

    T Ohki, A Nakagawa, T Hirano, T Hashimoto, Menezes, V, H Jokura, H Uenohara, Y Sato, T Saito, R Shirane, T Tominaga, K Takayama

    LASERS IN SURGERY AND MEDICINE 34 (3) 227-234 2004年

    出版者・発行元:WILEY-LISS

    DOI: 10.1002/lsm.20021  

    ISSN:0196-8092

    詳細を見る 詳細を閉じる

    Background and Objectives: Although water jet technology has been considered as a feasible neuroendoscopic dissection methodology because of its ability to perform selective tissue dissection without thermal damage, problems associated with continuous use of water and the ensuing fountain-effect-with catapulting of the tissue-could make water jets unsuitable for endoscopic use, in terms of safety and ease of handling. Therefore, the authors experimented with minimization of water usage during the application of a pulsed holmium:yttrium-aluminum-garnet (Ho:YAG) laser-induced liquid jet (LILJ), while assuring the dissection quality and the controllability of a conventional water jet dissection device. We have developed the LILJ generator for use as a rigid neuroendoscope, discerned its mechanical behavior, and evaluated its dissection ability using the cadaveric rabbit ventricular wall. Study Design/Materials and Methods: The LILJ generator is incorporated into the tip of a stainless steel tube (length: 22 cm; internal diameter: 1.0 mm; external diameter: 1.4 mm), so that the device can be inserted into a commercial, rigid neuroendoscope. Briefly, the LILJ is generated by irradiating an internally supplied water column within the stainless steel tube using the pulsed Ho:YAG laser (wave length: 2.1 mum, pulse duration time: 350 microseconds) and is then ejected through the metal nozzle (internal diameter: 100 mum). The Ho:YAG laser pulse energy is conveyed through optical quartz fiber (core diameter: 400 mum), while cold water (5degreesC is internally supplied at a rate of 40 ml/hour. The relationship between laser energy (range: 40-433 mJ/pulse), standoff distance (defined as the distance between the tip of the optical fiber and the nozzle end; range: 10-30 mm), and the velocity, shape, pressure, and average volume of the ejected jet were analyzed by means of high-speed camera, PVDF needle hydrophone, and digital scale. The quality of the dissection plane, the preservation of blood vessels, and the penetration depth were evaluated using five fresh cadaveric rabbit ventricular walls, under neuroendoscopic vision. Results: Jet velocity (7.0-19.6 m/second) and pressure (0.07-0.28 MPa) could be controlled by varying the laser energy, which determined the penetration depth in the cadaveric rabbit ventricular wall (0.07-1.30 mm/shot). The latter could be cut into desirable shapes-without thermal effects-under clear neuroendoscopic vision. The average volume of a single ejected jet could be confined to 0.42-1.52 mul/shot, and there was no accompanying generation of shock waves. Histological specimens revealed a sharp dissection plane and demonstrated that blood vessels of diameter over 100 mum could be preserved, without thermal damage. Conclusions: The present pulsed LILJ system holds promise as a safe and reliable dissection device for deployment in a rigid neuroendoscope. (C) 2004 Wiley-Liss, Inc.

  538. Lipomatous meningioma of the brain harboring metastatic renal-cell carcinoma: A case report 査読有り

    Tomomi Kimiwada, Osamu Motohashi, Toshihiro Kumabe, Mika Watanabe, Teiji Tominaga

    Brain Tumor Pathology 21 (1) 47-52 2004年

    DOI: 10.1007/BF02482177  

    ISSN:1433-7398

    詳細を見る 詳細を閉じる

    A 70-year-old woman presented with mild left hemiparesis and intermittent global headache. Magnetic resonance imaging showed a 6 × 6 × 6-cm tumor in the right frontal lobe, and abdominal computed tomography revealed a 8 × 8 × 7-cm mass lesion in the left kidney. Magnetic resonance imaging showed that the brain tumor consisted of a central hyperintense cystic component and an outer hypointense component. The patient underwent total surgical excision of the intracranial mass. Histological and immunohistochemical examination showed that the lesion was a lipomatous meningioma harboring metastatic renal-cell carcinoma. Both of these tumors are rare. The magnetic resonance imaging findings are indicative of but not specific to meningioma harboring metastatic tumor.

  539. A Case of Hyperemia during Arteriovenous Malformation Surgery Controlled with β-blocker and Jugular Bulb Oxygen Saturation (SjO2) Monitoring 査読有り

    Tomomi Kimiwada, Hideyuki Kamii, Teiji Tominaga, Masato Kato

    Japanese Journal of Anesthesiology 52 (10) 1074-1078 2003年10月

    ISSN:0021-4892

    詳細を見る 詳細を閉じる

    The authors report a case of hyperemic complications during arteriovenous malformation (AVM) surgery controlled with β-blocker. A 25-year-old male was anesthetized with propofol-fentanyl under jugular venous bulb oxygen saturation (SjO2) monitoring. Just after the total removal of AVM, SjO2 and blood pressure increased suddenly and brain swelling occurred. On the diagnosis of hyperemia of the brain, hyperventilation and controlled hypotension with nicardipine, diltiazem and sodium nitroprusside were started, but they were not effective. Thereafter, we injected a β-blocker (propranolol, 0.2 mg) intravenously, resulting in the decrease in blood pressure and the disappearance of the brain swelling. SjO2 monitoring supports the safe management of postresection hyperemia, and β-blocker can be usefull against hyperemic complications during and after AVM surgery.

  540. [Functional brain mapping using evoked potentials and magnetic fields: basic knowledge of clinical nerve physiology for neurosurgeons]. 査読有り

    Nakasato N, Shamoto H, Nakasato N, Kanno A, Ryogo T, Kumabe T, Tominaga T

    No shinkei geka. Neurological surgery 31 (9) 1030-1037 2003年9月

    ISSN:0301-2603

  541. Cervical cord compression with myelopathy caused by bilateral persistence of the first intersegmental arteries: case report. 査読有り

    Takahashi T, Tominaga T, Hassan T, Yoshimoto T

    Neurosurgery 53 (1) 234-7; discussion 237 2003年7月

    ISSN:0148-396X

  542. Selective loss of Purkinje cells in transverse and sigmoid dural arteriovenous fistulas - Report of two cases 査読有り

    T Tominaga, H Shamoto, H Shimizu, M Watanabe, T Yoshimoto

    JOURNAL OF NEUROSURGERY 98 (3) 617-620 2003年3月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/jns.2003.98.3.0617  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    The histological changes that occur in brain tissue have rarely been documented in patients with dural arteriovenous fistulas (AVFs). In this study the authors report on two patients with dural AVFs in the transverse-sigmoid sinus who presented with subarachnoid hemorrhage or progressive dementia. Histological studies of the cerebellar cortices showed a selective loss of Purkinje cells, indicating an ischemic insult caused by venous hypertension. Admission N-isopropyl-p-I-123-iodoamphetamine single-photon emission computerized tomography scans demonstrated a decrease in cerebral blood flow, including flow through the cerebellum. Venous hypertension caused by transverse-sigmoid sinus dural AVFs provokes an ischemic condition severe enough to cause selective neuronal damage in the cerebellum.

