2022/11/29 更新

写真a

ヒライシ テツヤ
平石 哲也
HIRAISHI Tetsuya
所属
脳研究所 助教
職名
助教
外部リンク

学位

  • 博士(医学) ( 2011年3月   新潟大学 )

研究分野

  • ライフサイエンス / 脳神経外科学

経歴(researchmap)

  • 新潟大学脳研究所   脳神経外科学部門   助教

    2016年4月 - 現在

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    国名:日本国

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  • 新潟大学医歯学総合病院   脳神経外科   特任助教

    2015年7月 - 2016年3月

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    国名:日本国

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  • 新潟大学医歯学総合病院   脳神経外科   病院助教

    2014年4月 - 2015年6月

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    国名:日本国

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  • 佐賀大学   脳神経外科   助教

    2010年4月 - 2010年9月

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    国名:日本国

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経歴

  • 新潟大学   脳研究所 臨床神経科学部門   助教

    2016年4月 - 現在

  • 新潟大学   医歯学総合病院 脳神経外科   特任助教

    2015年7月 - 2016年3月

学歴

  • 新潟大学   分子医学専攻   脳神経外科

    2007年4月 - 2011年3月

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    国名: 日本国

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  • 国立新潟大学   医学部医学科

    - 2002年3月

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論文

  • Visualization of cortical activation in human brain by flavoprotein fluorescence imaging. 国際誌

    Daiju Mitsuhashi, Ryuichi Hishida, Makoto Oishi, Tetsuya Hiraishi, Manabu Natsumeda, Katsuei Shibuki, Yukihiko Fujii

    Journal of neurosurgery   1 - 9   2022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)  

    OBJECTIVE: To develop an innovative brain mapping and neuromonitoring method during neurosurgery, the authors set out to establish intraoperative flavoprotein fluorescence imaging (iFFI) to directly visualize cortical activations in human brain. The significance of iFFI was analyzed by comparison with intraoperative perfusion-dependent imaging (iPDI), which is considered the conventional optical imaging, and by performing animal experiments. METHODS: Seven patients with intracerebral tumors were examined by iFFI and iPDI following craniotomy, using a single operative microscope equipped with a laser light source for iFFI and xenon lamp for iPDI. Images were captured by the same charge-coupled device camera. Responses to bipolar stimulation at selected points on the cortical surface were analyzed off-line, and relative signal changes were visualized by overlaying pseudocolor intensity maps onto cortical photographs. Signal changes exceeding 3 SDs from baseline were defined as significant. The authors also performed FFI and PDI on 10 mice using similar settings, and then compared signal patterns to intraoperative studies. RESULTS: Signals acquired by iFFI exhibited biphasic spatiotemporal changes consisting of an early positive signal peak (F1) and a delayed negative signal peak (F2). In contrast, iPDI signals exhibited only 1 negative peak (P1) that was significantly delayed compared to F1 (p < 0.02) and roughly in phase with F2. Compared to F2 and P1, F1 was of significantly lower amplitude (p < 0.02) and located closer to the bipolar stimulus center (p < 0.03), whereas F2 and P1 were more widespread, irregular, and partially overlapping. In mice, the spatiotemporal characteristics of FFI and PDI resembled those of iFFI and iPDI, but the early positive signal was more robust than F1. CONCLUSIONS: This is the first report in humans of successful intraoperative visualization of cortical activations by using iFFI, which showed rapid evoked cortical activity prior to perfusion-dependent signal changes. Further technical improvements can lead to establishment of iFFI as a real-time intraoperative tool.

    DOI: 10.3171/2022.1.JNS212542

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  • Endovascular treatment of an infectious aneurysm using the selective provocative test and transcranial motor evoked potential monitoring under general anesthesia: a case report. 国際誌

    Kazuhiro Ando, Tetsuya Hiraishi, Makoto Oishi, Hitoshi Hasegawa, Bumpei Kikuchi, Manabu Natsumeda, Tomoaki Suzuki, Shoji Saito, Tomoyoshi Ota, Yuichi Yoshida, Yukihiko Fujii

    Acta neurochirurgica   2021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)  

    The selective provocative test (SPT) under local anesthesia aids in protecting against ischemic complications during endovascular treatment. However, the use of this test under general anesthesia is not well described. Herein, we present a case of a 51-year-old man with a ruptured fusiform aneurysm in the middle cerebral artery M4 segment, which was thought to possibly supply the motor cortex. Internal trapping of the affected vessel and aneurysm by endovascular intervention was successfully performed after SPT using transcranial motor evoked potential (MEP) monitoring under general anesthesia. Transcranial MEP is suitable for neurological assessment during SPT under general anesthesia.

    DOI: 10.1007/s00701-021-05001-z

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  • 脳神経外科領域におけるPDTの現状と問題点 当科における光線力学療法の経験および次世代への挑戦

    棗田 学, 塚本 佳広, 温 城太郎, 渡邉 潤, 江田 岳誉, 平石 哲也, 佐野 正和, 大石 誠, 藤井 幸彦

    日本レーザー医学会誌   42 ( 3 )   161 - 161   2021年9月

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    記述言語:日本語   出版者・発行元:(NPO)日本レーザー医学会  

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  • 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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  • Four-dimensional multifusion imaging for assessment of meningioma hemodynamics

    Ryosuke Ogura, Makoto Oishi, Tetsuya Hiraishi, Haruhiko Takahashi, Kohei Shibuya, Tomoaki Suzuki, Manabu Natsumeda, Kouichirou Okamoto, Yukihiko Fujii

    Interdisciplinary Neurosurgery   24   101118 - 101118   2021年6月

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    掲載種別:研究論文(学術雑誌)   出版者・発行元:Elsevier {BV}  

    DOI: 10.1016/j.inat.2021.101118

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  • GH産生下垂体腺腫に対するソマトスタチンアナログの効果とソマトスタチン受容体発現分類の検討

    岡田 正康, 米岡 有一郎, 大石 誠, 平石 哲也, 佐野 正和, 棗田 学, 柿田 明美, 藤井 幸彦

    Brain Tumor Pathology   38 ( Suppl. )   094 - 094   2021年5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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  • 髄膜腫摘出術の7年後に発生した局所浸潤性・再発性fibromatosisの一例

