2021/12/04 更新

写真a

オオイシ マコト
大石 誠
OOISHI Makoto
所属
脳研究所 准教授
職名
准教授
外部リンク

学位

  • 博士(医) ( 2003年3月   新潟大学 )

経歴

  • 新潟大学   脳研究所 臨床神経科学部門   准教授

    2016年4月 - 現在

  • 新潟大学   脳研究所 臨床神経科学部門   助教

    2011年4月 - 2012年3月

  • 新潟大学   医歯学総合病院 高次救命災害治療センター   特任助教

    2009年10月 - 2011年3月

 

論文

  • Reactive astrocytes contribute to epileptogenesis in patients with cavernous angioma. 国際誌

    Hiroki Kitaura, Tetsuya Hiraishi, Yosuke Itoh, Makoto Oishi, Yukihiko Fujii, Masafumi Fukuda, Akiyoshi Kakita

    Epilepsy research   176   106732 - 106732   2021年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Patients with cavernous angioma (CA) often suffer from severe epilepsy, and surgical resection is often performed to attenuate these epileptic seizures. Several studies have suggested that surgical removal of the surrounding hemosiderin-pigmented tissues adjacent to CA achieves better seizure control than restricted lesionectomy. Pathological examination of the resected foci reveals not only hemosiderin pigmentation but also various degrees of inflammatory change, such as hemosiderin-laden macrophages, gliosis and fibrosis. However, there is some controversy regarding the epileptogenic potential of these regions due to the uncertain nature of the mechanisms contributing to these histopathological changes. METHODS: To investigate the correlations between neuron hyperexcitability and evident pathological changes, we performed ex vivo flavoprotein fluorescence imaging using surgically resected epileptogenic foci surrounding CA. The mirror surfaces of the tissues used for the physiological experiment were also subjected to morphological examination. RESULTS: Hemosiderin-laden macrophages and many gemistocytic astrocytes were observed in the area adjacent to CA, where horizontal spreading excitations were detected significantly more frequently. Outside these areas, we found fine granular iron deposits and only a few fibrillary astrocytes, and weakly propagating excitations were detected. Furthermore, areas of enhanced activation were more clearly correlated with the glial proliferation index than with iron deposition. CONCLUSION: These results suggest that the epileptogenesis in patients with CA may be based on a biological process, such as alteration of glial function, rather than direct chemical reactions involving iron deposition.

    DOI: 10.1016/j.eplepsyres.2021.106732

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  • Predicting BRAF V600E mutation in glioblastoma: utility of radiographic features.

    Manabu Natsumeda, Michael Chang, Ramil Gabdulkhaev, Haruhiko Takahashi, Yoshihiro Tsukamoto, Yu Kanemaru, Masayasu Okada, Makoto Oishi, Kouichirou Okamoto, Fausto J Rodriguez, Akiyoshi Kakita, Yukihiko Fujii, Karisa C Schreck

    Brain tumor pathology   38 ( 3 )   228 - 233   2021年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Detection of BRAF V600E mutation in glioblastomas (GBMs) is important because of potential therapeutic implications. Still, the relative paucity of these mutations makes molecular detection in all GBMs controversial. In the present study, we analyzed clinical, radiographic and pathologic features of 12 BRAF V600E-mutant GBMs and 12 matched controls from 2 institutions. We found that a majority of BRAF V600E-mutant GBMs displayed a combination of well-circumscribed lesions, large cystic components with thin walls and solid cortical component on MRI, but with some overlap with matched BRAF wildtype controls (p = 0.069). BRAF V600E-mutant GBMs were also apt to gross total resection (83% vs 17%, p = 0.016) and morphologically displayed epithelioid features (83% vs 0%, p < 0.0001). Identification of these clinical, radiographic, and pathologic characteristics should prompt testing for BRAF V600E in IDH-wildtype GBM.

    DOI: 10.1007/s10014-021-00407-0

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  • Delayed Bleeding of Unruptured Intracranial Aneurysms After Coil Embolization: A Retrospective Case Series. 国際誌

    Kazuhiro Ando, Hitoshi Hasegawa, Tomoaki Suzuki, Shoji Saito, Kohei Shibuya, Haruhiko Takahashi, Makoto Oishi, Yukihiko Fujii

    World neurosurgery   149   e135-e145   2021年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Delayed bleeding of unruptured intracranial aneurysms (UIAs) after coil embolization is rare; this study aimed to analyze the occurrence of delayed bleeding of UIAs after coil embolization. METHODS: We retrospectively analyzed patients with UIAs after coil embolization between January 2002 and December 2018 and assessed the features of UIAs with delayed bleeding after coil embolization. RESULTS: Analysis included 307 patients with 335 UIAs. Mean follow-up was 7.1 ± 4.9 years, and total follow-up was 2365 aneurysm-years. There were 271 (80.9%) aneurysms located in the anterior circulation and 64 (19.1%) aneurysms located in the posterior circulation. Significant differences were observed between the 2 groups in terms of maximum size of the aneurysm (P < 0.01), width of the aneurysm neck (P < 0.01), and number of retreatment cases (P < 0.01). During the follow-up period, delayed bleeding occurred in 4 aneurysms (annual bleeding rate of 0.17%); all were located in the posterior circulation. The original size was not relatively large (mean 8.6 ± 2.4 mm). All aneurysms bled within 5 years (mean 35 ± 9.6 months) after the initial treatment. Two were de novo aneurysms that developed adjacent to the coiled aneurysms and were not detected on follow-up magnetic resonance angiography. CONCLUSIONS: Cautious follow-up of UIAs with digital subtraction angiography is important, articularly within the first 5 years after the procedure. If there are changes in the anatomic outcomes, short-term reassessment or additional treatment should be actively considered, particularly for aneurysms in the posterior circulation.

    DOI: 10.1016/j.wneu.2021.02.061

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  • Low Detection Rate of H3K27M Mutations in Cerebrospinal Fluid Obtained from Lumbar Puncture in Newly Diagnosed Diffuse Midline Gliomas. 国際誌

    Jotaro On, Manabu Natsumeda, Jun Watanabe, Shoji Saito, Yu Kanemaru, Hideaki Abe, Yoshihiro Tsukamoto, Masayasu Okada, Makoto Oishi, Junichi Yoshimura, Akiyoshi Kakita, Yukihiko Fujii

    Diagnostics (Basel, Switzerland)   11 ( 4 )   2021年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Recent studies have suggested the feasibility of detecting H3K27M mutations in the cerebrospinal fluid of diffuse midline glioma (DMG) patients. However, cerebrospinal fluid from patients in these studies were collected mainly during biopsy, ventriculo-peritoneal shunt procedures or postmortem. We assessed circulating tumor DNA (ctDNA) extracted from cerebrospinal fluid (CSF) and plasma in a series of 12 radiographically suspected and/or pathologically confirmed diffuse midline glioma patients and assessed for H3F3A K27M mutation using digital droplet PCR. In 10 patients, CSF was obtained by lumbar puncture at presentation. A definitive detection of H3F3A K27M mutation was achieved in only one case (10%); H3F3A K27M mutation was suspected in three other cases (30%). H3F3A K27M mutation was detected in two patients in CSF obtained by ventricular tap during a ventriculo-peritoneal shunt for obstructive hydrocephalus. Cases in which a definitive assessment was possible (definite H3F3A K27M or definite H3F3A wildtype) tended to be younger (median 7.5 years vs. 40.5 years; p = 0.07) and have a higher concentration of CSF protein (median 123 mg/dL vs. 27.5 mg/dL; p = 0.21) compared to nondefinite cases. Low proliferation and apoptotic rates seemed to be characteristics of DMG unfavorable for liquid biopsy. More advanced lesions with necrosis and evidence of dissemination were unlikely to be candidates for lumbar puncture due to the fear of exacerbating obstructive hydrocephalus. Methods to safely sample CSF and a more sensitive detection of ctDNA are necessary for reliable liquid biopsy of DMG at presentation.

    DOI: 10.3390/diagnostics11040681

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  • Unilateral oculomotor nerve palsy caused by arterial compression accompanying subarachnoid hemorrhage: a case report. 国際誌

    Shoji Saito, Hitoshi Hasegawa, Toru Takino, Kazuhiro Ando, Kohei Shibuya, Haruhiko Takahashi, Jotaro On, Tomoaki Suzuki, Makoto Oishi, Yukihiko Fujii

    Acta neurochirurgica   163 ( 3 )   813 - 816   2021年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Unilateral oculomotor nerve palsy, often caused by aneurysmal compression, is one of the decisive findings for confirming the site of a ruptured aneurysm. However, arterial compression can also cause unilateral oculomotor nerve palsy. Here, we present the case of a 59-year-old woman with a ruptured right internal carotid-posterior communicating artery aneurysm accompanied by contralateral oculomotor nerve palsy. The nerve was found to be compressed by the posterior cerebral artery and was isolated from the ruptured aneurysm. When confirming a ruptured aneurysm based on the evidence of unilateral oculomotor palsy, the arteries surrounding the nerve must be thoroughly assessed.

    DOI: 10.1007/s00701-020-04633-x

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  • [Multinodular and Vacuolating Neuronal Tumor of the Cerebrum(MVNT)].

    Kouichirou Okamoto, Manabu Natsumeda, Makoto Oishi, Yukihiko Fujii

    No shinkei geka. Neurological surgery   49 ( 2 )   383 - 387   2021年3月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    Multinodular and vacuolating neuronal tumors of the cerebrum(MVNTs)are rare brain tumors that were described first in 2013. MVNTs have been added to the World Health Organization Classification of Tumors of the Central Nervous System in 2016(2016WHO), although an MVNT is a clinical-pathological lesion with uncertain class assignment. It remains unclear whether MVNTs should be considered a true neoplasm or malformative lesion. Their prevalence and pathophysiology are unknown. MVNTs typically occur in adults, predominantly in the cerebral subcortical region, and are most frequently associated with seizures or seizure equivalents. MVMTs can also present incidentally without seizures. MVNTs have been reported to show highly suggestive imaging features, especially on MRI scans. MVNTs consist of small T2 and T2-FLAIR hyperintense nodules in subcortical and juxtacortical areas with rare or no post-contrast enhancement. Most MVNTs reported in the literature involve the supratentorial part of the brain. Recently, lesions exhibiting a remarkably similar pattern of imaging findings were described in the posterior fossa, which are referred to as multinodular and vacuolating posterior fossa of unknown significance(MV-PLUS). Both MVNT and MV-PLUS are considered "leave-me-alone" lesions because of the absence of malignancy criteria and the lack of evolutivity on follow-up MRI scans.

    DOI: 10.11477/mf.1436204402

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  • [Dysplastic Cerebellar Gangliocytoma(Lhermitte-Duclos Disease)].

    Kouichirou Okamoto, Manabu Natsumeda, Makoto Oishi, Yukihiko Fujii

    No shinkei geka. Neurological surgery   49 ( 2 )   395 - 399   2021年3月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    Dysplastic cerebellar gangliocytoma or Lhermitte-Duclos disease(LDD)is a rare benign cerebellar lesion composed of dysplastic ganglion cells that conform to the existing cortical architecture. In this disease, the enlarged ganglion cells are predominantly located within the internal granular layer, and they thicken the cerebellar folia. The architecture of the affected cerebellar hemisphere with the enlarged cerebellar folia and the cystic changes, in some cases, present as "tiger-striped striations," a characteristic imaging finding that is not specific to LDD. This imaging feature may be observed in medulloblastoma and isolated cerebellar Rosai-Dorfman disease. This cerebellar lesion is a major central nervous system manifestation of Cowden syndrome, an autosomal dominant condition that causes various hamartomas and neoplasms. A molecular-based study estimated the prevalence of Cowden syndrome to be 1 case per 200,000. In a study involving 211 patients with Cowden syndrome, 32% developed LDD. LDD can be diagnosed in young children and older adults within the eighth decades of life. PTEN mutations have been identified in virtually all adult-onset LDDs, but not in childhood-onset cases.

    DOI: 10.11477/mf.1436204404

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  • [Melanocytic Tumors].

    Kouichirou Okamoto, Manabu Natsumeda, Makoto Oishi, Yukihiko Fujii

    No shinkei geka. Neurological surgery   49 ( 2 )   389 - 394   2021年3月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    Primary melanocytic neoplasms of the central nervous system(CNS)presumably arise from leptomeningeal melanocytes that are derived from the neural crest. Melanocytic neoplasms associated with neurocutaneous melanosis likely derive from melanocyte precursor cells that reach the CNS after somatic mutations, mostly, of the NRAS. They should be distinguished from other melanotic tumors involving the CNS, including metastatic melanoma and other primary tumors that undergo melanization, such as melanocytic schwannomas, medulloblastomas, paragangliomas, and various gliomas, because these lesions require different patient workups and therapy. Primary melanocytic neoplasms of the CNS that are diffuse and do not form macroscopic masses are called melanocytoses, whereas malignant diffuse or multifocal lesions are collectively called melanomatoses. Benign and intermediate-grade tumoral lesions are called melanocytomas. Discrete malignant tumors are called melanomas. CT and MRI of melanocytosis and melanomatosis show diffuse thickening and enhancement of the leptomeninges, often with focal or multifocal nodularity. Depending on the melanin content, diffuse and circumscribed melanocytic tumors of the CNS may show some characteristics on CT and MRI: iso- to hyperattenuation on CT and paramagnetic properties of melanin on MRI resulting in an isointense signal on T1WIs and iso- to hypointensity on T2WIs.

    DOI: 10.11477/mf.1436204403

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  • GLI3 Is Associated With Neuronal Differentiation in SHH-Activated and WNT-Activated Medulloblastoma. 国際誌

    Manabu Natsumeda, Hiroaki Miyahara, Junichi Yoshimura, Satoshi Nakata, Takanori Nozawa, Junko Ito, Yu Kanemaru, Jun Watanabe, Yoshihiro Tsukamoto, Masayasu Okada, Makoto Oishi, Junko Hirato, Takafumi Wataya, Sama Ahsan, Kensuke Tateishi, Tetsuya Yamamoto, Fausto J Rodriguez, Hitoshi Takahashi, Volker Hovestadt, Mario L Suva, Michael D Taylor, Charles G Eberhart, Yukihiko Fujii, Akiyoshi Kakita

    Journal of neuropathology and experimental neurology   80 ( 2 )   129 - 136   2021年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Glioma-associated oncogene homolog 3 (GLI3), whose main function is to inhibit GLI1, has been associated with neuronal differentiation in medulloblastoma. However, it is not clear what molecular subtype(s) show increased GLI3 expression. GLI3 levels were assessed by immunohistochemistry in 2 independent cohorts, including a total of 88 cases, and found to be high in both WNT- and SHH-activated medulloblastoma. Analysis of bulk mRNA expression data and single cell RNA sequencing studies confirmed that GLI1 and GLI3 are highly expressed in SHH-activated medulloblastoma, whereas GLI3 but not GLI1 is highly expressed in WNT-activated medulloblastoma. Immunohistochemical analysis has shown that GLI3 is expressed inside the neuronal differentiated nodules of SHH-activated medulloblastoma, whereas GLI1/2 are expressed in desmoplastic areas. In contrast, GLI3 is diffusely expressed in WNT-activated medulloblastoma, whereas GLI1 is suppressed. Our data suggest that GLI3 may be a master regulator of neuronal differentiation and morphology in these subgroups.