  543. [Transient hyperintensity lesions on diffusion-weighted MRI in the bilateral internal capsules due to hypoglycemic coma]. 査読有り

    Endo H, Shimizu H, Tominaga T, Yoshimoto T

    No to shinkei = Brain and nerve 55 (2) 174-175 2003年2月

    ISSN:0006-8969

  544. Amlodipine Lowers Blood Pressure without Significant Effect on Cerebral Blood Flow in Hypertensive Patients with a History of Stroke: A Quantitative Single Photon Emission Computed Tomography Study 査読有り

    Hiroaki Shimizu, Teiji Tominaga, Satoru Fujiwara

    Journal of Stroke and Cerebrovascular Diseases 12 (6) 266-270 2003年

    出版者・発行元:W.B. Saunders

    DOI: 10.1016/j.jstrokecerebrovasdis.2003.09.009  

    ISSN:1052-3057

    詳細を見る 詳細を閉じる

    Appropriate antihypertensive therapy is important to prevent cerebrovascular disease. The purpose of the present study was to investigate the effect of such therapy on cerebral blood flow in stroke patients. Twenty hypertensive patients with a history of ischemic stroke received amlodipine 2.5 or 5 mg daily for 12 weeks. Blood pressure and cerebral blood flow as measured by 133Xe single photon emission computed tomography at baseline and were compared at 12 weeks. There were statistically significant reductions in both systolic (167.0 to 140.9 mm Hg) and diastolic (97.8 to 81.8 mm Hg) blood pressures after 12 weeks of amlodipine treatment. No statistically significant effect was observed on cerebral blood flow (46.7 to 46.9 ml/100g brain/min). A weak but statistically significant change was observed in cerebellar blood flow (44.1 to 46.9 ml/100g brain/min). We concluded that amlodipine reduces blood pressure without affecting cerebral blood flow in hypertensive patients with a history of ischemic stroke. Investigation about its effect on cerebellar blood flow is mandatory.

  545. Rotational vertebral artery occlusion from occipital bone anomaly: a rare cause of embolic stroke - Case report 査読有り

    T Tominaga, T Takahashi, H Shimizu, T Yoshimoto

    JOURNAL OF NEUROSURGERY 97 (6) 1456-1459 2002年12月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/jns.2002.97.6.1456  

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Vertebral artery (VA) occlusion by rotation of the head is uncommon, but can result from mechanical compression of the artery, trauma, or atlantoaxial instability. Occipital bone anomalies rarely cause rotational VA occlusion, and patients with nontraumatic intermittent occlusion of the VA usually resent with compromised vertebrobasilar flow. A 34-year-old man suffered three embolic strokes in the vertebrobasilar system within 2 months. Magnetic resonance imaging demonstrated multiple infarcts in the vertebrobasilar territory. Angiography performed immediately after the third attack displayed an embolus in the right posterior cerebral artery. Radiographic and three-dimensional computerized tomography bone images exhibited an anomalous osscous process of the occipital bone projecting to the posterior arch of the atlas. Dynamic angiography indicated complete occlusion of the left VA between the osseous process and the posterior arch while the patient's head was turned to the right. Surgical decompression of the VA resulted in complete resolution of rotational occlusion of the artery. An occipital bone anomaly can cause rotational VA occlusion at the craniovertebral junction in patients who present with repeated embolic strokes resulting from injury to the arterial wall.

  546. Hypoglossal neurinoma presenting with intratumoral hemorrhage 査読有り

    T Takahashi, T Tominaga, Y Sato, M Watanabe, T Yoshimoto

    JOURNAL OF CLINICAL NEUROSCIENCE 9 (6) 716-719 2002年11月

    出版者・発行元:CHURCHILL LIVINGSTONE

    DOI: 10.1054/jocn.2001.1109  

    ISSN:0967-5868

    詳細を見る 詳細を閉じる

    Focal or microscopic hemorrhage in a neurinoma is common, but tumor origin from the hypoglossal nerve and extensive symptomatic intratumoral hemorrhage are both rare. A 59-year-old male presented with severe neck pain, nausea and vomiting of 1-day duration, accompanied by right hypoglossal nerve palsy. Neuroimaging disclosed a tumor located in the right cerebellome-dullary fissure and containing a hematoma. The right hypoglossal canal was slightly dilated. The intracranial tumor was resected via a suboccipital approach. Histological examination demonstrated spindle-shaped tumor cells with nuclear palisading and also relative hypervascularity with hyaline degeneration of the vessels. Extensive hemorrhage was present, as was necrosis. Thickening and hyalinization of arterial walls, a common occurrence in neurinomas, may have contributed to symptomatic intratumoral hemorrhage. (C) 2002 Published by Elsevier Science Ltd.

  547. Intraoperative angiography to prevent vertebral artery injury during reduction of a dislocated hangman fracture - Case report 査読有り

    T Takahashi, T Tominaga, M Ezura, K Sato, T Yoshimoto

    JOURNAL OF NEUROSURGERY 97 (3) 355-358 2002年10月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    The authors report on a 38-year-old woman with a dislocated hangman fracture associated with unilateral vertebral artery (VA) occlusion. The patient presented with a mild central cord syndrome, as well as anterior subluxation of the C-2 vertebral body upon C-3, bilateral neural arch fractures, and a unilateral locked facet joint. Digital subtraction angiography revealed occlusion of the right VA, with the posterior cerebral circulation entirely dependent on the left VA. Intraoperative angiography demonstrated that complete reduction of the dislocation would have caused severe stenosis of the left VA; partial reduction and anterior fixation were performed instead, with excellent neurological outcome. In this case, intraoperative angiography was particularly useful for preventing brain-related ischemic complications during reduction.

  548. Use of cerebrovascular reactivity in patients with symptomatic major cerebral artery occlusion to predict 5-year outcome: Comparison of xenon-133 and iodine-123-IMP single-photon emission computed tomography 査読有り

    K Ogasawara, A Ogawa, K Terasaki, H Shimizu, T Tominaga, T Yoshimoto

    JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM 22 (9) 1142-1148 2002年9月

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1097/00004647-200209000-00012  

    ISSN:0271-678X

    詳細を見る 詳細を閉じる

    The aim of this prospective study was to investigate whether decreased cerebrovascular reactivity to acetazolamide, as determined by single-photon emission computed tomography (SPECT), is an independent predictor of the 5-year risk of subsequent stroke in patients with symptomatic major cerebral artery occlusion. Cerebrovascular reactivity to acetazolamide in the middle cerebral artery (MCA) territory ipsilateral to the occluded artery was determined on the basis of two different methodologies: cerebral blood flow (CBF) percent change obtained quantitatively from xenon-133 (Xe-133) SPECT, and asymmetry index (AI) percent change obtained qualitatively from N-isopropyl-p-[I-123]-iodoamphetamine (IMP) SPECT. Seventy patients with unilateral internal carotid artery or MCA occlusion were divided into two groups within each SPECT methodology (normal or decreased CBF percent change and AI percent change) and followed up for 5 years. Cumulative recurrence-free survival rates for patients With decreased CBF percent change were significantly lower than for those with normal CBF percent change (P = 0.0205). There was no significant difference in cumulative recurrence-free survival rates between patients with decreased AI percent change and those with normal AI percent change. Only decreased CBF percent change was a significant independent predictor of stroke recurrence (P = 0.0051). The present study demonstrated that decreased cerebrovascular reactivity to acetazolamide determined quantitatively by Xe-133 SPECT is an independent predictor of the 5-year risk of subsequent stroke in patients with symptomatic major cerebral artery occlusion, and that the qualitative method using I-123-IMP SPECT is a poor predictor of the risk of subsequent stroke in this type of patient.

  549. Seizure-induced thoracic spine compression fracture: case report. 査読有り

    Takahashi T, Tominaga T, Shamoto H, Shimizu H, Yoshimoto T

    Surgical neurology 58 (3-4) 214-6; discussion 216 2002年9月

    DOI: 10.1016/S0090-3019(02)00837-6  

    ISSN:0090-3019

  550. Fatal subarachnoid hemorrhage, with brainstem and cerebellar infarction, caused by Aspergillus infection after cerebral aneurysm surgery: case report. 査読有り

    Endo T, Tominaga T, Konno H, Yoshimoto T

    Neurosurgery 50 (5) 1147-50; discussion 1150 2002年5月

    DOI: 10.1097/00006123-200205000-00039  

    ISSN:0148-396X

  551. Quantitative assessment of surgical decompression of the cervical spine with cine phase contrast magnetic resonance imaging. 査読有り

    Tominaga T, Watabe N, Takahashi T, Shimizu H, Yoshimoto T

    Neurosurgery 50 (4) 791-5; discussion 796 2002年4月

    DOI: 10.1097/00006123-200204000-00020  

    ISSN:0148-396X

  552. Bypass surgery for occluded internal carotid artery revascularized by vasa vasorum - Case report 査読有り

    H Shimizu, T Tominaga, M Ezura, T Yoshimoto

    NEUROLOGIA MEDICO-CHIRURGICA 42 (2) 57-61 2002年2月

    出版者・発行元:JAPAN NEUROSURGICAL SOC

    DOI: 10.2176/nmc.42.57  

    ISSN:0470-8105

    詳細を見る 詳細を閉じる

    A 47-year-old woman presented with two transient ischemic attacks due to occlusion of the left internal carotid artery. The affected artery was revascularized by vasa vasorum. Angiography showed occlusion of the left common carotid artery including the origin of the internal carotid artery. The distal internal carotid artery was revascularized by vasa vasorum at the level of the second cervical vertebral body. Left subclavian artery-internal carotid artery bypass surgery using a saphenous vein graft was performed successfully, during which the narrowed but patent lumen of the internal carotid artery was confirmed. Follow-up angiography showed enlargement of the left internal carotid artery distal to the patent bypass. Reconstructive bypass surgery is a possible treatment for patients with occluded internal carotid artery revascularized by vasa vasorum. Angiographic detection of the lumen of the internal carotid artery is important for surgical consideration.