    温 城太郎, 清水 宏, 齋藤 理恵, 渋谷 航平, 棗田 学, 平石 哲也, 佐野 正和, 梅津 哉, 藤井 幸彦, 柿田 明美

    Brain Tumor Pathology   38 ( Suppl. )   121 - 121   2021年5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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  • Hydrocephalus associated with small clinoidal meningioma that resolved after tumor removal: A case report 査読

    Hidemoto Fujiwara, Toyotaka Aiba, Tom Watanabe, Tetsuya Hiraishi, Yukihiko Fujii

    Neurological Surgery   44 ( 12 )   1039 - 1044   2016年12月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Igaku-Shoin Ltd  

    PURPOSE: Small meningiomas causing hydrocephalus without obstruction of the ventricular system are rare. Herein, we report a case of small clinoidal meningioma with communicating hydrocephalus, which resolved after tumor removal. CASE PRESENTATION: A 70-year-old woman presented with a 1-month history of memory disturbance followed by gait disturbance. MR images revealed a right clinoidal meningioma, 2 cm in diameter, and dilatation of the ventricles suggesting communicating hydrocephalus. The cerebrospinal fluid (CSF) pressure was 130 mmH2O, as determined via a lumbar puncture. High concentrations of protein (65 mg/dL) were detected in the lumbar CSF. The tumor was completely removed via a frontotemporal craniotomy. Higher protein concentrations (94 mg/dL) were detected in the CSF obtained intraoperatively from the sylvian cistern. The histopathological diagnosis was meningothelial meningioma. The patient's symptoms improved markedly after surgery. Postoperative MR images revealed resolution of the hydrocephalus. The lumbar CSF protein concentration returned to normal (43 mg/dL). Neither tumor recurrence nor progression of hydrocephalus has been observed for 4 years. DISCUSSION: Communicating hydrocephalus, associated with a small meningioma at the supratentorial region, has not been described. Previous studies have shown that patients with meningioma may develop communicating hydrocephalus after tumor removal or stereotactic radiosurgery. Thus, it is interesting that the small supratentorial meningioma in our case developed communicating hydrocephalus without any therapeutic intervention. Considering the CSF protein concentration, we speculate that the hydrocephalus was the result of CSF malabsorption associated with high CSF protein concentration and CSF pathway obstruction at the suprasellar cistern caused by the tumor.

    DOI: 10.11477/mf.1436203424

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  • Cortico-cortical evoked hemodynamic responses in human language systems using intraoperative near-infrared spectroscopy during direct cortical stimulation 査読

    Keisuke Sato, Masafumi Fukuda, Yosuke Sato, Tetsuya Hiraishi, Tetsuro Takao, Yukihiko Fujii

    NEUROSCIENCE LETTERS   630   136 - 140   2016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)   出版者・発行元:ELSEVIER IRELAND LTD  

    Background: Understanding of cortico-cortical activity in eloquent areas intraoperatively is crucial for neurosurgical procedures. Here, we used intraoperative near-infrared spectroscopy (iNIRS) during direct cortical stimulation as a robust tool to better understand the cortico-cortical connectivity in language systems.
    Methods: We applied iNIRS to 3 patients who underwent epilepsy surgery due to lesions (cavernous angioma, epidermoid cyst, and low-grade glioma) located in language areas. Using iNIRS, we measured the blood concentration changes of oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR) in the lateral temporal cortex during direct cortical stimulation (50 Hz) at the inferior frontal area where Broca's area was probabilistically located.
    Results: In all patients, 50 Hz stimulation elicited hemodynamic changes in the superior temporal gyrus (STG). During 0.8-4.8 s after stimulation, HbO2 increased and HbR decreased in the posterior part of the STG (Wernicke's area). Similar responses were observed in the anterior part of the STG 1.3-8.0 s after stimulation. Finally, these changes were disappeared in the middle temporal gyrus.
    Conclusions: Our results suggest that cortical stimulation of Broca's area elicits hemodynamic responses in Wernicke's area via cortico-cortical connectivity. We demonstrated cortico-cortical evoked responses in language systems using iNIRS during direct cortical stimulation. Our iNIRS data will provide useful information about cortico-cortical networks underlying human brain functions intraoperatively and will contribute to neurosurgical treatment in eloquent areas. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.neulet.2016.07.037

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  • Free-running EMG monitoring during microvascular decompression for hemifacial spasm 査読

    Masafumi Fukuda, Tetsuro Takao, Tetsuya Hiraishi, Yukihiko Fujii

    ACTA NEUROCHIRURGICA   157 ( 9 )   1505 - 1512   2015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)   出版者・発行元:SPRINGER WIEN  

    The aim of this work is to determine if free-running electromyography (frEMG) can detect activity before and after microvascular decompression (MVD) treatment for hemifacial spasm (HFS), and to evaluate correlations of frEMG findings with abnormal muscle responses (AMRs) or facial motor-evoked potentials (FMEPs).
    To elicit nerve responses while carrying out frEMG recording before and after MVD, saline, a lactic solution, or artificial cerebrospinal fluid was injected onto the root exit zone of the facial nerve.
    Significantly higher frEMG activity was observed following saline injection than for the other solutions (p &lt; 0.01). For frEMG activity ratios of a parts per thousand yenaEuro parts per thousand 50 %, there was a trend towards a greater likelihood of persistent AMRs. When frEMG activity decreased after MVD in the mentalis muscles, FMEP amplitude ratios were significantly smaller than when it did not (65 vs. 94 %, p &lt; 0.05).
    Changes in intraoperative frEMG, AMRs, and FMEPs likely reflect a component of the normalization of hyper-excitability of the facial nerve by MVD for HFS.