    DOI: 10.1093/jnen/nlaa141

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  • Hemodynamic features of an intracranial aneurysm rupture predicted by perianeurysmal edema: A case report. 国際誌

    Tomoaki Suzuki, Hitoshi Hasegawa, Kazuhiro Ando, Kohei Shibuya, Haruhiko Takahashi, Shoji Saito, Jotaro On, Makoto Oishi, Yukihiko Fujii

    Surgical neurology international   12   49 - 49   2021年

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    記述言語:英語  

    Background: Perianeurysmal edema (PAE) has been suggested as an indicator of potential aneurysm rupture; however, the hemodynamic features of these aneurysms are still unknown. A computational fluid dynamic (CFD) analysis was performed to evaluate the hemodynamic features of a very rare case of a ruptured middle cerebral artery (MCA) aneurysm with PAE. Case Description: A 65-year-old woman presented with disturbed consciousness. A subarachnoid hemorrhage due to an azygos anterior cerebral artery (ACA) aneurysm rupture was suspected. An unruptured MCA aneurysm with PAE was identified in the left temporal lobe. Although the ACA aneurysm was clipped to prevent re-bleeding, the MCA aneurysm subsequently ruptured 6 days later. Clipping of the MCA aneurysm was performed, and hemosiderin deposits suggestive of sentinel bleeding were found on the surface of the aneurysm dome. CFD analysis revealed unstable hemodynamic stress at the expanded bleb area after rupture, localized to the rupture site. Moreover, this analysis revealed flow impingement with pressure elevation and low wall shear stress, which indicated increased inflammation and aneurysm wall thinning that likely led to rupture. Conclusion: Hemosiderin deposits at the aneurysm wall and PAE indicates leakage from a cerebral aneurysm. Hemodynamic stress at the aneurysm may promote an inflammatory response and lead to wall weakening accompanied by PAE. Based on our findings, we recommend that surgical intervention should be considered as the first line of treatment for such aneurysms to prevent rupture.

    DOI: 10.25259/SNI_780_2020

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  • リン酸化プロテオミクスで同定した新規霊長類神経成長・再生マーカー:リン酸化 GAP-43 T172

    岡田 正康, 河嵜 麻実, 金子 奈穂子, 棗田 学, 大石 誠, 藤井 幸彦, 五十嵐 道弘

    サイトメトリーリサーチ   31 ( 1 )   7 - 13   2021年

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    記述言語:日本語   出版者・発行元:日本サイトメトリー学会  

    <p>For post-translational protein modifications such as phosphorylation, the involved residues have been recently identified by mass spectrometers. However, it is not easy to efficiently detect the therapeutic target from the vast amount of proteomic data. Neuronal growth cones are specialized, highly motile structures formed at the tip of axons, that are indispensable for synaptogenesis in the developing brain and for neuronal plasticity in the adult brain. However, there is lack of information on the molecular basis of growth cones in the mammalian brain. We performed a phosphoproteomic analysis of growth cone membrane fractions (2 mg) isolated from the rat forebrain on postnatal day 1. We chose the more abundant peptides as research-targets, based on the hypothesis that abundant phosphorylated sites are involved in important biological functions. The phosphopeptides detected with high frequency at the 1st (Serine [S] 96) and 9th (Threonine [T] 172) positions were the phosphorylation sites of neuronal growth-associated protein - 43 kDa (GAP 43). C-jun N-terminal kinase (JNK) was responsible for phosphorylation at these sites, which increased during neuronal development and axonal regeneration. T172 phosphorylation was also confi rmed in rodents and primates. This review introduces our methodology for fi nding novel phospho-proteins as therapeutic molecular targets for specifi c diseases, along with their regulatory kinases. We believe that our serial approach, as illustrated here, can be applied to various research fi elds. In future research, we propose to demonstrate that pT172 antibody can be utilized as an axonal growth and regeneration marker in humans.</p>

    DOI: 10.18947/cytometryresearch.31.1_7

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  • Pott's puffy tumour: a rare and life-threatening disease. 国際誌

    Nahoko Ikoma, Yuta Aizawa, Takanobu Sasaki, Makoto Oishi, Naka Saito, Hiroshi Yoshida, Akihiko Saitoh

    The Lancet. Infectious diseases   20 ( 12 )   1482 - 1482   2020年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1016/S1473-3099(20)30684-8

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  • Safety and feasibility of the distal transradial approach: A novel technique for diagnostic cerebral angiography. 国際誌

    Shoji Saito, Hitoshi Hasegawa, Tomoyoshi Ota, Toru Takino, Yuichi Yoshida, Kazuhiro Ando, Kohei Shibuya, Haruhiko Takahashi, Tomoaki Suzuki, Makoto Oishi, Yukihiko Fujii

    Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences   26 ( 6 )   713 - 718   2020年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: We aimed to evaluate the safety and feasibility of the distal transradial approach (DTRA) as a novel technique for cerebral angiography based on our institutional initial experience. METHODS: We retrospectively analyzed our institutional database of consecutive diagnostic cerebral angiographies performed with DTRA from December 2018 to August 2019. Patient demographics and clinical and procedural data were recorded. RESULTS: In total, 51 diagnostic cerebral angiographies in 51 patients (age, 15-83 years; mean age, 59.4 years, SD 13.5; 35 (69%) females) were performed or attempted with DTRA. Ultrasound evaluation showed that the mean inner distal radial artery diameter was significantly smaller than the mean inner forearm radial artery diameter (2.19 mm vs. 2.56 mm, P < 0.001). Cannulation via the distal radial artery was successful in 47 (92%) procedures. In the four procedures that failed, operators converted to the ipsilateral transradial approach without repositioning or redraping. Selective catheterization of the intended vessel was achieved in 64 (91%) of 70 vessels. In the remaining six, operators achieved the objective of the examination with angiography injecting from proximal and conversion to another approach was not required. One patient experienced temporary numbness around the puncture site after the procedure. No radial artery occlusion was identified in the patients who underwent ultrasound evaluation. CONCLUSION: Our results demonstrate that DTRA could become a standard approach for diagnostic cerebral angiography owing to the low complication rate and the high cannulation success rate.

    DOI: 10.1177/1591019920925709

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  • 栄養動脈塞栓術を行い摘出したhypervascular cerebellopontine angle pilocytic astrocytomaの一例

    吉村 淳一, 棗田 学, 長谷川 仁, 大石 誠, 藤井 幸彦

    小児の脳神経   45 ( 3 )   256 - 256   2020年10月

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    記述言語:日本語   出版者・発行元:(一社)日本小児神経外科学会  

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  • 脳腫瘍の遺伝子診断とゲノム医療2 ゲノム医療を想定したBRAF V600E変異を有する脳腫瘍の臨床病理像

    棗田 学, 金丸 優, 齋藤 祥二, 塚本 佳広, 岡田 正康, 大石 誠, 柿田 明美, 藤井 幸彦

    Brain Tumor Pathology   37 ( Suppl. )   076 - 076   2020年8月

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    記述言語:日本語   出版者・発行元:日本脳腫瘍病理学会  

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  • [Endovascular Revascularization for Acute Ischemic Stroke Related to Blunt Carotid Injury:A Case Report].

    Shoji Saito, Hitoshi Hasegawa, Daisuke Sato, Kazuhiro Ando, Kunio Motohashi, Manabu Natsumeda, Bumpei Kikuchi, Makoto Oishi, Yukihiko Fujii

    No shinkei geka. Neurological surgery   48 ( 6 )   527 - 532   2020年6月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    Although blunt carotid artery injury is known as an important cause of ischemic stroke, the role of the endovascular treatment for acute ischemic stroke related to blunt carotid injuries remains unclear. We report the case of a patient with acute ischemic stroke secondary to blunt carotid artery injury who was treated with endovascular revascularization. A 46-year-old man suffered from sudden left-sided hemiparesis a day after a strike from a Japanese fencing staff on his right neck. 3D-CT angiography revealed tandem internal carotid artery occlusions of the cervical and C1 portions. We performed endovascular revascularization with carotid artery stenting and direct aspiration of the thrombus and achieved complete recanalization. The patient recovered almost completely. We conclude that endovascular revascularization should not be withheld from patients with acute ischemic stroke related to blunt carotid injury.

    DOI: 10.11477/mf.1436204223

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  • Vascular Hyperintensity on Fluid-Attenuated Inversion Recovery Indicates the Severity of Hypoperfusion in Acute Stroke. 国際誌

    Toshiharu Nomura, Kouichirou Okamoto, Hironaka Igarashi, Masato Watanabe, Hitoshi Hasegawa, Makoto Oishi, Yukihiko Fujii

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association   29 ( 2 )   104467 - 104467   2020年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND AND AIM: Although fluid-attenuated inversion recovery vascular hyperintensities may be frequently seen in acute large-artery ischemic stroke, reports on their prognostic utility had been conflicting due to lack of quantitative evaluation of the perfusion status based on the signal intensity. We hypothesized that greater hyperintensity represents more severe hypoperfusion. METHODS: Overall, 27 patients with acute occlusion of the proximal middle cerebral artery were divided into 2 groups, based on their signal intensity in the insular segment of middle cerebral artery on the affected side, relative to that of the insular cortex: the low signal intensity group (hypo- or isointense signals, n = 12) and the high signal intensity group (hyperintense signals, n = 15). Using dynamic susceptibility contrast magnetic resonance imaging, we assessed the time of the maximum value of the residue function and mean transit time, in the entire middle cerebral artery cortical area and diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score regions, including the corona radiata. RESULTS: The high signal intensity group had significantly longer time of the maximum value of the residue function in all the diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score regions, except the M3 and M6 regions, and significantly longer mean transit time in the M1 and M4 regions. CONCLUSIONS: Quantitative analysis of the perfusion parameters revealed more severely compromised and widely disturbed perfusion status in the high signal intensity group than in the low signal intensity group.

    DOI: 10.1016/j.jstrokecerebrovasdis.2019.104467

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  • Possibility of Worsening Flow Diversion Effect Due to Morphological Changes of a Stented Artery With Multiple Overlapping Stents for Partially Thrombosed Vertebral Artery Aneurysms. 国際誌

    Tomoaki Suzuki, Hitoshi Hasegawa, Kazuhiro Ando, Kouhei Shibuya, Haruhiko Takahashi, Shoji Saito, Makoto Oishi, Yukihiko Fujii

    Frontiers in neurology   11   611124 - 611124   2020年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background: Morphological changes of a stented artery can cause a flow diversion effect to reduce intra-aneurysmal flow; however, there is a potential for the negative effect of increased intra-aneurysmal flow. We present cases with multiple overlapping stents for a partially thrombosed vertebral artery aneurysm and characterize the hemodynamic properties of a recurrent case by focusing on the morphological changes of the stented artery. Methods: Between October 2017 and April 2019, four consecutive cases of symptomatic unruptured large and giant partially thrombosed vertebral artery aneurysms were treated with multiple overlapping low-profile visualized intraluminal support stents and no coils. Both angiographic and clinical outcomes were assessed. Computational fluid dynamics analysis was performed to clarify hemodynamic features. The degree of pressure elevation was calculated as the pressure difference (Pd). Wall shear stress (WSS) was also calculated. Results: In three of the four cases, successful flow reduction was achieved with no morphological change of the stented arteries. The patients' symptoms were gradually improved. The remaining case required additional stents after the initial treatment. In the recurrent case, Pd was noticeably elevated at the aneurysm neck after treatment, and WSS was generally increased in the area due to altered blood flow into the aneurysm dome caused by morphological changes of the stented artery. Conclusion: Overlapping stents can be used for the treatment of large and giant thrombosed vertebral artery aneurysms with flow diversion effect; however, morphological changes of the stented artery requires careful attention as it may lead to an increase in the intra-aneurysmal flow, causing negative outcomes.

    DOI: 10.3389/fneur.2020.611124

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  • Comparison of circulating tumor DNA between body fluids in patients with primary central nervous system lymphoma. 国際誌

    Jun Watanabe, Manabu Natsumeda, Yu Kanemaru, Masayasu Okada, Makoto Oishi, Akiyoshi Kakita, Yukihiko Fujii

    Leukemia & lymphoma   60 ( 14 )   3587 - 3589   2019年12月

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  • Podoplanin Expression and IDH-Wildtype Status Predict Venous Thromboembolism in Patients with High-Grade Gliomas in the Early Postoperative Period. 国際誌

    Jun Watanabe, Manabu Natsumeda, Masayasu Okada, Yu Kanemaru, Yoshihiro Tsukamoto, Makoto Oishi, Akiyoshi Kakita, Yukihiko Fujii

    World neurosurgery   128   e982-e988   2019年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Venous thromboembolism (VTE) often is encountered in patients with high-grade gliomas. The underlying mechanisms are unclear, as is the optimal prophylactic protocol. The purpose of the present study was to identify risk factors of VTE and examine the validity of early VTE detection in high-grade gliomas. METHODS: We reviewed the medical records of 165 patients with newly diagnosed high-grade glioma treated at Niigata University Hospital during the years 2009 to 2016. If the serum D-dimer levels increased to 5.0 μg/mL or more, computed tomography was performed to detect VTE. Furthermore, immunohistochemistry with antibodies against podoplanin was performed on available 101 tumor tissues. RESULTS: Of the 165 patients, 44 (26.7%) developed VTE. Of the 44 patients, 34 (79.5%) developed VTE within 7 days after surgery. No fatal VTE occurred and major complications secondary to anticoagulation occurred in only 2 (1.2%) patients. On multivariate analysis, lower Karnofsky Performance Scale status, podoplanin expression, and isocitrate dehydrogenase-wildtype status were independently associated with the risk of VTE (P < 0.05). CONCLUSIONS: We found that most VTEs occurred early in the postoperative period and commonly in patients with lower Karnofsky Performance Scale status and isocitrate dehydrogenase-wildtype gliomas, which expressed podoplanin.