︎全件表示 ︎最初の5件までを表示

書籍等出版物 3

  1. Neurovascular Imaging

    Takahashi Shoki ed, Kumabe Toshihiro, Saito Ryuta, Kanamori Masayuki, Sonoda Yukihiko, Higano Shuichi, Takahashi Shoki, Tominaga Teiji

    Springer 2010年5月

  2. Neurovascular Imaging

    Takahashi Shoki ed, Kumabe Toshihiro, Kanamori Masayuki, Saito Ryuta, Nagamatsu Ken-ichi, Sonoda Yukihiko, Higano Shuichi, Takahashi Shoki, Tominaga Teiji

    Springer 2010年4月

  3. Moyamoya Disease Update

    Byung-Kyu Cho, Teiji Tominaga eds

    Springer 2009年3月

講演・口頭発表等 189

  1. 脳脊髄血管奇形の外科治療

    冨永悌二

    Acute Ischemic Stroke講演会 2012年3月24日

  2. 疾風に勁草を知る

    冨永悌二

    総合南東北病院 Medical Conference 2012年3月13日

  3. 流体科学と脳血管障害

    冨永悌二

    Brain Vascular Care Conference 2012年3月9日

  4. 東北大学脳神経外科:疾風に勁草を知る

    冨永悌二

    京都脳神経外科セミナー 2012 2012年2月11日

  5. 宮城県の医療復興の展望

    冨永悌二

    第5回石巻脳神経外科座談会 2011年12月27日

  6. 脳神経外科における新たな薬物送達法

    冨永悌二

    第240回山梨脳神経外科セミナー 2011年11月10日

  7. もやもや病 up date

    冨永悌二

    奈良脳神経外科カンファレンス 2011年10月28日

  8. 比較的希な脳梗塞の原因疾患と治療

    冨永悌二

    第25回かずさ脳血管障害談話会 2011年9月30日

  9. 脊髄血管障害の外科治療

    冨永悌二

    第11回北関東脊髄外科研究会 2011年9月16日

  10. 悪性脳腫瘍に対する新たな治療-CED

    冨永悌二

    第26回日本神経外科全国野球大会 神経外科セミナー 2011年8月31日

  11. 被災地最前線における脳卒中治療

    冨永悌二

    Stoke 2011 2011年7月30日

  12. もやもや病 up date

    冨永悌二

    第6回Miyagi Sennan Stroke Conference 2011年7月26日

  13. 脳動脈奇形の複合治療

    冨永悌二

    第15回脳血管外科治療セミナー 2011年7月1日

  14. 脳動脈奇形の複合治療

    冨永悌二

    第15回脳血管外科治療セミナー・イブニングセミナー 2011年7月1日

  15. lessons learned from Moyamoya disease 国際会議

    冨永悌二

    アジアもやもや病カンファレンス 2011年6月2日

  16. Current topics on AVM treatment in Sendai 国際会議

    冨永悌二

    Tohoku-Yonsei Joint Symposium on Cerebrovascular Surgery 2011年5月28日

  17. 脳脊髄血管奇形の病態と治療

    冨永悌二

    第7回東北脳卒中診断治療研究会 2011年3月11日

  18. 脳・脊髄血管奇形の外科治療

    冨永悌二

    第48回愛媛脳神経外科懇話会 2011年2月18日

  19. 薬剤の脳内注入:新たな治療法の開発

    冨永悌二

    第4回石巻脳神経外科座談会 2010年12月8日

  20. 脳・脊髄血管奇形の外科治療

    冨永悌二

    第14回KNC脳疾患研究会 2010年11月27日

  21. Moyamoya Disease:Update 国際会議

    冨永悌二

    The 38th Annual Meeting of the International Society for Pediatric Neurosurgery 2010年10月30日

  22. Onyxによる脳動脈奇形の外科摘出前塞栓術

    冨永悌二

    第69回社団法人日本脳神経外科学会総会 2010年10月27日

  23. 動静脈奇形の外科治療

    冨永悌二

    第69回福島県脳神経談話会 2010年10月20日

  24. 冨永悌二

    山梨脳血管障害研究会 2010 2010年10月5日

  25. 脳脊髄血管奇形の外科治療

    冨永悌二

    第24回中国地方脳神経外科手術研究会 2010年8月21日

  26. 脳・脊髄血管奇形の外科治療

    冨永悌二

    第12回徳島脳血管障害カンファレンス 2010年5月29日

  27. もやもや病に対する直接・間接血行再建術と周術期管理の工夫

    冨永悌二

    第1回北のまほろば脳神経外科手術研究会 2010年5月28日

  28. 切除に拠らないてんかんの外科治療:Convection enhanced delivery(CED) for the treatment of epilepsy

    冨永悌二

    第42回奈良エピレプシークラブ 2010年5月14日

  29. 脳脊髄血管奇形の最善の治療(AVMにおける血管内外科治療)