    DOI: 10.1007/s00701-015-2492-7

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  • Pharyngeal Motor Evoked Potential Monitoring During Skull Base Surgery Predicts Postoperative Recovery from Swallowing Dysfunction 査読

    Masafumi Fukuda, Tetsuro Takao, Tetsuya Hiraishi, Naoki Yajima, Akihiko Saito, Yukihiko Fujii

    WORLD NEUROSURGERY   84 ( 2 )   555 - 560   2015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)   出版者・発行元:ELSEVIER SCIENCE INC  

    OBJECTIVE: Monitoring pharyngeal motor evoked potential (PhMEP) with a modified endotracheal tube is useful for predicting postoperative swallowing dysfunction. However, the relationship between intraoperative PhMEP findings and recovery from postoperative swallowing dysfunction has not been clarified. The aim of this study was to determine whether PhMEP monitoring predicts swallowing dysfunction not only immediately after surgery but also in the postoperative recovery period.
    METHODS: We analyzed PhMEPs in 35 patients during treatment for skull base tumors. Recovery from postoperative swallowing dysfunction was evaluated when oral intake was started postsurgery and drip or tube feeding was discontinued. The correlation between the final to baseline PhMEP ratio and postoperative recovery times from swallowing dysfunction was examined.
    RESULTS: The PhMEP ratio significantly correlated with postoperative swallowing function immediately after surgery (P &lt; 0.001). The period before starting oral intake in patients with a PhMEP ratio &gt;50% (mean +/- standard deviation [SD], 3.8 +/- 43 days) was shorter than those with a PhMEP ratio &lt;= 50% (mean +/- SD, 14.7 +/- 11.8 days; P &lt; 0.01). Drip or tube feeding was removed from patients with a PhMEP ratio &gt;50% significantly earlier (mean I SD, 117 +/- 192 days) than those with a PhMEP ratio &lt;= 50% (mean +/- SD, 383 +/- 273 days; P &lt; 0.05). Both univariate and multivariate analysis showed that only the PhMEP ratio was predictive of early recovery from swallowing
    CONCLUSIONS: PhMEP monitoring allowed us to predict not only immediate swallowing dysfunction but also recovery from the dysfunction in the postsurgery period.

    DOI: 10.1016/j.wneu.2015.04.023

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  • Cortico-cortical activity between the primary and supplementary motor cortex: An intraoperative near-infrared spectroscopy study 査読

    Masafumi Fukuda, Tetsuro Takao, Tetsuya Hiraishi, Hiroshi Aoki, Ryosuke Ogura, Yosuke Sato, Yukihiko Fujii

    Surgical Neurology International   6 ( 1 )   2015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)   出版者・発行元:Medknow Publications  

    Background: The supplementary motor area (SMA) makes multiple reciprocal connections to many areas of the cerebral cortices, such as the primary motor cortex (PMC), anterior cingulate cortex, and various regions in the parietal somatosensory cortex. In patients with SMA seizures, epileptic discharges from the SMA rapidly propagate to the PMC. We sought to determine whether near-infrared spectroscopy (NIRS) is able to intraoperatively display hemodynamic changes in epileptic network activities between the SMA and the PMC. Case Descriptions: In a 60-year-old male with SMA seizures, we intraoperatively delivered a 500 Hz, 5-train stimulation to the medial cortical surface and measured the resulting hemodynamic changes in the PMC by calculating the oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR) concentration changes during stimulation. No hemodynamic changes in the lateral cortex were observed during stimulation of the medial surface corresponding to the foot motor areas. In contrast, both HbO2 and HbR increased in the lateral cortex corresponding to the hand motor areas when the seizure onset zone was stimulated. In the premotor cortex and the lateral cortex corresponding to the trunk motor areas, hemodynamic changes showed a pattern of increased HbO2 with decreased HbR. Conclusions: This is the first reported study using intraoperative NIRS to characterize the epileptic network activities between the SMA and PMC. Our intraoperative NIRS procedure may thus be useful in monitoring the activities of cortico-cortical neural pathways such as the language system.

    DOI: 10.4103/2152-7806.153872

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  • Drainage patterns of the superficial middle cerebral vein: Effects on perioperative managements of petroclival meningioma 査読

    Masafumi Fukuda, Akihiko Saito, Tetsuro Takao, Tetsuya Hiraishi, Naoki Yajima, Yukihiko Fujii

    Surgical Neurology International   6 ( 1 )   2015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)   出版者・発行元:Medknow Publications  

    Background: Although the superficial middle cerebral vein (SMCV) usually connects with the cavernous sinus, there are several anatomical variations. We determined whether differences in SMCV drainages patterns affected the perioperative management of petroclival meningioma. Methods: The subjects included 17 patients (4 men
    13 women) who underwent resection of a petroclival meningioma. SMCV drainage patterns were classified into four groups according to angiographic findings: (1) The SMCV connected with the cavernous sinus (Group A)
    (2) The SMCV was either absent or connected directly with the superior sagittal or transverse sinus through the cortical veins (Group B)
    (3) The SMCV turned downward and connected with the pterygoid plexus through the sphenobasal vein (SpBV, Group C)
    and (4) The SMCV ran across the bottom of the middle fossa and connected with transverse sinus via the sphenopetrosal sinus (SpPS, Group D). Results: In all 9 patients in Group A, the SMCV drainage pattern did not affect any aspect of perioperative management. In contrast, SMCV drainage patterns in 3 of 4 patients in Group B and both patients in Groups C and D had an effect on perioperative management, indicating a significant impact of variations in SMCV drainage patterns (P &lt
    0.005). In 2 patients in Group C and 1 in Group D, the operating corridor provided by a transpetrosal approach was small in order to preserve the SpBV or SpPS. In the other patient in Group D, an anterior transpetrosal approach was not selected preoperatively because the SpPS would likely be injured during surgery. Conclusions: In cases, where the SMCV directly connects with superior sagittal or transverse sinus, SpBV or SpPS, surgeons have to meticulously select a safe and effective approach and take measures to preserve the SpBV or SpPS during surgery.