    DOI: 10.1016/j.wneu.2019.05.049

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  • Dramatic response of BRAF V600E-mutant epithelioid glioblastoma to combination therapy with BRAF and MEK inhibitor: establishment and xenograft of a cell line to predict clinical efficacy. 国際誌

    Yu Kanemaru, Manabu Natsumeda, Masayasu Okada, Rie Saito, Daiki Kobayashi, Takeyoshi Eda, Jun Watanabe, Shoji Saito, Yoshihiro Tsukamoto, Makoto Oishi, Hirotake Saito, Masayuki Nagahashi, Takahiro Sasaki, Rintaro Hashizume, Hidefumi Aoyama, Toshifumi Wakai, Akiyoshi Kakita, Yukihiko Fujii

    Acta neuropathologica communications   7 ( 1 )   119 - 119   2019年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Epithelioid glioblastoma is a rare aggressive variant of glioblastoma (GBM) characterized by a dismal prognosis of about 6 months and frequent leptomeningeal dissemination. A recent study has revealed that 50% of epithelioid GBMs harbor three genetic alterations - BRAF V600E mutation, TERT promoter mutations, and homozygous deletions of CDKN2A/2B. Emerging evidence support the effectiveness of targeted therapies for brain tumors with BRAF V600E mutation. Here we describe a dramatic radiographical response to combined therapy with BRAF and MEK inhibitors in a patient with epithelioid GBM harboring BRAF V600E mutation, characterized by thick spinal dissemination. From relapsed tumor procured at autopsy, we established a cell line retaining the BRAF V600E mutation, TERT promoter mutation and CDKN2A/2B loss. Intracranial implantation of these cells into mice resulted in tumors closely resembling the original, characterized by epithelioid tumor cells and dissemination, and invasion into the perivascular spaces. We then confirmed the efficacy of treatment with BRAF and MEK inhibitor both in vitro and in vivo. Epithelioid GBM with BRAF V600E mutation can be considered a good treatment indication for precision medicine, and this patient-derived cell line should be useful for prediction of the tumor response and clarification of its biological characteristics.

    DOI: 10.1186/s40478-019-0774-7

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  • Malignant Hyperthermia and Cerebral Venous Sinus Thrombosis After Ventriculoperitoneal Shunt in Infant with Schizencephaly and COL4A1 Mutation. 国際誌

    Jun Watanabe, Kouichirou Okamoto, Tsukasa Ohashi, Manabu Natsumeda, Hitoshi Hasegawa, Makoto Oishi, Satoko Miyatake, Naomichi Matsumoto, Yukihiko Fujii

    World neurosurgery   127   446 - 450   2019年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Schizencephaly is a rare congenital central nervous system malformation characterized by linear, thickened clefts of the cerebral mantle. Recently, germline mutations in collagen type IV alpha 1 (COL4A1) have been reported to be a genetic cause of schizencephaly as a result of prenatal stroke. Patients with COL4A1 mutation demonstrate a variety of disease phenotypes. However, little is known about the potential complications of patients with COL4A1 mutations before and after neurologic surgery. CASE DESCRIPTION: A 9-month-old boy with schizencephaly and a congenital cataract underwent a ventriculoperitoneal shunt for progressive hydrocephalus. Postoperatively, he developed malignant hyperthermia and cerebral venous thrombosis. Early treatment with dantrolene sodium and hydration was effective. Genetic testing revealed a germline COL4A1 mutation. CONCLUSIONS: To our knowledge, malignant hyperthermia and cerebral venous thrombosis have not been reported in the literature in patients with COL4A1 mutations after surgery. Schizencephaly arising from COL4A1 mutations might be a disease prone to these adverse effects because this mutation is known to be associated with venous tortuosity, venous vulnerability, and muscle spasms due to basement membrane protein abnormalities. We need to better understand the wide spectrum of clinical phenotypes of COL4A1 mutations and potential complications in order to better manage surgery of patients with schizencephaly.

    DOI: 10.1016/j.wneu.2019.04.156

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  • 小児症例における内視鏡下経鼻経蝶形骨洞手術の解剖学的制限と安全性の検討

    温 城太郎, 岡田 正康, 中村 公彦, 米岡 有一郎, 大石 誠, 藤井 幸彦

    小児の脳神経   44 ( 2 )   166 - 166   2019年4月

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    記述言語:日本語   出版者・発行元:(一社)日本小児神経外科学会  

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  • EGFRvIII Is Expressed in Cellular Areas of Tumor in a Subset of Glioblastoma.

    Takanori Nozawa, Masayasu Okada, Manabu Natsumeda, Takeyoshi Eda, Hideaki Abe, Yoshihiro Tsukamoto, Kouichirou Okamoto, Makoto Oishi, Hitoshi Takahashi, Yukihiko Fujii, Akiyoshi Kakita

    Neurologia medico-chirurgica   59 ( 3 )   89 - 97   2019年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Epidermal growth factor receptor variant III (EGFRvIII) is a tumor-specific cell surface antigen often expressed in glioblastoma and has drawn much attention as a possible therapeutic target. We performed immunohistochemistry on histology sections of surgical specimens taken from 67 cases with glioblastoma, isocitrate dehydrogenase-wild type, and evaluated the morphological characteristics and distribution of the EGFRvIII-positive tumor cells. We then evaluated the localization of EGFRvIII-expression within the tumor and peritumoral areas. EGFRvIII immunopositivity was detected in 15 specimens taken from 13 patients, including two recurrent specimens taken from the same patient at relapse. Immunofluorescence staining demonstrated that EGFRvIII-positive cells were present in cells positive for glial fibrillary acidic protein (GFAP), and some showed astrocytic differentiation with multiple fine processes and others did not shown. The EGFRvIII-positive cells were located in cellular areas of the tumor, but not in the invading zone. In the two recurrent cases, EGFRvIII-positive cells were markedly decreased in one case and retained in the other. With regard to overall survival, univariate analysis indicated that EGFRvIII-expression in patients with glioblastoma was not significantly associated with a favorable outcome. Double-labeling immunofluorescence staining of EGFRvIII and GFAP showed that processes of large, well differentiated, GFAP-positive glia extend to and surround less differentiated, EGFRvIII-positive glial cells in cellular areas of tumor. However, in the tumor periphery, EGFRvIII-positive tumor cells were not observed. This finding suggests that EGFRvIII is involved in tumor proliferation, but that invading glioma cells lose their EGFRvIII expression.

    DOI: 10.2176/nmc.oa.2018-0078

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  • [Posterior Quadrantectomy for Infant with Refractory Epilepsy:A Case Report].

    Taiki Saito, Makoto Oishi, Masafumi Fukuda, Yoshihiro Tsukamoto, Tsukasa Ohashi, Jun Watanabe, Takuma Nemoto, Tadashi Kawaguchi, Yukihiko Fujii

    No shinkei geka. Neurological surgery   47 ( 3 )   349 - 356   2019年3月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    We present the case of an 11-month-old girl with linear nevus sebaceous syndrome who underwent posterior quadrantectomy(PQ)for intractable epilepsy due to cortical dysplasia extending from the temporal, parietal, and occipital lobes in the right hemisphere. Epileptic spasms started at 4 months after birth, and the frequency of her seizures gradually increased to 10 episodes per day. Electroencephalograms in the interictal periods showed hypsarrhythmia. Magnetic resonance imaging(MRI)suggested cortical dysplasia in the right temporal, parietal, and occipital lobes. Ictal single-photon emission computed tomography revealed increased cerebral blood flow in similar areas as the cortical dysplasia suggested on MRI. Several antiepileptic drugs were administered to control the epileptic spasms, without success. In addition, her developmental delay gradually became evident. Because the epileptic foci extended into the posterior region of the right hemisphere, we did not execute a focused resection, but performed a PQ. The epileptic spasms completely disappeared after surgery and her developmental delay gradually improved. Early surgical intervention via PQ is useful in patients with drug-resistant epilepsy in whom the epileptic foci have extended into the temporal, parietal, and occipital lobes. This intervention not only controls intractable seizures but also helps to facilitate normal development.

    DOI: 10.11477/mf.1436203943

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  • MGMT Expression Contributes to Temozolomide Resistance in H3K27M-Mutant Diffuse Midline Gliomas. 国際誌

    Hideaki Abe, Manabu Natsumeda, Masayasu Okada, Jun Watanabe, Yoshihiro Tsukamoto, Yu Kanemaru, Junichi Yoshimura, Makoto Oishi, Rintaro Hashizume, Akiyoshi Kakita, Yukihiko Fujii

    Frontiers in oncology   9   1568 - 1568   2019年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Diffuse midline gliomas (DMGs) show resistance to many chemotherapeutic agents including temozolomide (TMZ). Histone gene mutations in DMGs trigger epigenetic changes including DNA hypomethylation, one of which is a frequent lack of O6-methyl-guanine-DNA methyltransferase (MGMT) promoter methylation, resulting in increased MGMT expression. We established the NGT16 cell line with HIST1H3B K27M and ACVR1 G328E gene mutations from a DMG patient and used this cell line and other DMG cell lines with H3F3A gene mutation (SF7761, SF8628, JHH-DIPG1) to analyze MGMT promoter methylation, MGMT protein expression, and response to TMZ. Three out of 4 DMG cell lines (NGT16, SF8628, and JHH-DIPG1) had unmethylated MGMT promoter, increased MGMT expression, and showed resistance to TMZ treatment. SF7761 cells with H3F3A gene mutation showed MGMT promoter methylation, lacked MGMT expression, and sensitivity to TMZ treatment. NGT16 line showed response to ALK2 inhibitor K02288 treatment in vitro. We confirmed in vitro that MGMT expression contributes to TMZ resistance in DMG cell lines. There is an urgent need to develop new strategies to treat TMZ-resistant DMGs.

    DOI: 10.3389/fonc.2019.01568

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  • 治療に難渋しているACTH産生下垂体腺腫の1例

    岡田 正康, 米岡 有一郎, 温 城太郎, 本橋 邦夫, 菊池 文平, 長谷川 仁, 大石 誠, 藤井 幸彦

    新潟医学会雑誌   132 ( 11-12 )   399 - 400   2018年12月

  • Polysomnography as an indicator for cervicomedullary decompression to treat foramen magnum stenosis in achondroplasia. 国際誌

    Masakazu Sano, Nao Takahashi, Keisuke Nagasaki, Makoto Oishi, Junichi Yoshimura, Yukihiko Fujii

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery   34 ( 11 )   2275 - 2281   2018年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Management of cervicomedullary compression due to foramen magnum stenosis in achondroplasia remains controversial, especially for patients with no symptoms or mild symptoms. We examined the effectiveness of polysomnography (PSG) as an indicator for cervicomedullary decompression treatment. METHODS: We retrospectively reviewed nine achondroplasia cases (mean age 1 year and 9 months) treated from 2008 to 2015. All patients were examined by PSG, magnetic resonance imaging (MRI), and otolaryngeal fibroscopy. We analyzed demographic data, clinical presentation, degree and type of respiratory impairment, severity of foramen magnum stenosis and concomitant cervicomedullary compression, treatment (conservative or surgical), and clinical outcome. RESULTS: Eight of nine patients presented with no severe symptoms in the daytime. However, MRI revealed four severe, four moderate, and one mild case of cervicomedullary compression, and PSG demonstrated severe sleep apnea in four cases and moderate sleep apnea in five cases. All sleep apnea cases were obstructive or obstructive-dominant. Fibroscopy revealed no upper airway stenosis in six cases and mild stenosis in three cases. Four patients who had severe sleep-related respiratory disturbance on PSG and severe or moderate cervicomedullary compression were treated by cervicomedullary decompression. Three of these patients demonstrated improved sleep respiration soon after surgery, while one required temporary tracheostomy due to bilateral vocal cord paralysis caused by compression during intratracheal intubation. CONCLUSION: Polysomnography can be a useful indicator for cervicomedullary decompression surgery, especially in cases of seemingly asymptomatic achondroplasia with severe foramen magnum stenosis.

    DOI: 10.1007/s00381-018-3880-0

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  • Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data. 国際誌

    Rustam Al-Shahi Salman, Joseph Frantzias, Robert J Lee, Patrick D Lyden, Thomas W K Battey, Alison M Ayres, Joshua N Goldstein, Stephan A Mayer, Thorsten Steiner, Xia Wang, Hisatomi Arima, Hitoshi Hasegawa, Makoto Oishi, Daniel A Godoy, Luca Masotti, Dar Dowlatshahi, David Rodriguez-Luna, Carlos A Molina, Dong-Kyu Jang, Antonio Davalos, José Castillo, Xiaoying Yao, Jan Claassen, Bastian Volbers, Seiji Kazui, Yasushi Okada, Shigeru Fujimoto, Kazunori Toyoda, Qi Li, Jane Khoury, Pilar Delgado, José Álvarez Sabín, Mar Hernández-Guillamon, Luis Prats-Sánchez, Chunyan Cai, Mahesh P Kate, Rebecca McCourt, Chitra Venkatasubramanian, Michael N Diringer, Yukio Ikeda, Hans Worthmann, Wendy C Ziai, Christopher D d'Esterre, Richard I Aviv, Peter Raab, Yasuo Murai, Allyson R Zazulia, Kenneth S Butcher, Seyed Mohammad Seyedsaadat, James C Grotta, Joan Martí-Fàbregas, Joan Montaner, Joseph Broderick, Haruko Yamamoto, Dimitre Staykov, E Sander Connolly, Magdy Selim, Rogelio Leira, Byung Hoo Moon, Andrew M Demchuk, Mario Di Napoli, Yukihiko Fujii, Craig S Anderson, Jonathan Rosand

    The Lancet. Neurology   17 ( 10 )   885 - 894   2018年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Intracerebral haemorrhage growth is associated with poor clinical outcome and is a therapeutic target for improving outcome. We aimed to determine the absolute risk and predictors of intracerebral haemorrhage growth, develop and validate prediction models, and evaluate the added value of CT angiography. METHODS: In a systematic review of OVID MEDLINE-with additional hand-searching of relevant studies' bibliographies- from Jan 1, 1970, to Dec 31, 2015, we identified observational cohorts and randomised trials with repeat scanning protocols that included at least ten patients with acute intracerebral haemorrhage. We sought individual patient-level data from corresponding authors for patients aged 18 years or older with data available from brain imaging initially done 0·5-24 h and repeated fewer than 6 days after symptom onset, who had baseline intracerebral haemorrhage volume of less than 150 mL, and did not undergo acute treatment that might reduce intracerebral haemorrhage volume. We estimated the absolute risk and predictors of the primary outcome of intracerebral haemorrhage growth (defined as >6 mL increase in intracerebral haemorrhage volume on repeat imaging) using multivariable logistic regression models in development and validation cohorts in four subgroups of patients, using a hierarchical approach: patients not taking anticoagulant therapy at intracerebral haemorrhage onset (who constituted the largest subgroup), patients taking anticoagulant therapy at intracerebral haemorrhage onset, patients from cohorts that included at least some patients taking anticoagulant therapy at intracerebral haemorrhage onset, and patients for whom both information about anticoagulant therapy at intracerebral haemorrhage onset and spot sign on acute CT angiography were known. FINDINGS: Of 4191 studies identified, 77 were eligible for inclusion. Overall, 36 (47%) cohorts provided data on 5435 eligible patients. 5076 of these patients were not taking anticoagulant therapy at symptom onset (median age 67 years, IQR 56-76), of whom 1009 (20%) had intracerebral haemorrhage growth. Multivariable models of patients with data on antiplatelet therapy use, data on anticoagulant therapy use, and assessment of CT angiography spot sign at symptom onset showed that time from symptom onset to baseline imaging (odds ratio 0·50, 95% CI 0·36-0·70; p<0·0001), intracerebral haemorrhage volume on baseline imaging (7·18, 4·46-11·60; p<0·0001), antiplatelet use (1·68, 1·06-2·66; p=0·026), and anticoagulant use (3·48, 1·96-6·16; p<0·0001) were independent predictors of intracerebral haemorrhage growth (C-index 0·78, 95% CI 0·75-0·82). Addition of CT angiography spot sign (odds ratio 4·46, 95% CI 2·95-6·75; p<0·0001) to the model increased the C-index by 0·05 (95% CI 0·03-0·07). INTERPRETATION: In this large patient-level meta-analysis, models using four or five predictors had acceptable to good discrimination. These models could inform the location and frequency of observations on patients in clinical practice, explain treatment effects in prior randomised trials, and guide the design of future trials. FUNDING: UK Medical Research Council and British Heart Foundation.