    冨永悌二

    第30回日本脳神経外科コングレス 2010年5月7日

  30. 特別講演

    冨永悌二

    第33回香川脳血管障害研究会 2010年4月2日

  31. Multimodality management of AVM 国際会議

    冨永悌二

    35th The Annual Meeting of Egyptian Society of Neurological Surgeons 2010年3月10日

  32. 脳・脊髄血管奇形の外科治療

    冨永悌二

    第18回河田町脳神経外科懇話会 2010年3月6日

  33. 気になる心臓、脳、呼吸の病気:脳梗塞の治療最前線

    冨永悌二

    第2回元気!健康!フェア 2010年2月27日

  34. 脳動静脈奇形の外科治療

    冨永悌二

    第46回大分県脳卒中懇話会 2010年2月13日

  35. 脊髄AVMの一手術例

    冨永悌二

    第10回東北脊髄外科研究会 2010年2月5日

  36. 脳動静脈奇形の外科治療

    冨永悌二

    第2回石巻脳神経外科座談会 2009年12月10日

  37. 無症候性血管障害の外科治療

    冨永悌二

    第3回大阪脳血管障害研究会 2009年11月14日

  38. Surgical managemnet of intracerebral AVMs, Surgical management of intracerebral AVMs in a Multimodality team 国際会議

    冨永悌二

    第9回国際脳卒中学会 2009年11月12日

  39. 動静脈奇形:最近経験した興味ある症例から

    冨永悌二

    秋田ブレインアタック研究会 2009年11月6日

  40. 特別講演 2

    冨永悌二

    第11回みやぎブレインアタック研究会 2009年10月2日

  41. Convection enhanced delivery方ー基礎研究から臨床応用までー

    冨永悌二

    第1回松島カンファレンス 2009年7月30日

  42. 特別講演

    冨永悌二

    第13回宮城県脳ドック研究会 2009年7月21日

  43. Moyamoya Disease:Update 国際会議

    冨永悌二

    Department of Neurological Surgery -Grand Rounds(MGRXX036)- 2009年7月9日

  44. Surgical Management of Cervical Perimodullary AVF 国際会議

    冨永悌二

    The 7th Biennial Japan-Korea Conference on Spinal Surgery 2009年7月1日

  45. 脳卒中を予防し、治そう

    冨永悌二

    第50回日本神経学会総会 市民公開講座 2009年5月23日

  46. 脊椎血管奇形の外科治療

    冨永悌二

    第24回TKNJ Conference 2009年5月23日

  47. Surgical managemnet of intracerebral AVMs, Surgical management of intracerebral AVF 国際会議

    冨永悌二

    The 27th Annual Spring Meeting of the Korean Neurosurgical Society 2009年4月16日

  48. 頭蓋内動静脈瘻の外科治療

    冨永悌二

    第34回日本脳卒中学会総会・第38回日本脳卒中の外科学会・第25回スパズムシンポジウム 2009年3月20日

  49. 脳卒中の診断と治療〜最近のトピック

    冨永悌二

    総合南東北病院Medical Conference 2009年2月19日

  50. 脊髄疾患の外科治療:最近の経験

    冨永悌二

    第14回奈良脊髄外科研究会 2009年2月16日

  51. クモ膜下出血の稀な原因?脊髄血管性障害の外科治療

    冨永悌二

    第8回名古屋脳卒中外科研究会学術集会 2009年2月9日

  52. 脳卒中の救急に関して

    冨永悌二

    平成20年度 日本医師会生涯教育講座・救急医療医師研究会 2008年11月29日

  53. 脊髄血管奇形の外科治療

    冨永悌二

    第31回岩手脳神経外科談話会、第18回ハイテクリサーチセンター講演会 2008年10月31日

  54. 悪性神経膠腫に対する新たな治療展開ーConvection -enhanced delivery 法の臨床導入

    冨永悌二

    第67回日本脳神経外科学会総会 2008年10月2日

  55. 脊髄血管性障害の外科治療

    冨永悌二

    第54回鹿児島脳神経外科学会 2008年8月2日

  56. AVM多角的治療の諸問題

    冨永悌二

    第6回北海道ストロークフォーラム 2008年6月21日

  57. 硬膜AVFの診断と治療

    冨永悌二

    山梨脳血管障害研究会 2008年6月20日

  58. Surgical management of moyamoya disease:Recent advance 国際会議

    冨永悌二

    The 9th Japanese and Korean Friendship Conference on Surgery for Cerbral Stroke 2008年6月7日

  59. 脳卒中の外科治療:最近のトピック

    冨永悌二

    Shiga Neurosurgical Forum 2008年5月23日

  60. 脳卒中の診断と治療〜最近のトピック

    冨永悌二

    総合南東北病院Medical Conference 2008年2月19日

  61. 脊髄疾患の外科治療:最近の経験

    冨永悌二

    第14回奈良脊髄外科研究会 2008年2月16日

  62. くも膜下出血の稀な原因ー脊髄血管性障害の外科治療

    冨永悌二

    第8回名古屋脳卒中外科研究会学術集会 2008年2月9日

  63. Anaplastic ependymoma の治療成績

    齋藤竜太, 隈部俊宏, 金森政之, 園田順彦, 冨永悌二

    第25回日本脳腫瘍学会 2007年12月9日

  64. Diffuse astrocytoma の長期治療成績

    金森政之, 園田順彦, 渡辺みか, 隈部俊宏, 冨永悌二

    第25回日本脳腫瘍学会 2007年12月9日

  65. 膠芽腫長期生存例の解析

    園田順彦, 渡辺みか, 井上智夫, 金森政之, 隈部俊宏, 冨永悌二

    第25回日本脳腫瘍学会 2007年12月9日

  66. 再発germinoma に対する治療

    隈部俊宏, 金森政之, 園田順彦, 高井良尋, 冨永悌二

    第25回日本脳腫瘍学会 2007年12月9日

  67. 悪性神経膠腫に発生した肺塞栓症

    山下洋二, 川口奉洋, 金森政之, 園田順彦, 隈部俊宏, 渡辺みか, 冨永悌二

    第25回日本脳腫瘍学会 2007年12月9日

  68. 脳卒中の外科治療:最近のトピック

    冨永悌二

    第5回Kyushu CVD Conference 2007年12月1日

  69. 軟性鏡を用いた内視鏡的第三脳出開窓術の治療成績についての検討

    藤村幹, 城倉英史, 隈部俊宏, 冨永悌二

    第14回日本神経内視鏡学会 2007年12月1日

  70. 頭蓋咽頭腫に対する内視鏡支援下拡大経蝶形骨洞手術

    小川欣一, 清水宏明, 藤原悟, 冨永悌二

    第14回日本神経内視鏡学会 2007年12月1日

  71. 軟性神経内視鏡を用いて治療したcolloid cystの2例

    小濱みさき, 藤村幹, 永松謙一, 村上謙介, 冨永悌二

    第14回日本神経内視鏡学会 2007年12月1日

  72. 脳卒中の外科治療ー最近のTopic

    冨永悌二

    第19回山形県対脳卒中治療研究会 2007年11月24日

  73. New insight into Myoyamoya disease

    冨永悌二

    Suzuki Jiro Memorial Conference on Neurosurgery 2007年11月23日

  74. Surgical management of spinal vascular malformation 国際会議

    冨永悌二

    12th Asian Australasian Congress of Neurological Surgeons 2007年11月18日

  75. Radical surgical resection of insulo-opercular gliomas 国際会議

    Toshihiro Kumabe, Teiji Tominaga

    World Federation of Neurosurgical Societies, 13th Interim Meeting /The 12th Asian-Australasian Congress of Neurological Surgeons 2007年11月18日

  76. Efficacy of endoscopic third ventriculostomy using flexible neuroendoscopic system: outcome of 46 consecutive cases in Tohoku University

    Miki Fujimura, Hidefumi Jokura, Toshihiro Kumabe, Teiji Tominaga

    World Federation of Neurosurgical Societies, 13th Interim Meeting /The 12th Asian-Australasian Congress of Neurological Surgeons 2007年11月18日