    DOI: 10.4103/2152-7806.162483

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  • Drainage patterns of the superficial middle cerebral vein: Effects on perioperative managements of petroclival meningioma. 査読

    Fukuda M, Saito A, Takao T, Hiraishi T, Yajima N, Fujii Y

    Surgical neurology international   6   130   2015年

  • Cortico-cortical activity between the primary and supplementary motor cortex: An intraoperative near-infrared spectroscopy study. 査読

    Fukuda M, Takao T, Hiraishi T, Aoki H, Ogura R, Sato Y, Fujii Y

    Surgical neurology international   6   44   2015年

  • Clinical Factors Predicting Outcomes After Surgical Resection for Sporadic Cerebellar Hemangioblastomas 査読

    Masafumi Fukuda, Tetsuro Takao, Tetsuya Hiraishi, Junichi Yoshimura, Naoki Yajima, Akihiko Saito, Yukihiko Fujii

    WORLD NEUROSURGERY   82 ( 5 )   815 - 821   2014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)   出版者・発行元:ELSEVIER SCIENCE INC  

    OBJECTIVE: To determine whether various clinical factors are related to long-term outcomes of patients with sporadic cerebellar hemangioblastomas.
    METHODS: Subjects included 36 patients (19 men and 17 women) who underwent resection of sporadic hemangloblastorna in the cerebellum Age at surgery ranged from 17 79 years (mean, 49.7 years). The tumor size, which was defined as the largest diameter of the lesion including the extratumoral cyst, ranged from 10-67 mm (mean, 36.4 mm). Obstructive hydrocephalus secondary to mass effect on the fourth ventricle was present in 21 (58.3%) patients preoperatively.
    RESULTS: Total tumor removal was achieved in 31 of 36 patients (86%). In 4 (11%) patients with solid tumors, postoperative hematoma occurred in the removal cavity, and hernatoma removal was required immediately after surgery. We followed 30 patients for &gt;12 months after the initial surgery (mean, 72.9 months; range, 12-274 months). Recurrence of hemangioblastoma developed in 4 of 30 patients (13%) at 6 months, 17 months, 6 years, and 22 years after surgery. At the final follovv-up examination, 9 (30%) of 30 patients showed some residual neurologic symptoms (poor group), whereas the remaining 21 patients showed no deficits (good group). Using univariate analysis, both age at surgery and tumor characteristics (cystic or solid) were significantly related to long-term patient outcomes (P &lt; 0.05). However, in a multiple logistic regression analysis, only tumor characteristics were correlated with outcomes (P = 0.017). At the final follow-up examination, patients with solid tumors more frequently showed poor outcomes than patients with cystic tumors.
    CONCLUSIONS: The solid configuration observed on preoperative images of sporadic cerebellar hemangioblastomas is one of the most important clinical factors related to both immediate and long-term outcomes after surgery.

    DOI: 10.1016/j.wneu.2014.06.018

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  • Posterior condylar canals and posterior condylar emissary veins-a microsurgical and CT anatomical study Comments 査読

    Michael Bruneau, Giannantonio Spena, Peter A. Winkler, Helmut Bertalanffy

    NEUROSURGICAL REVIEW   37 ( 1 )   125 - 126   2014年1月

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    記述言語:英語   出版者・発行元:SPRINGER  

    DOI: 10.1007/s10143-013-0493-7

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  • Posterior condylar canals and posterior condylar emissary veins-a microsurgical and CT anatomical study 査読

    Ken Matsushima, Masatou Kawashima, Toshio Matsushima, Tetsuya Hiraishi, Tomoyuki Noguchi, Akio Kuraoka

    NEUROSURGICAL REVIEW   37 ( 1 )   115 - 125   2014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)   出版者・発行元:SPRINGER  

    The posterior condylar canals (PCCs) and posterior condylar emissary veins (PCEVs) are potential anatomical landmarks for surgical approaches through the lateral foramen magnum. We conducted computed tomography (CT) and microsurgical investigation of how PCCs and PCEVs can aid in planning and performing these approaches. We analyzed the microanatomy of PCCs and PCEVs using cadaveric specimens, dry skulls, and CT images. The recognition frequency and geometry of PCCs and PCEVs and their relationships with surrounding structures were evaluated. PCCs were identified in 36 of 50 sides in dry bones and 82 of 100 sides by CT. PCCs had a 3.5-mm mean diameter and a 6.8-mm mean canal length. We classified their courses into four types according to intracranial openings: the sigmoid sinus (SS) type, the jugular bulb (JB) type, the occipital sinus type, and the anterior condylar emissary vein type. In most cases, PCEV originated near the boundary between the SS and JB. PCCs and PCEVs can be useful anatomical landmarks to differentiate the transcondylar fossa approach from the transcondylar approach, thus preventing unnecessary injury of the atlantooccipital joint. They can also be used as landmarks when the jugular foramen (JF) and hypoglossal canal (HGC) are being exposed. The area anterior to the brain stem and the medial part of HGC can be accessed by removal of the lateral foramen magnum medial to PCC. JF and the lateral part of HGC can be accessed by removal of the skull base lateral to PCC without damaging the lateral rim of the foramen magnum.

    DOI: 10.1007/s10143-013-0493-7

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  • Importance of awareness of the rhomboid lip in microvascular decompression surgery for hemifacial spasm Clinical article 査読

    Yukiko Nakahara, Toshio Matsushima, Tetsuya Hiraishi, Tetsuro Takao, Takeshi Funaki, Jun Masuoka, Masatou Kawashima

    JOURNAL OF NEUROSURGERY   119 ( 4 )   1038 - 1042   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)   出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS  

    Object. The authors adopted the infrafloccular approach for microvascular decompression (MVD) surgery to treat hemifacial spasm (HFS). The inferior portion of the flocculus is retracted to observe the root exit zone of cranial nerve (CN) VII between CN IX and the flocculus. During the procedure, the rhomboid lip, a sheetlike layer of neural tissue forming the lateral recess of the fourth ventricle, is sometimes encountered. The existence of the rhomboid lip in cases of HFS was reviewed to determine the importance of the structure during MVD surgery.
    Methods. Preoperative imaging and intraoperative observations in 34 consecutive cases of HFS treated in the period from October 2008 through September 2011 were used to assess the frequency of encountering the rhomboid lip.
    Results. The rhomboid lip was observed during MVD surgery in 9 (26.5%) of the 34 cases but had been demonstrated on preoperative MR images in only 3 cases (8.8%). On T2-weighted images, it appeared as a high-intensity nonstructural area on the ventral side of the flocculus and continued into the fourth ventricle via the foramen of Luschka.
    Conclusions. A large rhomboid lip presents an impediment to MVD surgery in a significant minority of patients with RFS. It is seldom observed on preoperative MR images. Proper dissection of the rhomboid lip away from the arachnoid membrane and/or the lower CNs during MVD surgery provides good visualization of the root exit zone of CN VII and reduces injury of CNs IX and X, avoiding postoperative deficits like dysphagia.