    DOI: 10.1016/S1474-4422(18)30253-9

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  • MGMT Expression Contributes to Temozolomide Resistance in H3K27M-Mutant Diffuse Midline Gliomas and MGMT Silencing to Temozolomide Sensitivity in IDH-Mutant Gliomas.

    Hideaki Abe, Manabu Natsumeda, Yu Kanemaru, Jun Watanabe, Yoshihiro Tsukamoto, Masayasu Okada, Junichi Yoshimura, Makoto Oishi, Yukihiko Fujii

    Neurologia medico-chirurgica   58 ( 7 )   290 - 295   2018年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Histone H3 mutations are frequently found in diffuse midline gliomas (DMGs), which include diffuse intrinsic pontine gliomas and thalamic gliomas. These tumors have dismal prognoses. Recent evidence suggests that one reason for the poor prognoses is that O6-methylguanine-DNA methyltransferase (MGMT) promoter frequently lacks methylation in DMGs. This review compares the epigenetic changes brought about by histone mutations to those by isocitrate dehydrogenase-mutant gliomas, which frequently have methylated MGMT promoters and are known to be sensitive to temozolomide.

    DOI: 10.2176/nmc.ra.2018-0044

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  • High Incidence of Deep Vein Thrombosis in the Perioperative Period of Neurosurgical Patients. 国際誌

    Manabu Natsumeda, Takeo Uzuka, Jun Watanabe, Masafumi Fukuda, Yasuhisa Akaiwa, Kazuhiko Hanzawa, Masahiko Okada, Makoto Oishi, Yukihiko Fujii

    World neurosurgery   112   e103-e112   2018年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: A prospective study was designed to elucidate incidence and predictors of deep venous thrombosis (DVT) in patients undergoing craniotomies. MATERIALS AND METHODS: Ninety-two patients who underwent craniotomies received pre- and postoperative venous ultrasonography and/or contrast-enhanced spiral computed tomography for diagnosis of DVT. The primary endpoint was DVT occurrence. Serial levels of serum D-dimer, soluble fibrin, and thrombin-antithrombin complex (TAT) were analyzed. RESULTS: Twenty-four of 92 patients (26.1%) had DVT, of whom 10 (41.7%) were diagnosed preoperatively. In patients with preoperative DVT, age, incidence of decreased performance status and leg paresis, levels of D-dimer, soluble fibrin, and TAT were significantly greater. In patients with postoperative DVT, length of surgery, incidence of decreased postoperative performance status, levels of D-dimer on postoperative days (POD) 3, 7, and 14, and TAT on POD7 were significantly greater. Patients with postoperative DVT had elevated D-dimer levels on POD 7 compared with POD 3. The D-dimer cutoff of 2.65 μg/mL at POD 7 could be used to identify DVT with 85.7% sensitivity and 72.3% specificity. A cutoff of 5.25 μg/mL at POD 7 yielded a specificity of 96.9%. Decreased performance status and elevated D-dimer were independent predictors for preoperative DVT, prolonged operation time, and elevated D-dimer on POD 7 for postoperative DVT. CONCLUSIONS: DVT frequently was observed in patients before and after undergoing craniotomies. Patients with decreased performance status should be preoperatively screened for DVT by checking D-dimer levels. Elevated D-dimer levels on POD 7 compared with POD 3 and D-dimer levels greater than 2.65 μg/mL at POD7 suggest the presence of DVT.

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  • 3D Computer graphics simulation to obtain optimal surgical exposure during microvascular decompression of the glossopharyngeal nerve. 国際誌

    Tetsuya Hiraishi, Toshio Matsushima, Masatou Kawashima, Yukiko Nakahara, Yuichi Takahashi, Hiroshi Ito, Makoto Oishi, Yukihiko Fujii

    Neurosurgical review   36 ( 4 )   629 - 35   2013年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    The affected artery in glossopharyngeal neuralgia (GPN) is most often the posterior inferior cerebellar artery (PICA) from the caudal side or the anterior inferior cerebellar artery (AICA) from the rostral side. This technical report describes two representative cases of GPN, one with PICA as the affected artery and the other with AICA, and demonstrates the optimal approach for each affected artery. We used 3D computer graphics (3D CG) simulation to consider the ideal transposition of the affected artery in any position and approach. Subsequently, we performed microvascular decompression (MVD) surgery based on this simulation. For PICA, we used the transcondylar fossa approach in the lateral recumbent position, very close to the prone position, with the patient's head tilted anteriorly for caudal transposition of PICA. In contrast, for AICA, we adopted a lateral suboccipital approach with opening of the lateral cerebellomedullary fissure, to visualize better the root entry zone of the glossopharyngeal nerve and to obtain a wide working space in the cerebellomedullary cistern, for rostral transposition of AICA. Both procedures were performed successfully. The best surgical approach for MVD in patients with GPN is contingent on the affected artery--PICA or AICA. 3D CG simulation provides tailored approach for MVD of the glossopharyngeal nerve, thereby ensuring optimal surgical exposure.

    DOI: 10.1007/s10143-013-0479-5

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  • Glioneuonal tumorの周囲脳組織のイメージング解析と病理組織学的所見の検討

    福多 真史, 北浦 弘樹, 大石 誠, 高尾 哲郎, 平石 哲也, 澁木 克栄, 柿田 明美, 藤井 幸彦

    てんかん研究   31 ( 2 )   405 - 405   2013年9月

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    記述言語:日本語   出版者・発行元:(一社)日本てんかん学会  

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  • Interactive presurgical simulation applying advanced 3D imaging and modeling techniques for skull base and deep tumors. 国際誌

    Makoto Oishi, Masafumi Fukuda, Naoki Yajima, Kenzo Yoshida, Machiko Takahashi, Tetsuya Hiraishi, Tetsuro Takao, Akihiko Saito, Yukihiko Fujii

    Journal of neurosurgery   119 ( 1 )   94 - 105   2013年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECT: In this paper, the authors' goal was to report their novel presurgical simulation method applying interactive virtual simulation (IVS) using 3D computer graphics (CG) data and microscopic observation of color-printed plaster models based on these CG data in surgery for skull base and deep tumors. METHODS: For 25 operations in 23 patients with skull base or deep intracranial tumors (meningiomas, schwannomas, epidermoid tumors, chordomas, and others), the authors carried out presurgical simulation based on 3D CG data created by image analysis for radiological data. Interactive virtual simulation was performed by modifying the 3D CG data to imitate various surgical procedures, such as bone drilling, brain retraction, and tumor removal, with manipulation of a haptic device. The authors also produced color-printed plaster models of modified 3D CG data by a selective laser sintering method and observed them under the operative microscope. RESULTS: In all patients, IVS provided detailed and realistic surgical perspectives of sufficient quality, thereby allowing surgeons to determine an appropriate and feasible surgical approach. Surgeons agreed that in 44% of the 25 operations IVS showed high utility (as indicated by a rating of "prominent") in comprehending 3D microsurgical anatomies for which reconstruction using only 2D images was complicated. Microscopic observation of color-printed plaster models in 12 patients provided further utility in confirming realistic surgical anatomies. CONCLUSIONS: The authors' presurgical simulation method applying advanced 3D imaging and modeling techniques provided a realistic environment for practicing microsurgical procedures virtually and enabled the authors to ascertain complex microsurgical anatomy, to determine the optimal surgical strategies, and also to efficiently educate neurosurgical trainees, especially during surgery for skull base and deep tumors.

    DOI: 10.3171/2013.3.JNS121109

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  • Ictal near-infrared spectroscopy and electrocorticography study of supplementary motor area seizures. 国際誌

    Yosuke Sato, Masafumi Fukuda, Makoto Oishi, Atsushi Shirasawa, Yukihiko Fujii

    Journal of biomedical optics   18 ( 7 )   76022 - 76022   2013年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    The seizure onset zone (SOZ) and propagation pathways in supplementary motor area (SMA) seizures are difficult to identify because of the short duration and swift propagations of this seizure type. Herein, we studied ictal cerebral blood flow changes, seizure electrical activities, and clinical signs employing simultaneous near-infrared spectroscopy (NIRS) and electrocorticography (ECoG) recordings in a brain tumor patient with SMA seizures. Increased cerebral blood flow was observed from the SOZ in the ipsilateral SMA and spread to the ipsilateral premotor cortex, ipsilateral sensorimotor cortex, and also the contralateral hemisphere. These propagation patterns were concordant with ictal ECoG seizure activities and clinical signs. Removal of the SOZ and surrounding areas, where the higher blood flow and higher frequency oscillations had been identified, achieved a good outcome for this patient. Our ictal NIRS-ECoG technique is robust and useful for detecting the SOZ and seizure propagations.

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  • Significance of horizontal propagation of synchronized activities in human epileptic neocortex investigated by optical imaging and immunohistological study. 国際誌

    Tetsuya Hiraishi, Hiroki Kitaura, Makoto Oishi, Masafumi Fukuda, Shigeki Kameyama, Hitoshi Takahashi, Akiyoshi Kakita, Yukihiko Fujii

    Epilepsy research   104 ( 1-2 )   59 - 67   2013年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    To characterize the physiological condition of human epileptic neocortex, we employed flavoprotein fluorescence imaging (FFI), an optical imaging method which detects intrinsic signals accompanying neural activation, and immunohistologically studied human cortical specimens. The experimented materials were cortical tissues surrounding various intracerebral lesions obtained from 5 patients with epilepsy (epileptic patients: EPs) and 5 without epilepsy (non-epileptic patients: NEPs). These tissues were immersed in oxygenated artificial cerebrospinal fluid immediately after removal in the operating room. Signal changes of FFI in the cortical layers subjected to electrical stimulation were observed under bicuculline methiodide perfusion. Immunohistological staining for parvalbumin (PV), calbindin, and calretinin were performed on the same specimens to evaluate expressions of calcium-binding protein positive cells. The FFI study showed the characteristic cortical propagation pattern of elicited activities horizontally along the cortical layers in EPs but not in NEPs. The propagated area with more than 0.5% signal changes was significantly larger in EPs than in NEPs (p=0.008). Only the expression of PV positive neurons was significantly lower in EPs than in NEPs (p=0.006). The propagated area on FFI and the decrease in PV positive neurons correlated significantly (R=-0.78, p=0.04). The present study visualized the unique horizontal propagation of signal changes on FFI and demonstrated a correlation of this propagation with immunohistological decreases in PV positive neurons in human epileptic cortex. Further investigations may elucidate the mechanism of hyper-excitability and hyper-synchronization in epileptic cortical tissue itself.

    DOI: 10.1016/j.eplepsyres.2012.09.014

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  • [Intraoperative monitoring of motor evoked potentials during glioma removal].

    Masafumi Fukuda, Makoto Oishi, Tetsuro Takao, Tetsuya Hiraishi, Tsutomu Kobayashi, Hiroshi Aoki, Ryosuke Ogura, Akihiko Saito, Yukihiko Fujii

    No shinkei geka. Neurological surgery   41 ( 3 )   219 - 27   2013年3月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: To determine whether motor evoked potentials(MEPs)provide reliable monitoring of the motor system during resection of gliomas in or adjacent to the motor cortex or pyramidal tract. MATERIALS AND METHODS: MEP recording was performed during 64 operations in 55 patients harboring gliomas. Intraoperative MEP findings were classified into 3 groups:Group A was defined as having no significant MEP changes, Group B as having reversible MEP changes(?50% amplitude decrease or loss), and Group C as having irreversible changes. Postoperative motor function was evaluated according to the presence/absence of deterioration immediately after surgery and 1 month later, as compared to preoperative motor status RESULTS: Immediately after surgery, 13 of 39(33%)patients in Group A, 6 of 17(35%)in Group B, and 7 of 8(88%)in Group C experienced deterioration of motor function. One month after surgery, 4 of 39(10%)patients in Group A, 3 of 17(18%)in Group B, and 4 of 8(50%)showed deterioration of motor function. Both immediately(χ2=8.3, p<0.05)and 1 month(χ2=6.9, p<0.05)after surgery, MEP alterations correlated significantly with postoperative deterioration of motor function. Despite MEPs being stable throughout surgery(Group A), there were some patients with deterioration of motor function initially appearing to represent false negative monitoring. However, these deteriorations were confirmed to have been caused by secondary hemorrhage, venous return dysfunction, postoperative convulsion, or resection of the supplementary motor area. CONCLUSIONS: MEP monitoring provides reliable information on the motor system during glioma surgery. Although false negative MEP results may exist in some patients, most data were not influenced by intraoperative manipulation but rather were attributable to secondary postoperative events.