  77. Surgica management of spinal vascular malformations 国際会議

    冨永悌二

    第4回上海国際脳神経外科学会、第2回国際脳出血学会 2007年11月9日

  78. 最大摘出と細血管温存の両立を目的としたレーザージェットメスの開発:悪性神経膠腫4例の経験を踏まえて

    隈部俊宏, 中川敦寛, 金森政之, 渡辺みか, 斉藤竜太, 平野孝幸, 佐々木健吾, 高山和喜, 冨永悌二

    第12回日本脳腫瘍の外科学会 2007年11月2日

  79. ガンマナイフ治療後に外科治療を行った神経鞘腫の検討

    村上謙介, 藤村幹, 渡辺みか, 川岸潤, 城倉英史, 冨永悌二

    第12回日本脳腫瘍の外科学会 2007年11月2日

  80. 再発頭蓋咽頭腫の手術

    白根礼造, 林俊哲, 加藤貴弘, 冨永悌二

    第12回日本脳腫瘍の外科学会 2007年11月2日

  81. 視機能温存を目的とした脳磁図と白質線維描出統合情報の有用性

    園田順彦, 隈部俊宏, 中里信和, 井上敬, 高田志保美, 金森政之, 冨永悌二

    第12回日本脳腫瘍の外科学会 2007年11月2日

  82. Anaplastic ependymomaの治療成績

    齋藤竜太, 隈部俊宏, 金森政之, 園田順彦, 冨永悌二

    第12回日本脳腫瘍の外科学会 2007年11月2日

  83. 脳神経外科手術における細血管温存下切開デバイスの開発:臨床経験をふまえて

    冨永悌二

    第66回社団法人日本脳神経外科学会総会 2007年10月3日

  84. 安全で最大限の摘出を目指すglioma 手術の基本手技

    隈部俊宏, 冨永悌二

    第66回社団法人日本脳神経外科学会総会 2007年10月3日

  85. もやもや病に対するSTA-MCA吻合術後・症候性過灌流とその関連因子についての検討

    藤村幹, 清水宏明, 冨永悌二

    第66回日本脳神経外科学会総会 2007年10月3日

  86. Diffuse astrocytomaの長期治療成績

    金森政之, 園田順彦, 渡辺みか, 隈部俊宏, 冨永悌二

    第66回社団法人日本脳神経外科学会総会 2007年10月3日

  87. Glioblastomaの長期生存症例の検討

    園田順彦, 井上智夫, 渡辺みか, 金森政之, 隈部俊宏, 冨永悌二

    第66回社団法人日本脳神経外科学会総会 2007年10月3日

  88. 神経膠腫症18症例の臨床的検討

    井上智夫, 隈部俊宏, 金森政之, 渡辺みか, 園田順彦, 冨永悌二

    第66回社団法人日本脳神経外科学会総会 2007年10月3日

  89. WHO grade ?,?髄膜腫の治療

    村上謙介, 藤村幹, 隈部俊宏, 城倉英史, 冨永悌二

    第66回社団法人日本脳神経外科学会総会 2007年10月3日

  90. 小児悪性脳腫瘍の休眠状態の存在

    永松謙一, 金森政之, 斉藤竜太, 山下洋二, 井上智夫, 園田順彦, 隈部俊宏, 冨永悌二

    第66回社団法人日本脳神経外科学会総会 2007年10月3日

  91. 感度波長域7-14μmの赤外線画像開頭術中モニタリング:適応と術中〜術後急性期管理における臨床的意義

    中川敦寛, 藤村幹, 荒船龍彦, 山口喬弘, 清水宏明, 佐久間一郎, 冨永悌二

    第66回社団法人日本脳神経外科学会総会 2007年10月3日

  92. Clinical Features of Malignant Glioneuronal Tumors-5 cases report

    佐藤健一, 金森政之, 渡辺みか, 隈部俊宏, 冨永悌二

    第66回社団法人日本脳神経外科学会総会 2007年10月3日

  93. 正常カニクイザルにおけるConvection-Enhanced Delivery法によって投与されたACNUの薬剤分布と安全性の評価

    山下洋二, 杉山慎一郎, 井上智夫, 園田順彦, 隈部俊宏, 冨永悌二

    第66回社団法人日本脳神経外科学会総会 2007年10月3日

  94. 甲状腺機能亢進症を合併した(類)もやもや病手術例の検討:周術期管理と術後急性期脳循環動態について

    遠藤英徳, 藤村幹, 冨永悌二

    第66回社団法人日本脳神経外科学会総会 2007年10月3日

  95. もやもや病・病期進行例に対する血行再建術についての検討

    成澤あゆみ, 藤村幹, 冨永悌二

    第66回社団法人日本脳神経外科学会総会 2007年10月3日

  96. もやもや病に対する直接血行再建術後急性期の病態について:3-Tesla MRI を用いた検討

    小濱みさき, 藤村幹, 麦倉俊司, 冨永悌二

    第66回社団法人日本脳神経外科学会総会 2007年10月3日

  97. ラット脳腫瘍モデルにおける対流強化輸送法を用いた局所化学療法とテモゾロミド全身投与との併用効果

    杉山慎一郎, 山下洋二, 菊池登志雄, 齋藤竜太, 園田順彦, 隈部俊宏, 冨永悌二

    第66回社団法人日本脳神経外科学会総会 2007年10月2日

  98. ジストニアに対し両側淡蒼球茂樹術が有効であった二例

    永松謙一, 冨永悌二, 安藤肇史, 大友智, 木村格

    第81回日本神経学会東北地方会 2007年9月8日

  99. 症候性過灌流を呈した成人出血発症もやもや病の1 例:3-Tesla MRI による診断

    小濱みさき, 藤村 幹, 冨永悌二

    第43 回(社)日本脳神経外科学会東北地方会 2007年9月8日

  100. 片麻痺を伴うくも膜下出血症例における術中motor evoked potential(MEP)モニタリング

    中村太源, 岩崎真樹, 清水宏明, 社本 博, 上井英之, 佐藤清貴, 藤原 悟, 冨永悌二

    第43 回(社)日本脳神経外科学会東北地方会 2007年9月8日

  101. 経過観察中に解離が進行した若年性内頚動脈解離の1 例

    加藤貴弘, 林 俊哲, 白根礼造, 冨永悌二

    第43 回(社)日本脳神経外科学会東北地方会 2007年9月8日

  102. 脳表ヘモジデリン沈着症で発症した脊髄腫瘍の一例

    君和田友美, 村上謙介, 永松謙一, 隈部俊宏, 冨永悌二, 渡辺みか

    第43 回(社)日本脳神経外科学会東北地方会 2007年9月8日

  103. Foramen magnum syndrome を呈したdumbbell type C2 神経鞘腫の一例

    園部真也, 村上謙介, 小濱みさき, 隈部俊宏, 冨永悌二, 渡辺みか

    第43 回(社)日本脳神経外科学会東北地方会 2007年9月8日

  104. 軟性神経内視鏡を用いて治療した症候性透明中隔嚢胞の一例

    西嶌泰生, 藤村 幹, 小濱みさき, 冨永悌二

    第43 回(社)日本脳神経外科学会東北地方会 2007年9月8日

  105. 細血管温存と神経膠腫最大摘出の両立を目的としたレーザージェットメスの開発

    中川敦寛, 隈部俊宏, 金森政之, 平野孝幸, 佐々木健吾, 斉藤竜太, 冨永悌二, 渡辺みか, 高山和喜

    第43 回(社)日本脳神経外科学会東北地方会 2007年9月8日

  106. 多発性骨転移を来した膠芽腫の一例

    菊池登志雄, 隈部俊宏, 金森政之, 園田順彦, 冨永悌二, 渡辺みか

    第43 回(社)日本脳神経外科学会東北地方会 2007年9月8日

  107. 鞍底へ下方牽引された視交叉に対し、経蝶形骨洞的な直接剥離を要した下垂体腺腫の一例

    小川欣一, 清水宏明, 藤原悟, 冨永悌二

    第43 回(社)日本脳神経外科学会東北地方会 2007年9月8日

  108. Papillary tumor of the pineal region の1 例

    井上智夫, 隈部俊宏, 金森政之, 園田順彦, 冨永悌二, 渡辺みか

    第43 回(社)日本脳神経外科学会東北地方会 2007年9月8日

  109. 『洗浄法』によるシャント感染予防

    林俊哲, 加藤貴弘, 白根礼造, 冨永悌二

    第43 回(社)日本脳神経外科学会東北地方会 2007年9月8日

  110. 衝撃波による脳組織損傷:圧損傷閾値の同定と損傷機序に関する検討

    中川敦寛, 藤村幹, 加藤薫子, 奥山洋信, 斉藤敦志, 高山和喜, 冨永悌二

    第8回日本分子脳神経外科学会 2007年8月31日

  111. 膠芽腫の増殖におけるNotch signalingの役割に関する検討

    金森政之, 川口奉洋, Nigro JM, Feuerstein BG, Berger MS, Miele L, 隈部俊宏, 冨永悌二, Pieper RO

    第8回日本分子脳神経外科学会 2007年8月31日

  112. もやもや病患者末梢血における制御型T細胞関連マーカー(CD4/25, Foxp3)の検討

    藤村 幹, 藤村 卓, 相場節也, 冨永悌二

    第8回日本分子脳神経外科学会 2007年8月31日

  113. 脊髄損傷後の脳一次体性感覚野ReorganizationとNogo受容体の関連: 機能MRIによる検討

    遠藤俊毅, 藤村 幹, Lars Olson, 冨永悌二

    第8回日本分子脳神経外科学会 2007年8月31日

  114. 神経膠腫摘出術における細血管温存下切開デバイスの開発

    中川敦寛, 隈部俊宏, 金森政之, 斉藤竜太, 佐々木健吾, 平野孝幸, 高山和喜, 冨永悌二

    第26回日本脳神経超音波学会 2007年7月9日

  115. 衝撃波による脳神経組織損傷?閾値と機序に関する検討?