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

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

    Neurosurgical Review   36 ( 4 )   629 - 635   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. © 2013 Springer-Verlag Berlin Heidelberg.

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  • Interactive presurgical simulation applying advanced 3D imaging and modeling techniques for skull base and deep tumors Clinical article 査読

    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)   出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS  

    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 rnicrosurgical 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.

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

    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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    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. © 2012 Elsevier B.V.

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  • Intraoperative monitoring of motor evoked potentials during glioma removal 査読

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

    Neurological Surgery   41 ( 3 )   219 - 227   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&lt
    0.05) and 1 month (χ2=6.9. p&lt
    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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  • Facial nerve dysfunction after drainage of cerebrospinal fluid during vestibular schwannoma surgery 査読

    Tetsuya Hiraishi, Masafumi Fukuda, Makoto Oishi, Yukihiko Fujii

    CLINICAL NEUROLOGY AND NEUROSURGERY   115 ( 1 )   102 - 105   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)   出版者・発行元:ELSEVIER SCIENCE BV  

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  • Novel devices for intraoperative monitoring of glossopharyngeal and vagus nerves during skull base surgery. 査読

    Fukuda M, Takao T, Hiraishi T, Yajima N, Saito A, Fujii Y

    Surgical neurology international   4   97   2013年

  • Interactive virtual simulation using a 3D computer graphics model for microvascular decompression surgery Clinical article 査読

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

    JOURNAL OF NEUROSURGERY   117 ( 3 )   555 - 565   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)   出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS  

    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 &lt; 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. (http://thejns.org/doi/abs/10.3171/2012.5.JNS112334)

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  • Periventricular nodular heterotopia functionally couples with the overlying hippocampus 査読

    Hiroki Kitaura, Makoto Oishi, Nobuyuki Takei, Yong-Juan Fu, Tetsuya Hiraishi, Masafumi Fukuda, Hitoshi Takahashi, Katsuei Shibuki, Yukihiko Fujii, Akiyoshi Kakita

    EPILEPSIA   53 ( 7 )   e127 - e131   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)   出版者・発行元:WILEY-BLACKWELL  

    Patients with periventricular nodular heterotopia (PVNH) often have severe epilepsy. However, it is unclear how the heterotopia contributes to epileptogenesis. Recently, electrophysiologic studies using intraoperative depth electrodes have indicated that interaction between the heterotopia and overlying cortex is crucial for seizure onset. We performed an in vitro physiologic study using slices of resected brain from a 22-year-old man with PVNH, who manifested medically refractory mesial temporal lobe epilepsy. Preoperative evaluation indicated that the right mesial temporal structure and PVNH were the epileptogenic focus. The resected tissue was immediately immersed in cold artificial cerebrospinal fluid, and then slices of the brain tissue including the heterotopic nodules and overlying hippocampus were prepared. We electrically stimulated the incubated slices, and the elicited neural activities were analyzed as changes in the flavoprotein fluorescence signals. When we stimulated either the heterotopic nodule or the overlying hippocampus, clear functional coupling of neural activities between these structures was observed. The coupling response evoked by stimulation of the subiculum and developing within the heterotopic nodule was enhanced by application of bicuculline. Therefore, activities of the hippocampus and the nodule are closely correlated.

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  • Periventricular nodular heterotopia functionally couples with the overlying hippocampus.

    Kitaura Hiroki, Oishi Makoto, Takei Nobuyuki, Fu Yong-Juan, Hiraishi Tetsuya, Fukuda Masafumi, Takahashi Hitoshi, Shibuki Katsuei, Fujii Yukihiko, Kakita Akiyoshi

    Epilepsia   53 ( 7 )   e127 - e131   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)  

    Patients with periventricular nodular heterotopia (PVNH) often have severe epilepsy. However, it is unclear how the heterotopia contributes to epileptogenesis. Recently, electrophysiologic studies using intraoperative depth electrodes have indicated that interaction between the heterotopia and overlying cortex is crucial for seizure onset. We performed an in vitro physiologic study using slices of resected brain from a 22-year-old man with PVNH, who manifested medically refractory mesial temporal lobe epilepsy. Preoperative evaluation indicated that the right mesial temporal structure and PVNH were the epileptogenic focus. The resected tissue was immediately immersed in cold artificial cerebrospinal fluid, and then slices of the brain tissue including the heterotopic nodules and overlying hippocampus were prepared. We electrically stimulated the incubated slices, and the elicited neural activities were analyzed as changes in the flavoprotein fluorescence signals. When we stimulated either the heterotopic nodule or the overlying hippocampus, clear functional coupling of neural activities between these structures was observed. The coupling response evoked by stimulation of the subi

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  • Epidermoid cyst involving the medial temporal lobe: Surgical pathologic features of the epileptogenic lesion 査読

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

    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)   出版者・発行元:WILEY-BLACKWELL  

    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.

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

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

    JOURNAL OF NEUROSURGERY   116 ( 3 )   605 - 610   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)   出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS  

    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 &lt; 0.05), although not strongly (r = -0.47), correlated with the final/baseline PhMEP ratio. A PhMEP ratio &lt; 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 &gt; 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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  • Monitoring of abnormal muscle response and facial motor evoked potential during microvascular decompression for hemifacial spasm. 査読 国際誌

    Fukuda M, Oishi M, Takao T, Hiraishi T, Sato Y, Fujii Y

    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)  

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  • Spatiotemporal dynamics of epileptiform propagations: imaging of human brain slices.