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  • グリオーマ摘出術中の運動誘発電位モニタリングの有用性と限界

    福多 真史, 大石 誠, 高尾 哲郎, 平石 哲也, 小林 勉, 青木 洋, 小倉 良介, 斉藤 明彦, 藤井 幸彦

    Neurological Surgery   41 ( 3 )   219 - 227   2013年3月

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    記述言語:日本語   出版者・発行元:(株)医学書院  

    運動野および錐体路近傍のグリオーマ摘出術55例64回(男34例、女21例、平均43.5歳)を対象に、術中皮質刺激による運動誘発電位(MEP)モニタリングの有用性について検討した。術中MEPの振幅低下を認めなかったのは39例(A群)、一時的に振幅低下や反応消失を認め、最終的に回復したのは17例(B群)、回復なしが8例(C群)であった。術翌日に上肢の運動機能が術前に比較して悪化していたのはA群13例(33%)、B群6例(35%)、C群7例(88%)で、3群間に有意差が認められた。A群悪化例のうち、補足運動野症候群を呈したのが6例、術直後のけいれん発作、静脈灌流障害、術直後の出血による悪化が各1例であった。C群で悪化を認めなかった1例は、MEPが最終的に50%以下となった症例であった。術後1ヵ月目の悪化はA群4例、B群3例、C群4例と減少し、A群の内訳は補足運動野症候群の回復過程、術後の頻回なけいれん発作、腫瘍の再増大、照射中の浮腫増強であった。

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    その他リンク: https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J01228&link_issn=&doc_id=20130311040004&doc_link_id=10.11477%2Fmf.1436101949&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436101949&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

  • Facial nerve dysfunction after drainage of cerebrospinal fluid during vestibular schwannoma surgery. 国際誌

    Tetsuya Hiraishi, Masafumi Fukuda, Makoto Oishi, Yukihiko Fujii

    Clinical neurology and neurosurgery   115 ( 1 )   102 - 5   2013年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1016/j.clineuro.2012.04.003

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  • Hemodynamic and electrophysiological connectivity in the language system: simultaneous near-infrared spectroscopy and electrocorticography recordings during cortical stimulation. 国際誌

    Yosuke Sato, Makoto Oishi, Masafumi Fukuda, Yukihiko Fujii

    Brain and language   123 ( 1 )   64 - 7   2012年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    We applied near-infrared spectroscopy (NIRS) and electrocorticography (ECoG) recordings during cortical stimulation to a temporal lobe epilepsy patient who underwent subdural electrode implantation. Using NIRS, changes in blood concentrations of oxyhemoglobin (HbO(2)) and deoxyhemoglobin (HbR) during cortical stimulation of the left language areas were measured in each hemisphere. NIRS revealed that 2 Hz stimulation with 5 mA produced no significant hemodynamic changes in either hemisphere. By contrast, 50 Hz stimulation elicited significant increases in both HbO(2) and HbR at the stimulation site. Furthermore, with 50 Hz stimulation of the left superior temporal gyrus, the increases in HbO(2) and HbR were observed not only at the stimulation site but also concurrently at the left inferior frontal gyrus. This suggests the existence of functional connectivity in the language system. The present study demonstrates that simultaneous NIRS and ECoG studies during cortical stimulation allow a novel analysis of cerebral connectivity.

    DOI: 10.1016/j.bandl.2012.07.006

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  • Interactive virtual simulation using a 3D computer graphics model for microvascular decompression surgery. 国際誌

    Makoto Oishi, Masafumi Fukuda, Tetsuya Hiraishi, Naoki Yajima, Yosuke Sato, Yukihiko Fujii

    Journal of neurosurgery   117 ( 3 )   555 - 65   2012年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECT: The purpose of this paper is to report on the authors' advanced presurgical interactive virtual simulation technique using a 3D computer graphics model for microvascular decompression (MVD) surgery. METHODS: The authors performed interactive virtual simulation prior to surgery in 26 patients with trigeminal neuralgia or hemifacial spasm. The 3D computer graphics models for interactive virtual simulation were composed of the brainstem, cerebellum, cranial nerves, vessels, and skull individually created by the image analysis, including segmentation, surface rendering, and data fusion for data collected by 3-T MRI and 64-row multidetector CT systems. Interactive virtual simulation was performed by employing novel computer-aided design software with manipulation of a haptic device to imitate the surgical procedures of bone drilling and retraction of the cerebellum. The findings were compared with intraoperative findings. RESULTS: In all patients, interactive virtual simulation provided detailed and realistic surgical perspectives, of sufficient quality, representing the lateral suboccipital route. The causes of trigeminal neuralgia or hemifacial spasm determined by observing 3D computer graphics models were concordant with those identified intraoperatively in 25 (96%) of 26 patients, which was a significantly higher rate than the 73% concordance rate (concordance in 19 of 26 patients) obtained by review of 2D images only (p < 0.05). Surgeons evaluated interactive virtual simulation as having "prominent" utility for carrying out the entire surgical procedure in 50% of cases. It was evaluated as moderately useful or "supportive" in the other 50% of cases. There were no cases in which it was evaluated as having no utility. The utilities of interactive virtual simulation were associated with atypical or complex forms of neurovascular compression and structural restrictions in the surgical window. Finally, MVD procedures were performed as simulated in 23 (88%) of the 26 patients . CONCLUSIONS: Our interactive virtual simulation using a 3D computer graphics model provided a realistic environment for performing virtual simulations prior to MVD surgery and enabled us to ascertain complex microsurgical anatomy.

    DOI: 10.3171/2012.5.JNS112334

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  • Movement-related cortical activation with voluntary pinch task: simultaneous monitoring of near-infrared spectroscopy signals and movement-related cortical potentials. 国際誌

    Yosuke Sato, Masafumi Fukuda, Makoto Oishi, Yukihiko Fujii

    Journal of biomedical optics   17 ( 7 )   076011 - 076011   2012年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    This study was designed to evaluate hemodynamic and electrophysiological motor cortex responses to voluntary finger pinching in humans, with simultaneous recording of near-infrared spectroscopy (NIRS) signals and movement-related cortical potentials (MRCP). Six healthy, right-handed subjects performed 100 trials of voluntary right-thumb index-finger pinching with about a 10-second interval at their own pace. Throughout the session, 48 regions over the bilateral motor cortex were assessed by NIRS, while MRCP and electromyogram (EMG) were simultaneously monitored. MRCP started 1536 ± 58 ms before EMG onset and peaked 127 ± 24 ms after EMG onset. NIRS data showed bilateral prefrontal cortex at 0.5 ± 0.1 s before EMG onset and bilateral dorsal premotor cortex activations at 0.6 ± 0.1 s before EMG onset. The hand area of the sensorimotor cortex was activated left-dominantly, seen obviously peaked at 3.7 ± 0.2 s after EMG onset. The comparison between MRCP and NIRS results raised the possibility that the vascular response to neural activity occurs within 4 s with a voluntary pinch task. These results indicate that our technique allows detailed study of the motor control. Our method is a promising strategy for event-related motor control and neurovascular coupling studies.

    DOI: 10.1117/1.JBO.17.7.076011

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  • Epidermoid cyst involving the medial temporal lobe: surgical pathologic features of the epileptogenic lesion. 国際誌

    Tetsuya Hiraishi, Makoto Oishi, Hiroki Kitaura, Masae Ryufuku, Yong-Juan Fu, Masafumi Fukuda, Hitoshi Takahashi, Yukihiko Fujii, Akiyoshi Kakita

    Neuropathology : official journal of the Japanese Society of Neuropathology   32 ( 2 )   196 - 201   2012年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Epidermoid cysts in the middle fossa are rare and may involve the temporal lobe and lateral ventricle. Affected patients often suffer from seizures, but the pathomechanisms underlying the epileptogenic lesions have remained unclear. Here we report the surgical pathological features of the hippocampus in a 31-year-old woman with mesial temporal lobe epilepsy (mTLE), in whom an epidermoid cyst involving the right basal cistern and inferior horn of the lateral ventricle was evident. The ictal electrocorticogram indicated seizure onset at the parahippocampal gyrus. An anterior temporal lobectomy and amygdalohippocampectomy were performed. Histologically, the hippocampus showed marked atrophy with severe loss of pyramidal neurons in the cornu Ammonis subfields and granule cell loss in the dentate gyrus. At the ventricular surface of the hippocampus, there were small granulomatous lesions with spicularly anchored keratin substance. These features indicated multiple and chronic stab wounds by the cyst contents and consequent local inflammatory responses within the parenchyma. The predisposition to adhesion between the tumor and hippocampus may have caused neurons to develop abnormal irritability to certain chemical mediators present in the cyst. Epileptogenicity involving the atrophic hippocampus and medial temporal lobes nearby may have developed in association with these processes. This case appears to provide information that is useful for surgical planning in patients with mTLE and epidermoid cysts involving the medial temporal lobe.

    DOI: 10.1111/j.1440-1789.2011.01243.x

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  • Pharyngeal motor evoked potentials elicited by transcranial electrical stimulation for intraoperative monitoring during skull base surgery. 国際誌

    Masafumi Fukuda, Makoto Oishi, Tetsuya Hiraishi, Akihiko Saito, Yukihiko Fujii

    Journal of neurosurgery   116 ( 3 )   605 - 10   2012年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECT: The purpose of this study was to determine whether monitoring of pharyngeal motor evoked potentials (PhMEPs) elicited by transcranial electrical stimulation during skull base tumor surgery might be useful for predicting postoperative swallowing deterioration. METHODS: The authors analyzed PhMEPs in 21 patients during 22 surgical procedures for the treatment of skull base tumors. Corkscrew electrodes positioned at C3 or C4 and Cz were used to deliver supramaximal stimuli (220-550 V). Pharyngeal MEPs were recorded from the posterior wall of the pharynx through a modified endotracheal tube. The correlation between the final/baseline PhMEP ratio and postoperative swallowing function was examined. RESULTS: Postoperative swallowing function was significantly (p < 0.05), although not strongly (r = -0.47), correlated with the final/baseline PhMEP ratio. A PhMEP ratio < 50% was recorded during 4 of 22 procedures; in all 4 of these cases, the patients experienced postoperative deterioration of swallowing function. After 18 procedures, the PhMEP ratios remained > 50%; nevertheless, after 4 (22.2%) of these 18 procedures, patients showed deterioration of swallowing function. CONCLUSIONS: Intraoperative PhMEP monitoring can be useful for predicting swallowing deterioration following skull base surgery, especially in patients with swallowing disturbances that are mainly due to reduction in the motor functions of the pharyngeal muscles.

    DOI: 10.3171/2011.10.JNS111343

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  • Near-infrared spectroscopic study and the Wada test for presurgical evaluation of expressive and receptive language functions in glioma patients: with a case report of dissociated language functions. 国際誌

    Yosuke Sato, Takeo Uzuka, Hiroshi Aoki, Manabu Natsumeda, Makoto Oishi, Masafumi Fukuda, Yukihiko Fujii

    Neuroscience letters   510 ( 2 )   104 - 9   2012年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Near-infrared spectroscopy (NIRS) has proven to be useful for the evaluation of language lateralization in healthy subjects, infants, and epileptic patients. This study for the first time investigated the expressive and receptive language functions separately, using NIRS in presurgical glioma patients. We also describe a special case with dissociated pattern of language functions. Ten glioma patients were examined. Using NIRS, the hemodynamic changes during a verb generation task or story listening task were measured in the cerebral hemisphere on either side covering the language areas. Following the NIRS study, the Wada test was performed in all the patients. The NIRS study revealed increases of oxyhemoglobin and decreases of deoxyhemoglobin in the language areas elicited by both tasks. In 9 patients, who were all right-handed, the expressive and receptive language functions were lateralized to the left hemisphere. The results of the NIRS study were completely consistent with those of the Wada test. In the remaining 1 patient with a right sided insular glioma, who was right-handed, the NIRS study revealed stronger activation of the right inferior frontal region during the verb generation task, and stronger activation of the left superior temporal region during the story listening task. This dissociated language function was validated by the Wada test and the postoperative neurological course. These results demonstrate that a NIRS study using our technique is extremely valuable for preoperative assessment of the language functions and exemplifies how a preoperative NIRS study can allow detection of unforeseen language lateralization.

    DOI: 10.1016/j.neulet.2012.01.011

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  • Monitoring of abnormal muscle response and facial motor evoked potential during microvascular decompression for hemifacial spasm. 国際誌

    Masafumi Fukuda, Makoto Oishi, Tetsuro Takao, Tetsuya Hiraishi, Yosuke Sato, Yukihiko Fujii

    Surgical neurology international   3   118 - 118   2012年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: To determine whether the monitoring of abnormal muscle response (AMR) and facial motor evoked potential (FMEP) during microvascular decompression (MVD) for hemifacial spasm (HFS) might be useful for predicting the postoperative clinical course and final outcomes. METHODS: We analyzed 45 HFS patients who underwent both AMR and FMEP monitoring during MVD. Patients were divided into two groups on the basis of post-MVD disappearance (group AMR-A) or persistence (group AMR-B) of AMR. With regard to FMEPs, patients were classified into one of the two groups according to the ratio of the final to baseline FMEP amplitudes recorded for the orbicularis oculi muscle: one group with a ratio of <50% (group FMEP-A), and the other with a ratio of ≥50% (group FMEP-B). RESULTS: Twenty-one of the 26 (81%) patients in group AMR-A were assigned to group FMEP-A, whereas 9 of the 17 (53%) patients in group AMR-B were assigned to FMEP-B (P < 0.05). In 38 of the 40 (95%) patients in whom the AMRs disappeared or persisted at amplitudes <50% that at the baseline, HFS had subsided at the final follow-up. Forty of the 42 (95%) patients whose FMEP amplitude ratios indicated reduction in the amplitudes from the baseline, had complete relief of the symptoms. Nineteen of the 20 (95%) patients whose AMRs disappeared after MVD experienced immediate relief of their symptoms after the operation. With regard to 14 of the 20 (70%) patients whose AMRs persisted at the final recordings, the symptoms of HFS improved over time and eventually subsided (P < 0.001). CONCLUSIONS: Intraoperative monitoring of both AMR and FMEP during MVD may be useful in predicting the postoperative outcomes in HFS patients. The AMR-related findings may help to predict whether HFS disappears immediately after surgery or some time later.

    DOI: 10.4103/2152-7806.102328

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  • [Depiction of the cranial nerves around the cavernous sinus by 3D reversed FISP with diffusion weighted imaging (3D PSIF-DWI)].

    Go Ishida, Makoto Oishi, Shinya Jinguji, Yuichiro Yoneoka, Mitsuya Sato, Yukihiko Fujii

    No shinkei geka. Neurological surgery   39 ( 10 )   953 - 61   2011年10月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    To evaluate the anatomy of cranial nerves running in and around the cavernous sinus, we employed three-dimensional reversed fast imaging with steady-state precession (FISP) with diffusion weighted imaging (3D PSIF-DWI) on 3-T magnetic resonance (MR) system. After determining the proper parameters to obtain sufficient resolution of 3D PSIF-DWI, we collected imaging data of 20-side cavernous regions in 10 normal subjects. 3D PSIF-DWI provided high contrast between the cranial nerves and other soft tissues, fluid, and blood in all subjects. We also created volume-rendered images of 3D PSIF-DWI and anatomically evaluated the reliability of visualizing optic, oculomotor, trochlear, trigeminal, and abducens nerves on 3D PSIF-DWI. All 20 sets of cranial nerves were visualized and 12 trochlear nerves and 6 abducens nerves were partially identified. We also presented preliminary clinical experiences in two cases with pituitary adenomas. The anatomical relationship between the tumor and cranial nerves running in and around the cavernous sinus could be three-dimensionally comprehended by 3D PSIF-DWI and the volume-rendered images. In conclusion, 3D PSIF-DWI has great potential to provide high resolution "cranial nerve imaging", which visualizes the whole length of the cranial nerves including the parts in the blood flow as in the cavernous sinus region.