    加藤薫子, 藤村幹, 中川敦寛, 斉藤敦志, 奥山洋信, 高山和喜, 冨永悌二

    第26回日本脳神経超音波学会 2007年7月9日

  116. 脳表ヘモジデリン沈着症で発症した脊髄腫瘍の一例

    君和田友美, 村上 謙介, 永松 謙一, 隈部俊宏, 冨永 悌二, 渡辺 みか

    第7回東北脊髄外科研究会 2007年7月6日

  117. Intraoperative Brain Surface Monitoring Using Infrared Imaging in Patients with Moyamoya Disease 国際会議

    Atsuhiro Nakagawa, Teiji Tominaga, Ichiro Sakuma, Etsuko Kobayashi, Tatsuhiko Arafune, Miki Fujimura

    13th International Symposium on Intracranial Pressure and Brain Monitoring 2007年6月22日

  118. Shock Wave Induced Brain Injury: Pathological Evaluation Using Rat Model 国際会議

    Atsuhiro Nakagawa, Teiji Tominaga, Kazuyoshi Takayama, Hironobu Okuyama, Kaoruko Kato, Miki Fujimura

    13th International Symposium on Intracranial Pressure and Brain Monitoring 2007年6月22日

  119. 定位放射線治療の合併症

    城倉英史, 川岸潤, 冨永悌二

    第27回日本脳神経外科コングレス総会 2007年5月18日

  120. 頭蓋咽頭腫に対する安全で確実なsurgical radicality

    白根礼造, 林俊昭, 冨永悌二

    第16回脳神経外科手術と機器学会 2007年4月12日

  121. 頭蓋咽頭腫に対する経鼻的アプローチの摘出限界と工夫

    池田秀敏, 冨永悌二

    第16回脳神経外科手術と機器学会 2007年4月12日

  122. 軟性鏡による内視鏡的第三脳室開窓術の治療成績

    藤村幹, 隈部俊宏, 冨永悌二, 城倉英史

    第16回脳神経外科手術と機器学会 2007年4月12日

  123. Convection-Enhanced Delivery法によるACNU投与と放射線療法あるいはtemozolomide全身投与との併用療法

    山下洋二, 杉山慎一郎, 菊池登志雄, 金森政之, 隈部俊宏, 冨永悌二

    第16回脳神経外科手術と機器学会 2007年4月12日

  124. 神経膠腫摘出術における細血管温存を目的とした新規脳腫瘍切開デバイスの開発

    中川敦寛, 隈部俊宏, 金森政之, 斉藤竜太, 佐々木健吾, 平野孝幸, 冨永悌二, 高山和喜

    第16回脳神経外科手術と機器学会 2007年4月12日

  125. 5-ALAによる術中蛍光診断と病理組織像の検討

    金森政之, 齋藤竜太, 隈部俊宏, 冨永悌二, 渡辺みか

    第16回脳神経外科手術と機器学会 2007年4月12日

  126. 穿通枝描出における3.0 Tesla MRIの有用性

    隈部俊宏, 高田志保美, 新妻邦泰, 山下洋二, 金森政之, 冨永悌二

    第16回脳神経外科手術と機器学会 2007年4月12日

  127. 脳卒中の急性期診断と治療

    冨永悌二, 清水宏明

    第36回日本脳卒中の外科学会 2007年3月22日

  128. 当科における髄芽腫の治療成績

    隈部俊宏, 金森政之, 冨永悌二, 林俊哲, 白根礼造

    第29回東北小児がん研究会 2007年3月17日

  129. 硬膜下血腫で発症した乳児虐待

    林俊哲, 白根礼造, 冨永悌二

    第30回日本神経外傷学会 2007年3月16日

  130. くも膜下出血急性期脳損傷:SOD1過剰発現による酸化ストレス減少とAkt/GSK3β生存シグナル活性化の影響

    遠藤英徳, 藤村幹, 冨永悌二, チャン・パク

    第30回日本神経外傷学会 2007年3月16日

  131. 衝撃波による脳神経組織損傷の閾値および機序の解明:Caspase依存性経路によるアポトーシスの検討

    加藤薫子, 藤村幹, 中川敦寛, 斉藤敦志, 冨永悌二, 大木友博, 高山和喜

    第30回日本神経外傷学会 2007年3月16日

  132. 乳児虐待による急性硬膜下血腫 ?15年間における臨床像の変化?

    刈部博, 小沼武英, 亀山元信, 平野孝幸, 加藤薫子, 冨永悌二

    第30回日本神経外傷学会 2007年3月16日

  133. MRA及び頚動脈エコーにて頚部頚動脈閉塞が疑われたがCEAが可能であった2手術例

    坂田洋之, 清水宏明, 岩崎真樹, 藤原悟, 冨永悌二

    第42回(社)日本脳神経外科学会東北地方会 2007年3月10日

  134. 初期治療8年後に小脳虫部に膠芽腫を形成した神経膠腫症の1症例

    井上智夫, 金森政之, 隈部俊宏, 冨永悌二, 渡辺みか, 笹嶋寿郎, 神里信夫

    第42回(社)日本脳神経外科学会東北地方会 2007年3月10日

  135. パーキンソン病のジスキネジアに対する手術効果

    安藤肇史, 大友智, 冨永悌二

    第42回(社)日本脳神経外科学会東北地方会 2007年3月10日

  136. C-11 methionine PET が病変の活動性評価に有用であった小児身分化腫瘍の1例

    金森政之, 隈部俊宏, 冨永悌二, 渡辺みか, 中里洋一, 田代学, 伊藤正敏

    第42回(社)日本脳神経外科学会東北地方会 2007年3月10日

  137. 軟性鏡を用いた内視鏡的第3脳室空窓術の治療成績

    藤村幹, 隈部俊宏, 冨永悌二, 城倉英史

    第42回(社)日本脳神経外科学会東北地方会 2007年3月10日

  138. 5-ALAによる術中蛍光診断と病理組織像の検討

    金森政之, 斎藤竜太, 隈部俊宏, 冨永悌二, 渡辺みか

    第3回日本脳神経外科光線力学研究会 2007年2月24日

  139. 多発性脳神経播腫を伴った松果体部悪性リンパ腫の一例

    遠藤英徳, 藤村幹, 隈部俊宏, 金森政之, 冨永悌二

    第42回(社)日本脳神経外科学会東北地方会 2007年2月10日

  140. 島・弁蓋部神経膠腫手術に伴う問題点:血管障害を中心に

    隈部俊宏, 金森政之, 冨永悌二, 日向野修一, 高橋昭喜

    第36回日本神経放射線学会 2007年2月8日

  141. Telovelar(transcerebellomedullary fissure)approachを用いた第4脳室及び脳幹部腫瘍摘出術

    隈部俊宏, 金森政之, 冨永悌二

    第11回日本脳腫瘍の外科学会 2006年12月8日

  142. 神経膠腫摘出中完全覚醒維持による言語機能温存

    永松謙一, 隈部俊宏, 金森政之, 冨永悌二, 鈴木匡子, 中里信和, 佐藤清貴

    第4回日本 Awake Surgery 研究会 2006年12月7日

  143. Collaboration of microsurgery and endovascular surgery in the treatment of cerebral aneurysms: its benefit and pitfall 国際会議