    Kitaura Hiroki, Hiraishi Tetsuya, Murakami Hiroatsu, Masuda Hiroshi, Fukuda Masafumi, Oishi Makoto, Ryufuku Masae, Fu Yong-Juan, Takahashi Hitoshi, Kameyama Shigeki, Fujii Yukihiko, Shibuki Katsuei, Kakita Akiyoshi

    Neuroimage   58 ( 1 )   50 - 59   2011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)  

    Seizure activities often originate from a localized region of the cerebral cortex and spread across large areas of the brain. The properties of these spreading abnormal discharges may account for clinical phenotypes in epilepsy patients, although the manner of their propagation and the underlying mechanisms are not well understood. In the present study we performed flavoprotein fluorescence imaging of cortical brain slices surgically resected from patients with partial epilepsy caused by various symptomatic lesions. Elicited neural activities in the epileptogenic tissue spread horizontally over the cortex momentarily, but those in control tissue taken from patients with brain tumors who had no history of epilepsy demonstrated only localized responses. Characteristically, the epileptiform propagation comprised early and late phases. When the stimulus intensity was changed gradually, the early phase showed an all-or-none behavior, whereas the late phase showed a gradual increase in the response. Moreover, the two phases were propagated through different cortical layers, suggesting that they are derived from distinct neural circuits. Morphological investigation revealed the presence

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  • Spatiotemporal dynamics of epileptiform propagations: Imaging of human brain slices 査読

    Hiroki Kitaura, Tetsuya Hiraishi, Hiroatsu Murakami, Hiroshi Masuda, Masafumi Fukuda, Makoto Oishi, Masae Ryufuku, Yong-Juan Fu, Hitoshi Takahashi, Shigeki Kameyama, Yukihiko Fujii, Katsuei Shibuki, Akiyoshi Kakita

    NEUROIMAGE   58 ( 1 )   50 - 59   2011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)   出版者・発行元:ACADEMIC PRESS INC ELSEVIER SCIENCE  

    Seizure activities often originate from a localized region of the cerebral cortex and spread across large areas of the brain. The properties of these spreading abnormal discharges may account for clinical phenotypes in epilepsy patients, although the manner of their propagation and the underlying mechanisms are not well understood. In the present study we performed flavoprotein fluorescence imaging of cortical brain slices surgically resected from patients with partial epilepsy caused by various symptomatic lesions. Elicited neural activities in the epileptogenic tissue spread horizontally over the cortex momentarily, but those in control tissue taken from patients with brain tumors who had no history of epilepsy demonstrated only localized responses. Characteristically, the epileptiform propagation comprised early and late phases. When the stimulus intensity was changed gradually, the early phase showed an all-or-none behavior, whereas the late phase showed a gradual increase in the response. Moreover, the two phases were propagated through different cortical layers, suggesting that they are derived from distinct neural circuits. Morphological investigation revealed the presence of hypertrophic neurons and loss of dendritic spines, which might participate in the aberrant activities observed by flavoprotein fluorescence imaging. These findings indicate that synchronized activities of the early phase may play a key role in spreading abnormal discharges in human cortical epilepsies. (C) 2011 Elsevier Inc. All rights reserved.

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

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

    NEUROLOGICAL RESEARCH   33 ( 6 )   578 - 582   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)   出版者・発行元:MANEY PUBLISHING  

    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&lt;0.005) and orbicularis oris (r=-0.80, P&lt;0.001) muscles. The correlations between FNMEP ratios and facial nerve function remained significant during long-term followup (orbicularis oculi muscle: r=-0.43, P&lt;0.05; orbicularis oris muscle: r=-0.71, P&lt;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.

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  • Clinicopathological factors related to regrowth of vestibular schwannoma after incomplete resection 査読

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

    JOURNAL OF NEUROSURGERY   114 ( 5 )   1224 - 1231   2011年5月

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    Object. The authors retrospectively analyzed various clinicopatholouical 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 S 13]).
    Results. Gross-total resection (GTR) was performed in 41 (55%) of the 74 patients; subtotal resection GSTR]; 90-99%) in 25 (34%); and partial resection ([PR]; &lt; 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. (DO!: 10.3171/2010.11.JNS101041)

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

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

    NEUROLOGICAL RESEARCH   33 ( 4 )   360 - 362   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)   出版者・発行元:MANEY PUBLISHING  

    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.

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  • Prediction of the Microsurgical Window for Skull-Base Tumors by Advanced Three-Dimensional Multi-fusion Volumetric Imaging 査読

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

    NEUROLOGIA MEDICO-CHIRURGICA   51 ( 3 )   201 - 207   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)   出版者・発行元:JAPAN NEUROSURGICAL SOC  

    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 deja-vu effect of the simulation increased the confidence of the surgeon in the planned surgical procedures.

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  • Presurgical Simulation With Advanced 3-Dimensional Multifusion Volumetric Imaging in Patients With Skull Base Tumors 査読

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

    NEUROSURGERY   68 ( 1 Suppl Operative )   188 - 99; discussion 199   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)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    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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  • Presurgical Simulation With Advanced 3-Dimensional Multifusion Volumetric Imaging in Patients With Skull Base Tumors 査読

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

    NEUROSURGERY   68 ( 3 )   188 - 199   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)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    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.