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  • Intraoperative facial nerve motor evoked potential monitoring during skull base surgery predicts long-term facial nerve function outcomes. 国際誌

    Masafumi Fukuda, Makoto Oishi, Tetsuya Hiraishi, Akihiko Saito, Yukihiko Fujii

    Neurological research   33 ( 6 )   578 - 82   2011年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVES: This study was designed to clarify whether facial nerve motor evoked potentials (FNMEPs) elicited by transcranial electrical stimulation during skull base surgery are useful for predicting long-term facial nerve function. METHODS: We analyzed FNMEP findings in 35 patients with skull base tumors. Mean follow-up was 24.4 months. Corkscrew electrodes positioned at C3 or C4 and Cz were used to deliver supramaximal stimuli. FNMEPs were recorded from the orbicularis oculi and oris muscles. RESULTS: The correlation between the final-to-baseline FNMEP ratio and initial or long-term facial nerve function was examined. Initial post-operative facial nerve function correlated significantly with the FNMEP ratios in the orbicularis oculi (r = -0.53, P < 0.005) and orbicularis oris (r = -0.80, P < 0.001) muscles. The correlations between FNMEP ratios and facial nerve function remained significant during long-term follow-up (orbicularis oculi muscle: r = -0.43, P < 0.05; orbicularis oris muscle: r = -0.71, P < 0.001). All patients in whom the FNMEP ratio in the orbicularis oculi muscles remained above 50% were assigned to the satisfactory facial nerve function (House-Brackmann Grades i and ii) group at the final examination. DISCUSSION: FNMEP monitoring can predict facial nerve function not only immediately after surgery but also long-term.

    DOI: 10.1179/016164110X12700393823697

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  • Usefulness of motor-evoked potential monitoring during coil embolization of anterior choroidal artery aneurysms: technical reports. 国際誌

    Tetsuya Hiraishi, Masafumi Fukuda, Makoto Oishi, Kazuhiko Nishino, Junsuke Shinbo, Takatoshi Sorimachi, Yasushi Ito, Yukihiko Fujii

    Neurological research   33 ( 4 )   360 - 2   2011年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVES: To determine whether transcranial motor-evoked potential (TCMEP) monitoring is useful for detecting blood flow insufficiency in the anterior choroidal artery (AChA) and reflects motor function during coil embolization of AChA aneurysms. METHODS: We analysed MEP findings in seven patients who underwent coil embolization for AChA aneurysms. Corkscrew electrodes positioned at C3 and C4 were used to deliver supra-maximal stimuli (230-550 V). TCMEPs were recorded from the brachioradialis, abductor pollicis brevis, anterior tibialis, and abductor hallucis muscles during all endovascular surgery procedures. RESULTS: Three of seven patients showed transient decreases in TCMEP amplitudes obtained from the lower extremities after coil insertion into the aneurysms, although digital subtraction angiography (DSA) showed no blood flow insufficiency in the AChAs. In two of these three patients, extraction of the coils resulted in recovery of TCMEP amplitudes. In the other patient, the amplitude recovered gradually during repeated TCMEP recordings. One of the three patients experienced transient hemiparesis and aphasia 3 hours after treatment. No patients experienced permanent morbidity post-operatively. DISCUSSION: Decreases in TCMEP amplitude during endovascular treatment for AChA aneurysms are likely to reflect motor dysfunction due to a subtle blood flow insufficiency in the AChA, not detectable by DSA. TCMEP monitoring is a simple and safe monitoring method during coil embolization of AChA aneurysms.

    DOI: 10.1179/016164110X12807570

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  • Clinicopathological factors related to regrowth of vestibular schwannoma after incomplete resection. 国際誌

    Masafumi Fukuda, Makoto Oishi, Tetsuya Hiraishi, Manabu Natsumeda, Yukihiko Fujii

    Journal of neurosurgery   114 ( 5 )   1224 - 31   2011年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECT: The authors retrospectively analyzed various clinicopathological factors to determine which are related to regrowth during a long-term follow-up period in patients who underwent incomplete vestibular schwannoma (VS) resection. METHODS: This study involved 74 patients (25 men and 49 women) in whom a VS was treated surgically via the lateral suboccipital approach, and who had postoperative follow-up periods exceeding 5 years. The mean follow-up was 104.1 months (range 60-241 months), and the mean patient age at surgery was 48.1 years (range 19-75 years). The tumors ranged in size from 0 mm (localized within the internal auditory canal) to 56 mm (28.3 ± 12.2 mm [mean ± SD]). RESULTS: Gross-total resection (GTR) was performed in 41 (55%) of the 74 patients; subtotal resection ([STR]; 90-99%) in 25 (34%); and partial resection ([PR]; < 90%) in 8 (11%). Regrowth rates in the GTR, STR, and PR groups were 2.4% (1 of 41 cases), 52% (13 of 25), and 62.5% (5 of 8), respectively, and the times to regrowth ranged from 6 to 76 months (median 31.9 months). The regrowth-free survival curves differed significantly between the complete (GTR) and incomplete (STR and PR) resection groups. Eighteen (54.5%) of the 33 patients who underwent incomplete resection showed evidence of regrowth during follow-up. Univariate and multivariate analyses of various factors revealed that both the thickness of the residual tumor, based on MR imaging after surgery, and the MIB-1 index were positively related to residual tumor regrowth. The receiver operating characteristic curves, plotted for both the thickness of the residual tumor and the MIB-1 index, identified the optimal cutoff points for these values as 7.4 mm (sensitivity 83.3%, specificity 86.7%) and 1.6 (sensitivity 83.3%, specificity 66.7%), respectively. CONCLUSIONS: Greater residual tumor thickness, based on MR imaging after the initial surgery, and a higher MIB-1 index are both important factors related to postoperative tumor regrowth in patients who have undergone incomplete VS resection. These patients require frequent neuroimaging investigation during follow-up to assure early detection of tumor regrowth.

    DOI: 10.3171/2010.11.JNS101041

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  • Presurgical simulation with advanced 3-dimensional multifusion volumetric imaging in patients with skull base tumors. 国際誌

    Makoto Oishi, Masafumi Fukuda, Go Ishida, Akihiko Saito, Tetsuya Hiraishi, Yukihiko Fujii

    Neurosurgery   68 ( 1 Suppl Operative )   188 - 99   2011年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Despite recent diagnostic and technical advancements in the field of neurosurgery, surgical treatment for tumors in the skull base region, ie, skull base tumors (SBTs), remains a challenge. OBJECTIVE: To validate the utility of presurgical simulation for the treatment of SBTs by 3-dimensional multifusion volumetric imaging (3D MFVI), including volume rendering and image fusion, to combine data from various imaging modalities. METHODS: We performed presurgical simulation using 3D MFVI for 21 SBTs (acoustic neurinomas, jugular neurinomas, meningiomas, chordomas, and others) in 20 patients. We collected targeted data from computed tomography, magnetic resonance imaging, computed tomography or magnetic resonance angiography, and digital subtraction angiography and combined these data using image-analyzing software. The simulations were used to assess the 3D relationships among the microsurgical anatomical components, the appropriate surgical approach, and the resectable parts of the tumor. Finally, we compared the results of the simulation with the operative results. RESULTS: In all patients, the 3D MFVI techniques enabled adequate visualization of the microsurgical anatomy and facilitated presurgical simulation, thereby allowing the surgeons to determine an appropriate and feasible surgical approach. All procedures to open the bone window were performed in accordance with the simulations, except for the surgical exposure of the acoustic canal for 2 acoustic neurinomas. In 3 of the 21 cases, tumor removal could not be performed according to the simulations because of unexpected bleeding or other restrictions. CONCLUSION: The 3D MFVI technique was of a sufficiently high quality to enable visualization of the 3D microsurgical anatomy. This promising method can facilitate determination of the most appropriate approach and safe and precise surgical procedures for SBTs.

    DOI: 10.1227/NEU.0b013e318207b3ad

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  • [Depiction of the trigeminal nerve deviated by a tumor lesion, using probabilistic diffusion tensor tractography].

    Go Ishida, Makoto Oishi, Masafumi Fukuda, Mitsuya Sato, Yukihiko Fujii

    No shinkei geka. Neurological surgery   39 ( 3 )   255 - 62   2011年3月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    We attempted presurgical visualization of the trigeminal nerve deviated by tumor compression using the probabilistic diffusion tractography (PDT) technique, which is used to analyze diffusion tensor imaging (DTI) data. We acquired DTI data of 3 patients with a tumor lesion around the trigeminal nerve (2 patients with trigeminal neurinomas and 1 with epidermoid) using the 3T magnetic resonance imaging system. The DTI data was analyzed by PDT using the Diffusion Toolbox, and the software of FMRIB (FDT; www.fmrib.ox.ac.uk/fsl). In all 3 patients, PDT allowed successful visualization of the trigeminal nerve which is further distal to the trigeminal ganglion, even when heavy T2-weighted imaging and conventional fiber-tracking analysis of the DTI data revealed only the cisternal segment of the nerves. Especially in 2 cases with the tumor mainly located in the Meckel's cave, the location of the nerve was determined only by PDT. All these findings obtained by PDT were concordant with the intraoperative observation of the actual nerves. In conclusion, PDT is a useful technique for visualization of the trigeminal nerve even when it is severely deviated by tumor compression, and this technique could have potential for evaluating other cranial nerves in surgical cases with a tumor in the skull base.

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  • Trigeminal neuralgia associated with the specific bridging pattern of transverse pontine vein: diagnostic value of three-dimensional multifusion volumetric imaging. 国際誌

    Makoto Oishi, Masafumi Fukuda, Yoshiyuki Noto, Tadashi Kawaguchi, Tetsuya Hiraishi, Yukihiko Fujii

    Stereotactic and functional neurosurgery   89 ( 4 )   226 - 33   2011年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVES: We report the specific bridging pattern of a transverse pontine vein (TPV) associated with trigeminal neuralgia (TN), which was evaluated by 3-dimensional (3D) multifusion volumetric imaging (MFVI). METHODS: In 3 cases with TN (V1 or V1-2 territory), constructive interference in steady state (CISS) imaging confirmed no arterial compression but indicated a vein draining into Meckel's cave. Virtual endoscopic (VE) analysis for CISS images and 3D MFVI (in 2 cases) including venous information was obtained by a multidetector row computed tomography (MDCT) system. Additionally, we investigated the bridging pattern of veins around Meckel's cave on 3D MFVI of 50 cerebellopontine angle (CPA) regions without any lesions. RESULTS: In all 3 patients, VE of CISS or 3D MFVI identified a bridging vein from the TPV causing the focal deformity of the trigeminal nerve near Meckel's cave. All those patients achieved a pain-free state after surgically coagulating and cutting the vein. In investigating 3D MFVI of 50 CPA regions, this type of the bridging vein was found in 4 (8%) including the presented 2 cases. CONCLUSIONS: The specific bridging pattern of the TPV draining into Meckel's cave can be associated with TN. The 3D MFVI analysis using venous information obtained by MDCT was useful to evaluate surgical anatomy including the offending vein which can be missed.

    DOI: 10.1159/000326778

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  • Prediction of the microsurgical window for skull-base tumors by advanced three-dimensional multi-fusion volumetric imaging.

    Makoto Oishi, Masafumi Fukuda, Go Ishida, Akihiko Saito, Tetsuya Hiraishi, Yukihiko Fujii

    Neurologia medico-chirurgica   51 ( 3 )   201 - 7   2011年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    The surgery of skull base tumors (SBTs) is difficult due to the complex and narrow surgical window that is restricted by the cranium and important structures. The utility of three-dimensional multi-fusion volumetric imaging (3-D MFVI) for visualizing the predicted window for SBTs was evaluated. Presurgical simulation using 3-D MFVI was performed in 32 patients with SBTs. Imaging data were collected from computed tomography, magnetic resonance imaging, and digital subtraction angiography. Skull data was processed to imitate actual bone resection and integrated with various structures extracted from appropriate imaging modalities by image-analyzing software. The simulated views were compared with the views obtained during surgery. All craniotomies and bone resections except opening of the acoustic canal in 2 patients were performed as simulated. The simulated window allowed observation of the expected microsurgical anatomies including tumors, vasculatures, and cranial nerves, through the predicted operative window. We could not achieve the planned tumor removal in only 3 patients. 3-D MFVI afforded high quality images of the relevant microsurgical anatomies during the surgery of SBTs. The intraoperative déjà-vu effect of the simulation increased the confidence of the surgeon in the planned surgical procedures.

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  • [Effects of abnormal muscle response monitoring on manipulation of microvascular decompression].

    Masafumi Fukuda, Makoto Oishi, Tetsuya Hiraishi, Yukihiko Fujii

    No shinkei geka. Neurological surgery   38 ( 6 )   531 - 8   2010年6月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Intraoperative abnormal muscle response (AMR) monitoring is used as an indicator of postoperative outcome in patients with hemifacial spasm (HFS). We investigated whether AMR findings influence manipulation of microvascular decompression and improve the postoperative results. MATERIALS AND METHODS: Subjects were 102 HFS patients who underwent AMR monitoring during surgery. The value of AMR monitoring was classified into four categories: a guiding, a confirming, an indirect confirming, or an inconclusive role. The relationship between AMR monitoring results and surgical outcome was analyzed. RESULTS: The overall cure rate was 92.2%. A guiding role of AMR monitoring was apparent in 13.7% of patients, and a confirming role was demonstrated in 53.9% of patients. The cure rate was 92.9% in patients defined as guiding, and 96.4% in patients defined as confirming cases. When the AMR remained disappearance until completion of decompression in patients assigned in indirect confirming, 13 of 15 patients (86.7%) experienced resolution postoperatively. In patients defined as inconclusive cases, 14 of 16 patients (87.5%) in whom AMR still presented but its amplitude decreased at the end of surgery experienced complete resolution. CONCLUSIONS: This study demonstrates that meticulous evaluation of AMR findings intraoperatively can help to improve the results of surgery. We believe that intraoperative AMR monitoring is useful in microvascular decompression for HFS.