    Teiji Tominaga, Hiroaki Shimizu, Akira Takahashi

    8th International Conference on Cerebrovascular Surgery 2006年11月30日

  144. Collabpration of microsurgery and endovascular surgery 国際会議

    Tominaga Teiji

    Collabpration of The 8th International Conference on 2006年11月30日

  145. 神経系への分化を示す小型異型細胞群を含有した

    佐藤健一, 金森政之, 隈部俊宏, 冨永悌二, 渡辺みか

    第13回東北神経病理研究会 2006年11月25日

  146. Anaplastic oligodendrogliomaとgangliocytomaの

    渡辺みか, 佐藤健一, 金森政之, 隈部俊宏, 冨永悌二

    第13回東北神経病理研究会 2006年11月25日

  147. 脊髄空洞症を伴う水頭症に対し第三脳室開窓術が

    藤村幹, 川口奉洋, 冨永悌二, 高橋敏行, 清水宏明, 藤原悟

    第13回日本神経内視鏡学会 2006年11月17日

  148. 覚醒下脳機能マッピング導入後10年間の治療経験

    永松謙一, 隈部俊宏, 冨永悌二, 鈴木匡子, 佐藤清貴, 中里信和

    第65回社団法人日本脳神経外科学会総会 2006年10月18日

  149. 頭蓋咽頭腫に対する経頭蓋手術

    白根礼造, 林俊哲, 冨永悌二

    第65回社団法人日本脳神経外科学会総会 2006年10月18日

  150. 無症候性髄膜腫に対するガンマナイフ治療の長期成績

    城倉英史, 川岸潤, 須貝和幸, 高橋康, 冨永悌二

    第65回社団法人日本脳神経外科学会総会 2006年10月18日

  151. 脳動静脈奇形に対するガンマナイフ治療の長期治療成績

    川岸潤, 城倉英史, 高橋康, 須貝和幸, 冨永悌二

    第65回社団法人日本脳神経外科学会総会 2006年10月18日

  152. ラトケ嚢胞の臨床的およびMRI所見の検討?短期間に経験した多彩な症候を持つラトケ嚢胞症例の解析より?

    井上智夫, 池田秀敏, 小川欣一, 冨永悌二

    第65回社団法人日本脳神経外科学会総会 2006年10月18日

  153. 乳児虐待による急性硬膜下血腫

    刈部博, 小沼武英, 亀山元信, 平野孝幸, 中川敦寛, 冨永悌二

    第65回社団法人日本脳神経外科学会総会 2006年10月18日

  154. ACNUを基本化学療法剤とした膠芽腫の治療成績

    隈部俊宏, 金森政之, 冨永悌二

    第65回脳神経外科学会総会 2006年10月18日

  155. 内頚動脈瘤に対するバイパス+親動脈閉塞術の長期成績

    清水宏明, 社本博, 藤原悟, 松本康史, 冨永悌二

    第65回脳神経外科学会総会 2006年10月18日

  156. 脳腫瘍診断における見かけ上の拡散係数測定の有用性

    山下洋二, 隈部俊宏, 金森政之, 菊池登志雄, 冨永悌二, 日向野修一, 渡辺みか

    第65回脳神経外科学会総会 2006年10月18日

  157. 頸髄動静脈奇形の診断と治療成績

    高橋敏行, 清水宏明, 藤原悟, 松本康史, 江面正幸, 高橋明, 冨永悌二

    第65回脳神経外科学会総会 2006年10月18日

  158. 欠突起膠腫における予後規定因子に関する検討

    金森政之, 齋藤竜太, 山下洋二, 隈部俊宏, 冨永悌二, 渡辺みか

    第65回脳神経外科学会総会 2006年10月18日

  159. パーキンソン病に対する両側視床下核刺激術の

    安藤肇史, 大友智, 冨永悌二, 永松謙一

    第65回脳神経外科学会総会 2006年10月18日

  160. tumstatinによるインテグリンα?β3依存性腫瘍増殖抑制効果におけるPTEN/Akt経路の役割について

    川口奉洋, 山下洋二, 金森政之, 隈部俊宏, 冨永悌二, Krystof Bankiewicz, Gabriele Bergers、Russell Pieper

    第65回脳神経外科学会総会 2006年10月18日

  161. Drug carrierを用いたConvection?enhanced delivery:新規脳腫瘍治療法の開発

    齋藤竜太, 山下洋二, 隈部俊宏, 冨永悌二, バーガーミッチェル, バンキービッツクリス, パークジョン

    第65回脳神経外科学会総会 2006年10月18日

  162. Convection?Enhanced Delivery法を用いたACNU投与の安全性と効果

    杉山慎一郎, 山下洋二, 菊池登志雄, 齋藤竜太, 隈部俊宏, 冨永悌二

    第65回脳神経外科学会総会 2006年10月18日

  163. CED法を用いた薬剤局所投与と放射線治療の併用による

    菊池登志雄, 齋藤竜太, 山下洋二, 杉山慎一郎, 隈部俊宏, 冨永悌二

    第65回脳神経外科学会総会 2006年10月18日

  164. 脊髄脂肪腫術後脊髄係留症候群の手術治療

    林俊哲, 白根礼造, 冨永悌二

    第65回脳神経外科学会総会 2006年10月18日

  165. 微小血管温存を目的とした新規脳腫瘍切開デバイスの開発

    中川敦寛, 隈部俊宏, 金森政之, 齋藤竜太, 平野孝之, 冨永悌二, 高山和喜

    第65回脳神経外科学会総会 2006年10月18日

  166. 虚血性海馬CA1神経細胞死における

    遠藤英徳, 藤村幹, 冨永悌二, チャンパク

    第65回脳神経外科学会総会 2006年10月18日

  167. モヤモヤ病に対する血行再建術前後の脳循環と臨床像:

    藤村幹, 中川敦寛, 冨永悌二, 麦倉俊司, 金田朋洋, 清水宏明

    第65回脳神経外科学会総会 2006年10月18日

  168. モヤモヤ病血行再建術後の痙攣:術後局所過灌流との

    成澤あゆみ, 藤村幹, 冨永悌二, 清水宏明

    第65回脳神経外科学会総会 2006年10月18日

  169. Diagnostic value of perfusion-weighted MRI for evaluating postoperative alteration of cerebral hemodynamics in patients with moyamoya disease 国際会議

    Fujimura M, Mugikura S, SHimizu H, Tominaga T

    Congress of Neurological Surgeons, 2006年10月7日

  170. 乏突起膠腫における予後規定因子に関する検

    金森政之, 齋藤竜太, 山下洋二, 隈部俊宏, 冨永悌二, 渡辺みか

    第24回日本脳腫瘍学会 2006年10月1日

  171. 頭蓋内微小環境におけるintegrin a?β3発現の

    金森政之, 齋藤竜太, 山下洋二, 隈部俊宏, 冨永悌二, 渡辺みか

    第24回日本脳腫瘍学会 2006年10月1日

  172. Convection?Enhanced Delivery法を用いたACNU脳内局所投与の安全性と効果

    山下洋二, 杉山慎一郎, 齋藤竜太, 菊池登志雄, 金森政之, 隈部俊宏, 冨永悌二

    第24回日本脳腫瘍学会 2006年10月1日

  173. 基底核胚細胞腫瘍の臨床的特徴

    杉山慎一郎, 山下洋二, 金森政之, 齋藤竜太, 隈部俊宏, 冨永悌二

    第24回日本脳腫瘍学会 2006年10月1日

  174. 当科における髄芽腫の治療成績

    隈部俊宏, 金森政之, 山下洋二, 冨永悌二, 林俊哲, 白根礼造

    第24回日本脳腫瘍学会 2006年10月1日

  175. くも膜下出血急性期脳損傷におけるAkt/GSK3β生存シグナルの役割

    遠藤英徳, 藤村 幹, チャン パク, 冨永悌二

    第7回日本分子脳神経外科学会 2006年9月2日

  176. Symptomatic cerebral hyperperfusion following 国際会議

    Fujimura M, Kaneta T, Narisawa A, Tominaga T

    The 8th Korean and Japanese Friendship Conference 2006年8月5日

  177. 脊髄血管障害の診断と治療

    冨永悌二

    東北脊髄外科研究会 2006年7月14日

  178. CLINICAL CHARACTERISTICS OF GERM CELL TUMORS ORIGINATING IN THE BASAL GANGLIA 国際会議

    Shin-ichiro Sugiyama, Yoji Yamashita, Masayuki Kanamori, Ryuta Saito, Toshihiro Kumabe, Teiji Tominaga