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  • Trigeminal Neuralgia Associated with the Specific Bridging Pattern of Transverse Pontine Vein: Diagnostic Value of Three-Dimensional Multifusion Volumetric Imaging 査読

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

    STEREOTACTIC AND FUNCTIONAL NEUROSURGERY   89 ( 4 )   226 - 233   2011年

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

    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&apos;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&apos;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&apos;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&apos;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. Copyright (C) 2011 S. Karger AG, Basel

    DOI: 10.1159/000326778

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  • Effects of abnormal muscle response monitoring on manipulation of microvascular decompression 査読

    Masafumi Fukuda, Makoto Oishi, Tetsuya Hiraishi, Yukihiko Fujii

    Neurological Surgery   38 ( 6 )   531 - 538   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. Materias 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 査読

    Masafumi Fukuda, Makoto Oishi, Tetsuya Hiraishi, Yukihiko Fujii

    JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY   81 ( 5 )   519 - 523   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)   出版者・発行元:B M J PUBLISHING GROUP  

    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&lt;0.001 and p&lt;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&lt;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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  • Unstable Stenosis of the Internal Carotid Artery Caused by a Craniofacial Nail-Gun Injury-Case Report 査読

    Tetsuya Hiraishi, Tadashi Kawaguchi, Tsutomu Kobayashi, Masaru Tomikawa, Yasushi Ito, Yukihiko Fujii

    NEUROLOGIA MEDICO-CHIRURGICA   49 ( 12 )   590 - 593   2009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)   出版者・発行元:JAPAN NEUROSURGICAL SOC  

    A 30-year-old carpenter suffered accidental piercing of his jaw by a 3-inch nail from a nail gun. No neurological deficits were found on admission. Computed tomography showed that the tip of the nail had reached the foramen lacerum. Cerebral angiography revealed severe stenosis at the C(4) portion of the left internal carotid artery (ICA) and marked decrease in the flow of the distal ICA. He had developed right hemiparesis and sensory aphasia by the following morning. T(2)-weighted and fluid-attenuated inversion recovery magnetic resonance imaging showed a focal hyperintense signal in the left central region indicating cerebral infarction. Repeat angiography demonstrated that the antegrade blood flow from the occluded point on the admission day had partially resumed, and endovascular trapping of the ICA was successfully carried out. The nail was then removed safely without problematic bleeding. The patient suffered no additional deficit, and his sensory aphasia and right hemiparesis gradually improved. The fluctuating blood flow through the unstable stenosis of the ICA related to nail movement possibly caused the delayed cerebral infarction. To avoid the occurrence of such events, rapid treatment after necessary investigations is recommended in patients with craniofacial penetrating injuries that affect the ICA.

    DOI: 10.2176/nmc.49.590

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  • Presurgical Evaluaton for Lateral Suboccipital Craniotomy Using Contrast-enhanced CT Volumetric Imaging 査読

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

    NEUROLOGICAL SURGERY   37 ( 5 )   459 - 465   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)   出版者・発行元:IGAKU-SHOIN LTD  

    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 (TSS) 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 asterion 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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  • A Case of Bilateral Common Carotid Artery Dissections due to Localized Dissection of the Aortic Arch 査読

    Tetsuya Hiraishi, Hiroshi Motoyama, Hiroshi Abe

    NEUROLOGICAL SURGERY   37 ( 4 )   387 - 391   2009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)   出版者・発行元:IGAKU-SHOIN LTD  

    We report a case of a 56-year-old man who had a localized dissection of the aortic arch presenting with left conjugate deviation, right homonymous hemianopsia, and right hemiparesis. Diffusion-weighted MRI revealed multiple fresh cerebral infarctions of the left cerebral hemisphere and the bilateral cerebellar hemispheres.
    The patient did not complain of chest pain, but thoracic computed tomography (CT) and three-dimensional CT angiography showed a localized dissection of the aortic arch at the bases of the brachiocephalic artery and left common carotid artery (CCA). He was diagnosed with embolic cerebral infarctions due to aortic dissection and treated with heparin and edaravone. However, without progressive symptoms and enlargement of the dissected aneurysm, we continued to follow the "wait-and-scan" policy for the aortic dissection. Neurological signs and symptoms gradually improved during his admission. The pseudolumen had yet to close and there has been no change in size and shape of the dissected aneurysm for about one year. It is necessary to carefully follow up the case and to keep in mind cerebral infarctions caused by aortic dissection.

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  • Delayed brain abscess after penetrating transorbital injury 査読

    Tetsuya Hiraishi, Masaru Tomikawa, Tsutomu Kobayashi, Tadashi Kawaguchi

    NEUROLOGICAL SURGERY   35 ( 5 )   481 - 486   2007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)   出版者・発行元:IGAKU-SHOIN LTD  

    We report a case of brain abscess caused by a penetrating head injury that occurred 9 years earlier. A 14-year-old girl presenting with fever, headache, and stiff neck was admitted to our hospital. She was diagnosed with aseptic meningitis and treated conservatively. Seven days after admission she became stuporous and showed left hemiparesis. Computed tomography (CT) revealed two ring-enhancing masses with perifocal edema in the right frontal lobe. We diagnosed brain abscess and performed right Pronto-temporal decompressive craniectomy and stereotactic aspiration, followed by systemic antibiotic therapy. Post-surgery bone window CT revealed a well-defined, low-density foreign body passing from the left orbita to the right frontal lobe through the ethmoid sinus. We learned that the patient had been struck with a plastic chopstick in the left medial eyelid at the age of 5 years. No particular symptoms developed during the following 9 years. After the cerebral edema had diminished over the next 10 days, a second surgery was performed to remove the residual chopstick, repair the fistula at the base of the skull, and perform cranioplasty. The patient was discharged with only slight hyposmia after a 4-week course of antibiotics. This case showed that it is necessary to remove a residual foreign body and to close the dural fistula if there is a possibility of recurrent central nervous system infection. When a child presents with brain abscess, previous penetrating head injury should be considered.