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  • Facial nerve motor-evoked potential monitoring during microvascular decompression for hemifacial spasm. 国際誌

    Masafumi Fukuda, Makoto Oishi, Tetsuya Hiraishi, Yukihiko Fujii

    Journal of neurology, neurosurgery, and psychiatry   81 ( 5 )   519 - 23   2010年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: To determine whether monitoring facial nerve motor-evoked potentials (FNMEPs) elicited by transcranial electrical stimulation during microvascular decompression (MVD) for hemifacial spasm (HFS) is useful for predicting postoperative outcome. METHODS: The authors analysed FNMEP findings in 25 patients with HFS. Corkscrew electrodes positioned at C3 or C4 and Cz were used to deliver supramaximal stimuli (152-450 V). FNMEPs were recorded from the orbicularis oculi, mentalis and oris muscles. Differences in amplitude or response duration between the final (at dural closure) and baseline FNMEP were evaluated. Final-to-baseline FNMEPs ratios (shown as percentages) obtained from the three muscles were examined. RESULTS: In the orbicularis oculi muscles, both duration and amplitude in the final FNMEP were significantly reduced compared with the baseline FNMEP (p<0.001 and p<0.0005, respectively). The FNMEP ratio obtained from the orbicularis oculi muscle (44.8+/-25.4%) was significantly lower than the other two muscles (95.8+/-51.2% for the mentalis muscle and 84.5+/-34.6% for the orbicularis oris muscle; p<0.0001). In one patient who showed the same degree of symptoms immediately after surgery as in the preoperative state, neither LSRs nor FNMEP from the orbicularis oculi muscle changed. CONCLUSIONS: The FNMEP amplitude from the orbicularis oculi muscle decreased after MVD in HFS patients whose symptoms were resolved postoperatively, thus suggesting normalisation of facial nerve excitability. FNMEP monitoring during MVD surgery as well as LSR monitoring could predict postoperative outcome in HFS patients.

    DOI: 10.1136/jnnp.2009.181495

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  • Long-term outcomes after surgical treatment of jugular foramen schwannoma. 国際誌

    Masafumi Fukuda, Makoto Oishi, Akihiko Saito, Yukihiko Fujii

    Skull base : official journal of North American Skull Base Society ... [et al.]   19 ( 6 )   401 - 8   2009年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    The purpose of this article is to clarify long-term outcomes following surgery for jugular foramen schwannomas. Fifteen adult patients underwent surgery, predominantly via the lateral suboccipital approach, for jugular foramen schwannomas between December 1987 and May 2007. All information was collected retrospectively from patient medical records at a university hospital. The main outcome measures were tumor regrowth and IX-X nerve function at median 84.3 months (range, 12 to 166 months) following surgery. Near total removal was achieved in 10 patients, and the remaining 5 patients had subtotal removal. Tumor regrowth was observed in 9 of 15 patients at 6 to 89 months (mean, 31.2 months) after surgery. The actual tumor control rate was 70.0 +/- 12.8% at 5 years. Fourteen of 15 patients exhibited IX-X nerve dysfunction immediately after surgery, but 8 of these 14 patients experienced amelioration of the symptoms at the final follow-up period. No patients required additional treatment. We found in our study that for jugular foramen schwannoma, tumor volume should be reduced as much as possible to avoid severe IX-X nerve damages postoperatively. If a small amount of tumor remains, long-term follow-up is necessary.

    DOI: 10.1055/s-0029-1220197

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  • [Presurgical evaluaton for lateral suboccipital craniotomy using contrast-enhanced CT volumetric imaging].

    Makoto Oishi, Masafumi Fukuda, Akihiko Saito, Tetsuya Hiraishi, Yukihiko Fuji

    No shinkei geka. Neurological surgery   37 ( 5 )   459 - 65   2009年5月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    To safely and precisely accomplish lateral suboccipital craniotomy (LSOC), we have presurgically evaluated the three-dimensional (3-D) relationships of various vascular structures and cranial landmarks in the occipito-cervical region by volumetric imaging of 3-D contrast enhanced computed tomography (CECT). The 3-D anatomies visualized by adjusting the window width, window level, and opacity level of the specific CT value for each structure were an occpital artery (OA), mastoid and posterior condylar emissary veins (MEV and PCEV), which were useful in dissecting muscles and exposing the cranial surface, and the relationship of the transverse-sigmoid sinus CTSS) and the asterion, which was necessary and decisive for making a key burr hole to perform craniotomy. The morphologic analysis for our 48 cases with cerebello-pontine angle tumor or neurovascular compression syndrome showed running patterns of OA, varieties of MEV and PCEV in their sizes and connections, right dominance of TSS, and the various relationship between the TSS and the asterion. Especially, the exact location of the TSS compared to the astenon was found to be inferior in 56%, right below in 38%, and superior in 6%. In conclusion, presurgical evaluation using volumetric imaging of 3-D CECT is a convenient and valuable method for obtaining the anatomic information required for performing LSOC safely and precisely in individual patients.

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  • Three-dimensional visualization of neurovascular compression: presurgical use of virtual endoscopy created from magnetic resonance imaging. 国際誌

    Tetsuro Takao, Makoto Oishi, Masafumi Fukuda, Go Ishida, Mitsuya Sato, Yukihiko Fujii

    Neurosurgery   63 ( 1 Suppl 1 )   ONS139-45; discussion ONS145-6   2008年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: To assess the usefulness of presurgical simulation of microvascular decompression (MVD) by virtual endoscopy (VE), a new tool to analyze three-dimensionally reconstructed magnetic resonance data sets in patients with trigeminal neuralgia or hemifacial spasm (HFS). METHODS: In 17 patients (10 with trigeminal neuralgia and seven with HFS) determined to be candidates for MVD, we performed presurgical simulation of MVD using VE. We used constructive interference in steady-state imaging and magnetic resonance angiography to obtain the original images. VE findings were compared with surgical findings. RESULTS: The three-dimensional relations between visible structures seen on VE were consistent with intraoperative findings in all patients. In total, 20 (91%) of 22 neurovascular compression sites in all 17 patients were correctly delineated on VE, with the exception of two small branches identified as offending vessel in two patients with HFS. Perforators that were not apparent on VE limited our ability to accomplish transpositioning of the offending vessels as simulated. The positions of structures that can affect individual surgical approaches, such as the petrosal vein, cerebellar flocculus, and vertebral artery, were also adequately predicted on VE. All patients had excellent surgical outcomes. CONCLUSION: Presurgical VE in patients with trigeminal neuralgia or HFS is a novel technique that provides excellent visualization of the three-dimensional relations between neurovascular structures and allows simulation of MVD.

    DOI: 10.1227/01.neu.0000335028.77779.7c

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  • [Facial nerve motor evoked potentials elicited by transcranial electrical stimulation for intraoperative monitoring].

    Masafumi Fukuda, Makoto Oishi, Akihiko Saito, Tetsuro Takao, Yukihiko Fujii

    No shinkei geka. Neurological surgery   36 ( 4 )   315 - 21   2008年4月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: To determine whether monitoring facial nerve motor evoked potentials (FNMEPs) elicited by transcranial electrical stimulation during skull base tumor surgery is useful for predicting facial nerve outcome. METHODS: We analyzed FNMEP findings in 31 patients with skull base tumor. Surgery was performed twice in 2 of the 31 patients because of tumor regrowth. FNMEP monitoring was conducted 33 times in the present study. Corkscrew electrodes positioned at C3 or C4 and Cz were used to deliver supramaximal stimuli (140-550V). FNMEPs were recorded from the orbicularis oculi and oris muscles. Correlation between the final-to-baseline FNMEP ratio and postoperative facial nerve function (House & Brackmann grade) was examined. RESULTS: Valid FNMEPs were obtained in 26 of the 33 (78.8%) recordings from the orbicularis oculi muscle and in 31 of the 33 (93.9%) recordings from the orbicularis oris muscle. Facial nerve function correlated significantly with the FNMEP ratios in the orbicularis oculi (r = -0.52 N=26, p < 0.01) and orbicularis oris (r = -0.60, N=31, p < 0.001) muscles. An FNMEP ratio of -50% consistently predicted immediate postoperative facial palsy, although the degree of palsy differed among the patients. CONCLUSIONS: Intraoperative FNMEP monitoring is useful for predicting facial nerve function after skull base surgery.

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  • Etiopathological factors related to hydrocephalus associated with vestibular schwannoma. 国際誌

    Masafumi Fukuda, Makoto Oishi, Tadashi Kawaguchi, Masatoshi Watanabe, Tetsuro Takao, Ryuichi Tanaka, Yukihiko Fujii

    Neurosurgery   61 ( 6 )   1186 - 92   2007年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: We retrospectively analyzed various clinical factors to determine whether or not these factors are etiopathologically related to the development of hydrocephalus in patients with vestibular schwannomas. METHODS: There were 68 patients (29 men, 39 women) in this study who underwent resection of a vestibular schwannoma. The age at the time of surgery ranged from 19 to 76 years (mean age, 51.4 yr). The maximum diameter of the tumor in the cerebellopontine cistern ranged from 0 (localized within the internal auditory canal) to 56 mm (mean, 32.0 +/- 12.9 mm). Cerebrospinal fluid (CSF) protein concentration in the cerebellomedullary cistern was measured intraoperatively in all patients. RESULTS: Sixteen (23.5%) of the 68 patients exhibited radiographic evidence of hydrocephalus. Univariate analysis of various factors revealed that both tumor size and CSF protein concentration were positively related to development of hydrocephalus (P < 0.05 and P < 0.01, respectively). However, in multiple logistic regression analysis, only the CSF protein concentration was predictive for development of hydrocephalus (P = 0.022). There was a trend toward increased CSF protein concentration in patients with a large tumor (> or = 40 mm) compared with those with a small tumor (< 40 mm) (P = 0.06). CONCLUSION: A high CSF protein concentration in fluid from the cerebellomedullary cistern is one of the most important factors contributing to hydrocephalus associated with vestibular schwannoma. It is important to judge whether or not any further treatment is required for hydrocephalus, in addition to tumor resection, especially in patients with communicating hydrocephalus.

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  • [The utility of presurgical simulation of microvascular decompression by MR virtual endoscopy].

    Makoto Oishi, Masafumi Fukuda, Tetsuro Takao, Go Ishida, Mitsuya Sato, Yukihiko Fujii

    No shinkei geka. Neurological surgery   35 ( 11 )   1087 - 95   2007年11月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: We conducted the present study to assess the utility of virtual endoscopy (VE) created by volume rendering of MR images in presurgical simulation for trigeminal neuralgia (TN) and hemifacial spasm (HFS). METHODS: In 12 patients (six with TN and six with HFS), we presurgically evaluated the anatomy of the cerebellopontine angle (CPA) region and simulated an appropriate surgical approach by VE of heavy T2-weighted imaging and MR angiography. RESULTS: The three-dimensional (3-D) relations of neurovascular structures in the CPA region were compatible between on-VE and on-the-intraoperative view in all patients. The compression sites and the major offending vessels were correctly depicted, except for two small branches as the offending vessel. The other important structures affecting the surgical procedure were identified as major petrosal veins in all patients with TN, a vertebral artery in three with HFS, and a large cerebellar flocculus in three with HFS. Transposition of the offending vessels was performed as simulated in all patients with TN and in three patients with HFS. All patients had an excellent surgical outcome. CONCLUSIONS: Presurgical simulation by VE in patients with TN and HFS is a novel method that provides excellent visualization of the 3-D relations of neurovascular structures in the CPA region and allows us to accomplish successful and safe surgery.

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  • Stereotactic radiofrequency thermocoagulation for hypothalamic hamartoma with intractable gelastic seizures. 国際誌

    Junpei Homma, Shigeki Kameyama, Hiroshi Masuda, Takehiko Ueno, Ayataka Fujimoto, Makoto Oishi, Masafumi Fukuda

    Epilepsy research   76 ( 1 )   15 - 21   2007年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Management of hypothalamic hamartoma with intractable gelastic epilepsy remains controversial. We have used stereotactic thermocoagulation for treatment of hypothalamic hamartoma with intractable gelastic epilepsy since 1997. Herein, we review our experience in five cases to clarify the usefulness of this treatment. A total of five patients with hypothalamic hamartoma were treated by stereotactic thermocoagulation at our hospital during the period October 1997 through February 2004. In all patients, the hamartoma was less than 10mm in diameter and was located on the floor of the third ventricle with sessile attachment to the wall. To identify ictal onset, chronic intracranial electroencephalography was performed in three patients with the use of a depth electrode implanted in the hamartoma. Attempts were made to induce gelastic seizure by electrical stimulation of the hamartoma in three patients. After magnetic resonance imaging-guided targeting, radiofrequency thermocoagulation of the boundary between the hamartoma and normal hypothalamus was performed to achieve disconnection effects. Marked reductions in seizure frequency were obtained in all cases, with three patients becoming seizure-free after the procedure. No intraoperative complications occurred except in one patient who experienced acute and transient panidrosis with hot flushes during coagulation. Our results suggest that stereotactic thermocoagulation of hypothalamic hamartoma is an acceptable treatment option for patients with intractable gelastic seizures.

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  • [A case of solitary fibrous tumor in the cerebral convexity indicating its non-dural origin].

    Masakazu Sano, Akihiko Saito, Yasushi Nishihira, Makoto Oishi, Akiyoshi Kakita, Hitoshi Takahashi, Yukihiko Fujii

    No shinkei geka. Neurological surgery   35 ( 7 )   697 - 702   2007年7月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    We report a case of solitary fibrous tumor (SFT) in the cerebral convexity, and present characteristic radiological and surgical findings to determine its origin. The patient was a 59-year-old man with mental dullness and mild gait disturbance. CT scan and MR images showed a highly enhanced large mass lesion mimicking a meningioma in the left parietal convexity. However, neither dural enhancement nor tail sign indicative of meningioma was observed. Angiography showed prominent feedings from branches of the internal carotid and basilar arteries rather than the external carotid artery. For this reason, presurgically, we suggested hemangiopericytoma or other specific meningiomas as a differential diagnoses. Surgery confirmed that the tumor had no attachment to the dura mater and was covered by the arachnoid membrane. The bottom of the tumor adhered tightly to brain tissue. The origin was considered to be the brain surface, pia mater or a part of the arachnoid membrane. Histopathologically, the tumor was diagnosed as a SFT with findings of "attemless pattern" and diffuse CD34 staining. The radiological and surgical findings of the present case indicated in the cerebral convexity as a unique site of origin of SFT.

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  • [New diagnostic imaging methods in neurosurgery: advent of anatomical and functional neuroimaging].