    12th International Symposium on Pediatric Neuro-Oncology 2006 2006年6月6日

  179. PRERADIATION CHEMOTHERAPY FOR MALIGNANT BRAIN TUMOR PATIENTS YOUNGER THAN 3 YEARS OLD : EXPERIENCE WITH 10 CONSECTIVE CASES 国際会議

    Kuniyasu Niizuma, Toshihiro Kumabe, Ryuta Saito, Masayuki Kanamori, Reizo Shirane, Teiji Tominaga

    12th International Symposium on Pediatric Neuro-Oncology 2006 2006年6月6日

  180. 頚部頚動脈狭窄診断上の問題点:CEA適応との関連で

    清水宏明, 藤原悟, 冨永悌二

    第30回北日本脳神経外科連合会学術集会 2006年6月1日

  181. 髄芽腫における見かけ上の拡散係数測定の意義

    山下洋二, 隈部俊宏, 金森政之, 冨永悌二, 日向野修一, 渡辺みか

    第30回北日本脳神経外科連合会学術集会 2006年6月1日

  182. 基底核部胚細胞腫の臨床的特徴

    杉山慎一郎, 齋藤竜太, 金森政之, 山下洋二, 隈部俊宏, 冨永悌二

    第30回北日本脳神経外科連合会学術集会 2006年6月1日

  183. 幼児期に発症した頭蓋頚椎移行部のNeuroenteric cystの一手術例

    坂田洋之, 藤村幹, 岩崎真樹, 冨永悌二

    第30回北日本脳神経外科連合会学術集会 2006年6月1日

  184. 脊髄播種に対し積極的治療を施行し長期生存しえた悪性神経膠腫の一例

    佐藤健一, 隈部俊宏, 冨永悌二, 高橋敏行, 渡辺みか

    第21回日本脊髄外科学会 2006年5月25日

  185. Ischemic complications caused by resection of opercular gliomas 国際会議

    Kumabe Toshihiro, Higano S, Takashi S, Tominaga T

    16th Biennial International Brain Tumor Research and Therapy Meeting 2006年4月26日

  186. 小児頭蓋咽頭腫の治療と問題点

    白根礼造, 林俊哲, 冨永悌二

    第28回東北小児がん研究会 2006年3月4日

  187. 神経膠腫摘出における5―アミノレブリン酸(5-ALA)及び紫色半導体レーザー装置を用いた蛍光診断の有用性

    隈部俊宏, 齋藤竜太, 金森政之, 冨永悌二, 渡辺みか

    第2回日本脳神経外科光線力学研究会 2006年2月4日

  188. fiber trackingを用いた白質線維描出の問題点

    新妻邦泰, 隈部俊宏, 冨永悌二, 日向野修一, 高橋昭喜

    第29回日本脳神経CI学会総会 2006年1月27日

  189. 赤外線画像システムIRIS Vを用いたもやもや病血行再建術中脳表モニタリング:術後経過との相関に関する検討

    藤村幹, 冨永悌二, 清水宏明, 高山和喜

    第30回北日本脳神経外科連合会学術集会 2005年6月1日

︎全件表示 ︎最初の5件までを表示

社会貢献活動 2

  1. [日本国内] 財団法人広南会広南病院

    2007年5月 ~

  2. [日本国内] 財団法人宮城県対脳卒中協会

    2004年7月6日 ~

メディア報道 3

  1. [日本国内] なるほど健康雑学 東北大リレー講座 45

    河北新報

    2007年5月28日

    メディア報道種別: 新聞・雑誌

    詳細を見る 詳細を閉じる

    脳の手術の発展:神経学の発達が貢献

  2. [日本国内] なるほど健康雑学 東北大リレー講座 44

    河北

    2007年5月21日

    メディア報道種別: 新聞・雑誌

    詳細を見る 詳細を閉じる

    多様化する脳神経外科治療:長所・短所勘案し選択

  3. [日本国内] なるほど健康雑学 東北大リレー講座 43

    河北新報

    2007年5月14日

    メディア報道種別: 新聞・雑誌

    詳細を見る 詳細を閉じる

    脳梗塞治療の新局面について:早期治療で症状改善

その他 20

  1. 神経・血管温存下に最大級の病変摘出を伴う手術用治療器(パルスウォータジェットメス)の開発

    詳細を見る 詳細を閉じる

    神経・血管温存下に最大級の病変摘出を伴う手術用治療器(パルスウォータジェットメス)の開発

  2. ウィリス動脈輪閉塞症の診断・治療に関する研究

    詳細を見る 詳細を閉じる

    ウィリス動脈輪閉塞症の診断と治療に関する研究

  3. 標準治療抵抗性神経膠芽腫に対するペプチドワクチンの第III相臨床研究

    詳細を見る 詳細を閉じる

    標準治療抵抗性神経膠芽腫に対するペプチドワクチンの第III相臨床研究

  4. 学術動向の調査研究

    詳細を見る 詳細を閉じる

    学術動向の調査研究

  5. 最大限の病変摘出と機能温存を両立するパルスジェットメスの開発

    詳細を見る 詳細を閉じる

    最大限の病変摘出と機能温存を両立するパルスジェットメスの開発

  6. 高齢者重症頭部外傷集中治療における二次侵襲モニタリングとquality assuranceシステムの構築

    詳細を見る 詳細を閉じる

    高齢者重症頭部外傷集中治療における二次侵襲モニタリングとquality assuranceシステムの構築

  7. 流体ジェットの医用応用に関する基礎研究

    詳細を見る 詳細を閉じる

    流体ジェットの医用応用に関する基礎研究

  8. 放射線による認知機能障害を回避する転移性脳腫瘍の治療法に関する研究

    詳細を見る 詳細を閉じる

    放射線による認知機能障害を回避する転移性脳腫瘍の治療法に関する研究

  9. ウィリス動脈輪閉塞症における生体試料の収集に関する研究

    詳細を見る 詳細を閉じる

    ウィリス動脈輪閉塞症における生体試料の収集に関する研究

  10. 非もやもや病小児閉塞性脳血管障害の実態把握と治療指針に関する研究

    詳細を見る 詳細を閉じる

    非もやもや病小児閉塞性脳血管障害の実態把握と治療指針に関する研究

  11. 脳内対流の解析による脳局所投薬技術の改良

    詳細を見る 詳細を閉じる

    脳内対流の解析による脳局所投薬技術の改良

  12. 脳梗塞急性期における抗血小板薬の有効性に関する研究

    詳細を見る 詳細を閉じる

    脳梗塞急性期における抗血小板薬の有効性に関する研究

  13. ウィリス動脈輪閉塞症の診断・治療に関する研究

    詳細を見る 詳細を閉じる

    ウィリス動脈輪閉塞症の診断・治療に関する研究

  14. 高分子ミセルのconvection-enhanced法による抗がん活性評価

    詳細を見る 詳細を閉じる

    高分子ミセルのconvection-enhanced法による抗がん活性評価

  15. 高次脳機能を温存する転移性脳腫瘍の治療法確立に関する研究

    詳細を見る 詳細を閉じる

    高次脳機能を温存する転移性脳腫瘍の治療法確立に関する研究

  16. 脳卒中ネットワークのためのソフトウェアの開発

    詳細を見る 詳細を閉じる

    脳卒中ネットワークのためのソフトウェアの開発

  17. ウィリス動脈輪閉塞症における病態・治療に関する研究

    詳細を見る 詳細を閉じる

    ウィリス動脈輪閉塞症における病態・治療に関する研究

  18. 正常圧水頭症と関連疾患の病因・病態と治療に関する研究

    詳細を見る 詳細を閉じる

    正常圧水頭症と関連疾患の病因・病態と治療に関する研究

  19. 内頚動脈閉塞症に伴う血行力学的脳梗塞の発症予防に関する研究

    詳細を見る 詳細を閉じる

    内頚動脈閉塞症に伴う血行力学的脳梗塞の発症予防に関する研究

  20. 転移性脳腫瘍に対する標準的治療法確立に関する研究

    詳細を見る 詳細を閉じる

    転移性脳腫瘍に対する標準的治療法確立に関する研究

︎全件表示 ︎最初の5件までを表示