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共同研究・競争的資金等の研究

  • 悪性髄膜腫における標的可能遺伝子変異の同定と新規治療確立

    研究課題/領域番号:18K08990  2018年4月 - 2021年3月

    日本学術振興会  科学研究費助成事業 基盤研究(C)  基盤研究(C)

    平石 哲也, 大石 誠, 棗田 学, 永橋 昌幸, 藤井 幸彦

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    配分額:4420000円 ( 直接経費:3400000円 、 間接経費:1020000円 )

    近年の遺伝子発現解析技術により、髄膜腫の腫瘍発生機序に関わる背景が徐々に解明されてきた。しかし、その疾患概念の基盤は脆弱でまだ不明な点が多く、がん医療で先行して利用され始めた「遺伝子パネルを利用することで悪性髄膜腫固有のドライバー変異同定可能である」という仮説を立て、本研究を計画している。
    本研究の目的は、悪性髄膜腫の標的可能遺伝子変異を同定することで悪性髄膜腫症例の個々に応じた最適治療薬を同定して新規治療を確立することである。そのため、H30年度は、実験基盤の確立と症例の蓄積が目標であった。実際、悪性髄膜腫症例から患者固有の腫瘍細胞の培養にも成功し、遺伝子パネルによる 標的可能遺伝子の検索を行った。培養細胞も樹立されているが、継代していくと増殖能が減退しており、H31年度以降の研究計画での治療実験へ対応できるように現在、培養細胞にTERT遺伝子を導入を試みている。また、頭蓋内希少固形腫瘍に関しても順次検索を進められる体制が整ってきた。

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  • てんかん焦点同定のための高精度術前評価法の開発-高密度脳波での高周波律動の解析-

    研究課題/領域番号:15K19955  2015年4月 - 2018年3月

    日本学術振興会  科学研究費助成事業 若手研究(B)  若手研究(B)

    平石 哲也, 福多 真史, 大石 誠, 高尾 哲郎, 柿田 明美

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    配分額:4030000円 ( 直接経費:3100000円 、 間接経費:930000円 )

    てんかん外科の普及には,今までとは異なるアプローチでのてんかん焦点の同定が必要である.高空間分解能かつ動きに強い,顔面まで含む脳波測定が可能な最大電極数が256個の高密度ネット型センサーの脳波システムを用いて,難治性てんかん症例においててんかん性脳波周辺から高周波律動の検出が確認された.疾患特異的にてんかん波と高周波律動の関係を検証をすることにより,高密度脳波計はてんかん焦点解析の一助になる可能性が示唆された.

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  • 脳機能再構築に基づく脳腫瘍新規治療法の開発

    研究課題/領域番号:25462247  2013年4月 - 2017年3月

    日本学術振興会  科学研究費助成事業 基盤研究(C)  基盤研究(C)

    藤井 幸彦, 松澤 等, 平石 哲也, 青木 洋, 倉部 聡, 塚本 佳広, 福多 真史, 中田 力

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    配分額:5070000円 ( 直接経費:3900000円 、 間接経費:1170000円 )

    運動機能では、機能的MRlにより、脳腫瘍患者の腫瘍と対側の掌握運動時に、腫瘍側の感覚運動野の賦活部位の変位を認め、更には、腫瘍対側の小脳賦活の有意な増強を認めた。小脳においても脳機能再構築が起こりえることを捉えた。言語機能では、近赤外線スペクトロスコピー(NIRS)を用いて、術中にBroca運動性言語領域を刺激し、Wernicke感覚性言語領域でNIRSの変化を観察できた。言語領域皮質間の刺激伝搬の視覚化に成功した。これらの世界初の新知見は、脳機能再構築のメカニズムの解明に繋がり、延いては脳機能再構築に基づいた脳腫瘍の新しい手術治療法開発の可能性を示唆した重要な研究成果となった。

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  • 先進的三次元工学技術を基盤とした微小解剖ライブラリーを完成させる

    研究課題/領域番号:25462209  2013年4月 - 2016年3月

    日本学術振興会  科学研究費助成事業 基盤研究(C)  基盤研究(C)

    高尾 哲郎, 大石 誠, 平石 哲也, 福多 真史

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    配分額:4940000円 ( 直接経費:3800000円 、 間接経費:1140000円 )

    高難度の脳神経外科開頭手術の術前評価として行ってきた高解像度の頭部 MRIなどから作成した三次元データが蓄積され、ライブラリーとして使用できる。頭蓋底髄膜腫、前庭神経鞘腫、片側顔面けいれんをはじめとした疾患モデルが揃っている。修練医や手術初心者の術前準備のみならず、希少症例の確認に使用している。各疾患の研究においても、データ集積の一助になる。御遺体による解剖セミナーにおいても、種々の手術アプローチについて段階毎のモデルを作成し、実際の解剖体と照合しながら解剖を進めるという画期的な学習法を確立した。

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  • 近赤外分光法を用いた新しい術中モニタリングの開発-神経ネットワークの可視化-

    研究課題/領域番号:25462246  2013年4月 - 2016年3月

    日本学術振興会  科学研究費助成事業 基盤研究(C)  基盤研究(C)

    福多 真史, 青木 洋, 高尾 哲郎, 平石 哲也, 佐藤 圭輔, 佐藤 洋輔

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    配分額:4420000円 ( 直接経費:3400000円 、 間接経費:1020000円 )

    脳神経外科手術中に,新たに開発したプローベを用いた近赤外分光法(NIRS)により,脳表から直接脳血流を測定することに成功した.てんかん発症の脳腫瘍症例で補足運動野のてんかん焦点の電気刺激によって,離れた部位の一次運動野で術中NIRSにより脳血流の増加が確認された.また別の症例では言語野である左下前頭回の電気刺激によって,左上側頭回の脳血流増加が確認された.これらは術中NIRSによる脳表での血流増加が離れた部位での神経ネットワークの存在を反映しているものと思われ,将来的に言語野の術中モニタリングとして実用化される可能性が示唆された.

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  • ヒト脳組織スライスの検討によるてんかん原性の発現・獲得過程の解明

    研究課題/領域番号:24592116  2012年4月 - 2015年3月

    日本学術振興会  科学研究費助成事業 基盤研究(C)  基盤研究(C)

    大石 誠, 平石 哲也, 北浦 弘樹

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    配分額:5460000円 ( 直接経費:4200000円 、 間接経費:1260000円 )

    脳組織において「てんかん原性」がいかに発現し獲得されるかは,いまなお解明されていない.本研究では,脳神経外科手術摘出直後の生きた大脳組織標本を実験に活用し,当施設で開発された蛍光イメージング(フラビン傾向反応)による組織の生理学的反応,特に刺激の易伝播性と,免疫組織学的所見・病理組織検索による抑制ニューロンの脱失所見が相関すること,しかもてんかん発症初期にすでにこの所見が見られていることを明らかにすることに成功し,てんかん原性の発現と獲得の過程の一部を視覚化し得ることができた.

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