    Makoto Oishi, Takeo Uzuka, Yuichiro Yoneoka, Yukihiko Fujii, Hironaka Igarashi

    No shinkei geka. Neurological surgery   35 ( 3 )   291 - 300   2007年3月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    Progress in imaging techniques has contributed to improvements in reliable diagnosis and surgical decision making in neurosurgery. From the viewpoint of neurosurgeons, there are two major needs in the development of imaging techniques. One is greater accuracy in demonstrating the anatomy of the brain at microscopic resolutions and the other is visualization of function or metabolism that is invisible on surgical views. Use of 3.0 T magnetic resonance imaging (MRI) in clinical patients has revealed anatomy appropriate for microsurgery at high resolution, and three-dimensional reconstruction of MRI on high-specification computers helps neurosurgeons to understand the anatomy of the brain in individual patients. Functional imaging methods such as functional MRI, positron emission tomography, and magnetoencephalography have provided new insights in brain surgery, visualizing various cerebral functions on anatomic images. Recently, diffusion tensor imaging is used to visualize neural tracts passing through subcortical white matter and MR spectroscopy is used to show the metabolic status of lesions. These tools are also forms of functional imaging. New noninvasive imaging techniques are still being developed to visualize function more easily. Here, we summarize the roles of recent imaging techniques in our previous studies and discuss the future of imaging in neurosurgery.

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  • Unusual giant cerebral venous varix associated with brain abscess: variant of hereditary hemorrhagic telangiectasia--case report.

    Makoto Oishi, Osamu Sasaki, Shinji Nakazato, Kenji Suzuki, Keiko Kitazawa, Tetsuro Takao, Tetsuo Koike

    Neurologia medico-chirurgica   47 ( 2 )   74 - 8   2007年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    A 35-year-old man suffered secondary generalized tonic-clonic convulsions due to a large brain abscess. Neuroimaging incidentally revealed another tumor-like lesion. Cerebral angiography confirmed that the lesion was an unusual giant venous varix associated with a high-flow pial arteriovenous fistula (AVF) and showed one more small arteriovenous malformation (AVM). Pulmonary AVF, which can cause brain abscess, was also detected. Surgical ligation of the AVF and removal of the small AVM via individual craniotomies resulted in successful extirpation of the cerebrovascular malformations. Although the typical mucocutaneous symptoms were absent in this patient, the combination of arteriovenous anomalies was highly suggestive of hereditary hemorrhagic telangiectasia.

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  • Magnetoencephalography in patients with tuberous sclerosis and localization-related epilepsy. 国際誌

    Takanori Kamimura, Jun Tohyama, Makoto Oishi, Noriyuki Akasaka, Osamu Kanazawa, Mutsuo Sasagawa, Mitsuhiro Kato, Kousaku Ohno, Hiroshi Masuda, Shigeki Kameyama, Makoto Uchiyama

    Epilepsia   47 ( 6 )   991 - 7   2006年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: To clarify the usefulness of magnetoencephalography (MEG) for diagnosis of the spatial relations between spike foci and suspicious epileptogenic tubers on MRI in patients with tuberous sclerosis (TS) and to compare MEG spike foci with single-photon emission computed tomography (SPECT) findings. METHODS: We analyzed magnetic fields of epileptic spike discharges in 15 patients with TS and localization-related epilepsy (LRE) by using MEG (a whole-head 204-channel magnetometer system). We investigated the spatial relation between the equivalent current dipoles (ECDs) of interictal spike discharges and visible cortical tubers on MRI. We also compared results of MEG and MRI with SPECT findings. RESULTS: MEG detected a cluster of ECDs around one cortical tuber in six of 15 patients and clusters of ECDs around two cortical tubers in five patients. Interictal SPECT was disappointing in detection of epileptic foci in TS. However, MEG spike foci showed spatial consistency with ictal hyperperfusion areas in two patients. Three patients with single ECD clusters underwent surgical treatment: two have been seizure free, and one has obtained seizure reduction of >90%. CONCLUSIONS: ECDs were located around visible tuber nodules. MEG enabled precise localization of the epileptic foci and provided crucial information for surgical treatment in patients with TS and partial epilepsy. TS patients showing a single ECD cluster on MEG may be appropriate candidates for surgical treatment.

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  • Single and multiple clusters of magnetoencephalographic dipoles in neocortical epilepsy: significance in characterizing the epileptogenic zone. 国際誌

    Makoto Oishi, Shigeki Kameyama, Hiroshi Masuda, Jun Tohyama, Osamu Kanazawa, Mutsuo Sasagawa, Hiroshi Otsubo

    Epilepsia   47 ( 2 )   355 - 64   2006年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: To characterize the epileptogenic zone in neocortical epilepsy (NE) by using magnetoencephalography (MEG). METHODS: We defined and compared locations of single and multiple clusters of equivalent current dipoles (ECDs) for interictal spikes with MRI findings, ictal-onset zones (IOZs) from subdural electroencephalography (SDEEG), resected areas, and postsurgical outcomes of 20 patients who underwent cortical resection for medically intractable NE. RESULTS: Fourteen patients had single clusters; six had multiple clusters. Overlap of clusters and IOZs defined group A (nine patients), in which a single cluster coincided with the IOZ; group B1 (four patients), in which a single cluster was within or partially overlapped the IOZ; group B2 (five patients), in which multiple-cluster sections overlapped IOZs; group C (two patients; one single; one multiple), in which no overlap was seen. More single clusters (nine of 14) than multiple clusters (none of six) coincided with the IOZ (p = 0.014). More patients with single clusters (10 of 14) than patients with multiple clusters (one of six) had seizure-free outcomes (p = 0.049). Eight of nine patients in group A, versus three of 11 in groups B1, B2, and C, achieved seizure-free outcomes (p = 0.0098). Correlations between MRI findings and postsurgical outcomes were not statistically significant; eight of 13 patients with single lesions, one of four with no lesions, and two of three with multifocal lesions had seizure-free outcomes. CONCLUSIONS: In neocortical epilepsy, MEG ECD clusters correlated with SDEEG IOZs. Single clusters indicated discrete epileptogenic zones that required complete resection for seizure-free outcome. Multiple clusters necessitated that the multiple or extensive epileptogenic zones be completely identified and delineated by SDEEG.

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  • Characterizing magnetic spike sources by using magnetoencephalography-guided neuronavigation in epilepsy surgery in pediatric patients. 国際誌

    Koji Iida, Hiroshi Otsubo, Yuuri Matsumoto, Ayako Ochi, Makoto Oishi, Stephanie Holowka, Elizabeth Pang, Irene Elliott, Shelly K Weiss, Sylvester H Chuang, O Carter Snead 3rd, James T Rutka

    Journal of neurosurgery   102 ( 2 Suppl )   187 - 96   2005年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECT: The authors sought to validate magnetoencephalography spike sources (MEGSSs) in neuronavigation during epilepsy surgery in pediatric patients. METHODS: The distributions of MEGSSs in 16 children were defined and classified as clusters (Class I), greater than or equal to 20 MEGSSs with 1 cm or less between MEGSSs; small clusters (Class II), 6 to 19 with 1 cm or less between; and scatters (Class III), less than 6 or greater than 1 cm between spike sources. Using neuronavigation, the MEGSSs were correlated to epileptic zones from intra- and extraoperative electrocorticography (ECoG), surgical procedures, disease entities, and seizure outcomes. Thirteen patients underwent MEGSSs: nine had clusters; two had small clusters, one with and one without clusters; and three had scatters alone. All 13 had scatters. Clusters localized within and extended from areas of cortical dysplasia and at margins of tumors or cystic lesions. All clusters were colocalized to ECoG-defined epileptic zones. Four of 10 patients with clusters and/or small clusters underwent complete excisions, and six underwent partial excision with or without multiple subpial transections. In the three patients with scatters alone, ECoG revealed epileptic zones buried within MEGSS areas; these regions of scatters were completely excised and treated with multiple subpial transections. Coexisting scatters were left untreated in nine of 10 patients. Postoperatively, nine of 13 patients were seizure free; the four patients with residual seizures had clusters in unresected eloquent cortex. Three patients in whom no MEGSSs were demonstrated underwent lesionectomies and were seizure free. CONCLUSIONS: Magnetoencephalography spike source clusters indicate an epileptic zone requiring complete excision. Coexisting scatters remote from clusters are nonepileptogenic and do not require excision. Scatters alone, however, should be examined by ECoG; an epileptic zone may exist within these distributions.

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  • Cortical activation in area 3b related to finger movement: an MEG study. 国際誌

    Makoto Oishi, Shigeki Kameyama, Masafumi Fukuda, Kuniko Tsuchiya, Toru Kondo

    Neuroreport   15 ( 1 )   57 - 62   2004年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    To evaluate cortical activation reflecting sensory feedback after finger movement, we recorded movement-related cerebral fields (MRCFs) following voluntary finger movement and somatosensory evoked fields for mixed (median) and pure cutaneous (radial) nerve stimulations (mSEFs and rSEFs) in six normal subjects. Equivalent current dipoles for movement-evoked field 1 (MEF1) in MRCFs and the component (70m) obtained in mSEFs, not clearly in rSEFs, were similarly distributed in each subject. They were located in area 3b, but both mean locations were significantly (p < 0.01) medial to N20m in mSEFs. MEF1 and 70m reflect similar cortical activities related to finger movement and have the same neuronal generator in area 3b, which is different from that of N20m.

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  • Epileptic spikes: magnetoencephalography versus simultaneous electrocorticography. 国際誌

    Makoto Oishi, Hiroshi Otsubo, Shigeki Kameyama, Nobuhito Morota, Hiroshi Masuda, Masaomi Kitayama, Ryuichi Tanaka

    Epilepsia   43 ( 11 )   1390 - 5   2002年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: To test the sensitivity of extracranial magnetoencephalography (MEG) for epileptic spikes in different cerebral sites. METHODS: We simultaneously recorded MEG and electrocorticography (ECoG) by using subdural electrodes with 1-cm interelectrode distances for one patient with lateral frontal epilepsy and one patient with basal temporal epilepsy. We analyzed MEG spikes associated with ECoG spikes and compared the maximal amplitude and number of electrodes involved. We estimated and evaluated the locations and moments of the equivalent current dipoles (ECDs) of MEG spikes. RESULTS: In patient 1, MEG detected 100 (53%) of 188 ECoG lateral frontal spikes, including 31 (46%) of 67 spikes that activated three subdural electrodes. MEG spike amplitudes correlated with ECoG spike amplitudes and the number of electrodes activated (p < 0.01). ECDs were perpendicular to the superior frontal sulcus. In patient 2, MEG detected 31 (26%) of 121 ECoG basal temporal spikes, but none that activated only three subdural electrodes. ECDs were localized in the entorhinal and parahippocampal gyri, oriented perpendicular to those basal temporal cortical surfaces. The ECD strength was 136.6 +/- 71.5 nAm in the frontal region, but 274.5 +/- 150.6 nAm in the temporal region (p < 0.01). CONCLUSIONS: When lateral frontal ECoG spikes extend >3 cm2 across the fissure, MEG can detect >50%, correlating with spatial activation and voltage. In the basal temporal region, MEG requires higher-amplitude discharges over a more extensive area. MEG shows a significantly higher sensitivity to lateral convexity epileptic discharges than to discharges in isolated deep basal temporal regions.

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  • Fusiform gyrus epilepsy: the use of ictal magnetoencephalography. Case report. 国際誌

    Makoto Oishi, Shigeki Kameyama, Nobuhito Morota, Masaru Tomikawa, Manabu Wachi, Akiyoshi Kakita, Hitoshi Takahashi, Ryuichi Tanaka

    Journal of neurosurgery   97 ( 1 )   200 - 4   2002年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    The authors report successful presurgical identification of an epileptic focus in the fusiform gyrus by using ictal magnetoencephalography (MEG), which was performed with the aid of an advanced whole-brain neuromagnetometer. A 22-year-old man had suffered from medically refractory complex partial seizures since he was 10 years of age. Seizure symptoms, magnetic resonance imaging, and ictal single-photon emission computerized tomography examinations indicated right temporal lobe epilepsy; however, ictal electroencephalography, including sphenoidal recordings, failed even to lateralize the seizure focus. The MEG studies revealed that equivalent current dipoles of interictal activities were scattered bilaterally around the medial temporal structures, but those of ictal onset and postictal activities formed a cluster in the left fusiform gyrus. After confirmation of each ictal and interictal MEG finding by using long-term electrocorticography recordings, focal cortical resection of the left inferior temporal and fusiform gyri was performed. The histopathological diagnosis was cortical dysplasia, and the patient has achieved a good seizure outcome, now 15 months after the operation. Ictal and also postictal MEG may be more specific than interictal MEG for identifying the ictal onset zone.

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  • [Presurgical functional mapping of the sensorimotor area using evoked magnetic fields].

    Makoto Oishi, Shigeki Kameyama, Masatoshi Watanabe, Tadashi Kawaguchi, Nobuhito Morota, Masaru Tomikawa, Hiroshi Masuda, Hideaki Takahashi, Ryuichi Tanaka

    No shinkei geka. Neurological surgery   30 ( 4 )   391 - 7   2002年4月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    In the present study, we evaluated the usefulness of magnetoencephalography (MEG) for presurgical identification of not only the central sulcus by somatosensory evoked magnetic fields (SEFs), which is a well-known, reliable technique, but also the primary hand motor area by movement-related cerebral magnetic fields (MRCFs). Subjects were 10 patients with brain tumor (6 glial tumors, 3 cavernous angiomas, and 1 metastatic tumor) around the sensorimotor area. Identification of the central sulcus by SEF responses to multiple sites of stimulation (median nerve, tibial nerve, thumb, and lower lip) was performed in all patients, and identification of the hand motor area by MRCF responses to the index finger extension task was made in 9. All MEG data were superimposed on sectional or three-dimensional magnetic resonance (MR) images. The central sulcus was clerAly identified by SEFs in all patients, even in 5 whose MR images showed severe distortion, and the primary hand motor area was identified by MRCFs in 6 of 9 patients. The central sulcus and primary motor area identified by MEG were confirmed by cortical recording of somatosensory evoked potentials in response to median nerve stimulation in 7 patients and motor evoked potentials in response to direct cortical stimulation in 5. All patients underwent tumor removal guided by functional mapping by MEG and experienced no surgical complications. In conclusion, MEG is a useful tool in presurgical functional mapping of the sensorimotor area. This is the first report of a case in which identification of the hand motor area by MRCFs was used in a clinical setting.

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MISC

  • GH産生下垂体腺腫へのソマトスタチンアナログ使用例におけるソマトスタチン受容体発現解析

    岡田正康, 米岡有一郎, 米岡有一郎, 平石哲也, 佐野正和, 大石誠, 石黒創, 伊藤崇子, 曽根博仁, 藤井幸彦

    日本内分泌学会雑誌   96 ( 3 (Web) )   2020年

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