記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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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  

2018年7月に当科に光線力学療法(photodynamic therapy:PDT)を導入してから2021年6月まで,当科でPDTを施行した悪性脳腫瘍症例の臨床的特徴および無増悪生存期間(progression free survival:PFS),全生存期間(overall survival:OS),主な合併症について検討した.初発膠芽腫9例におけるPFSの中央値は14ヵ月,OS中央値は未達であった.死亡例は早期に遠隔再発を来した1例のみであった.主な合併症は光過敏症が1例,脳表に可逆性のFLAIR高信号が3例,術後うつ状態が5例に認め,いずれも一過性であった.術後の長期間遮光管理が原因と思われるうつ症状には,早期遮光解除などの工夫が必要と思われた.実際の症例を提示し我々のPDT初期治療経験を紹介し,また,次世代治療と考える近赤外光線免疫療法(near-infrared photoimmunotherapy:NIR-PIT)の研究に関しても紹介する.NIR-PITは,癌細胞の表面抗原を標識とし,近赤外線照射により生じた熱エネルギーにより腫瘍細胞の細胞膜を破壊する画期的な治療法である.今回,我々は膠芽腫細胞株に特異的な表面抗原Xに対する抗体を用いたNIR-PITを行い,殺細胞効果を確認した.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01213&link_issn=&doc_id=20230803380003&doc_link_id=10.2530%2Fjslsm.jslsm-44_0024&url=https%3A%2F%2Fdoi.org%2F10.2530%2Fjslsm.jslsm-44_0024&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本レーザー医学会  

2018年7月に当科に光線力学療法(photodynamic therapy:PDT)を導入してから2021年6月まで,当科でPDTを施行した悪性脳腫瘍症例の臨床的特徴および無増悪生存期間(progression free survival:PFS),全生存期間(overall survival:OS),主な合併症について検討した.初発膠芽腫9例におけるPFSの中央値は14ヵ月,OS中央値は未達であった.死亡例は早期に遠隔再発を来した1例のみであった.主な合併症は光過敏症が1例,脳表に可逆性のFLAIR高信号が3例,術後うつ状態が5例に認め,いずれも一過性であった.術後の長期間遮光管理が原因と思われるうつ症状には,早期遮光解除などの工夫が必要と思われた.実際の症例を提示し我々のPDT初期治療経験を紹介し,また,次世代治療と考える近赤外光線免疫療法(near-infrared photoimmunotherapy:NIR-PIT)の研究に関しても紹介する.NIR-PITは,癌細胞の表面抗原を標識とし,近赤外線照射により生じた熱エネルギーにより腫瘍細胞の細胞膜を破壊する画期的な治療法である.今回,我々は膠芽腫細胞株に特異的な表面抗原Xに対する抗体を用いたNIR-PITを行い,殺細胞効果を確認した.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01213&link_issn=&doc_id=20230803380003&doc_link_id=10.2530%2Fjslsm.jslsm-44_0024&url=https%3A%2F%2Fdoi.org%2F10.2530%2Fjslsm.jslsm-44_0024&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

Diffuse midline glioma(DMG)の80%以上がヒストンH3K27M変異を有する.橋に局在する病変は摘出術の適応はなく,針生検でも重篤な合併症が生じ得るためDMGに対してliquid biopsyの確立が切望される.我々は初発時に腰椎穿刺で採取した脳脊髄液よりH3K27Mを同定するのは困難と報告した.本稿では,多発病変および播種病変を有しliquid biopsyによりH3K27M変異と同定された2症例を紹介し,liquid biopsyの恩恵を受ける症例の特徴について迫る.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00650&link_issn=&doc_id=20230215270002&doc_link_id=10.34544%2Fjspn.47.4_358&url=https%3A%2F%2Fdoi.org%2F10.34544%2Fjspn.47.4_358&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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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記述言語：英語  

Meningoencephalocele in the lateral sphenoid sinus (SS) has been determined to be a rare entity often detected by cerebrospinal fluid (CSF) rhinorrhea. To date, the pathology of meningoencephalocele in the lateral SS has remained to be unclear in many cases. In this study, we report on a case of a 72-year-old woman with an arteriovenous malformation who presented with CSF rhinorrhea. Radiologic investigations revealed a left temporal meningoencephalocele in the lateral SS. We removed the meningoencephalocele and performed skull base repair, after which the CSF rhinorrhea resolved. Pathological examination showed congenital cortical abnormalities with dysmorphic neurons in various shapes and acquired chronic tissue alterations including fibrillary gliosis and scattered Rosenthal fibers. These findings may further aid in understanding the etiopathogenesis of meningoencephalocele in the lateral SS.

DOI： 10.2176/jns-nmc.2022-0152

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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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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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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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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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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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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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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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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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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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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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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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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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DOI： 10.4103/2152-7806.162483

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DOI： 10.4103/2152-7806.153872

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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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記述言語：英語   出版者・発行元：SPRINGER  

DOI： 10.1007/s10143-013-0493-7

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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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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.

DOI： 10.3171/2013.4.JNS121546

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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.

DOI： 10.1007/s10143-013-0479-5

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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.

DOI： 10.3171/2013.3.JNS121109

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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. © 2012 Elsevier B.V.

DOI： 10.1016/j.eplepsyres.2012.09.014

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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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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  

DOI： 10.1016/j.clineuro.2012.04.003

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DOI： 10.4103/2152-7806.115650

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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)

DOI： 10.3171/2012.5.JNS112334

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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.

DOI： 10.1111/j.1528-1167.2012.03509.x

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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

DOI： 10.1111/j.1528-1167.2012.03509.x

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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.

DOI： 10.1111/j.1440-1789.2011.01243.x

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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)

DOI： 10.3171/2011.10.JNS111343

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.4103/2152-7806.102328

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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

DOI： 10.1016/j.neuroimage.2011.05.046

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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.

DOI： 10.1016/j.neuroimage.2011.05.046

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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.

DOI： 10.1179/016164110X12700393823697

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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 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)

DOI： 10.3171/2010.11.JNS101041

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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.

DOI： 10.1179/016164110X12807570

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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.

DOI： 10.2176/nmc.51.201

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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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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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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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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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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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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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PubMed

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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.

Web of Science

PubMed

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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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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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PubMed

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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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記述言語：日本語   出版者・発行元：新潟医学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00990&link_issn=&doc_id=20180209010018&doc_link_id=%2Fdg3nigta%2F2017%2Fs13109%2F014%2F0563-0563%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2017%2Fs13109%2F014%2F0563-0563%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)医学書院  

70歳女性。物忘れと歩行困難を主訴に近医を受診、頭部CTにて水頭症を指摘され、紹介となった。頭部MRIでは全脳室拡大を認めたが、脳室系の閉塞所見は認めず、交通性水頭症と考えられた。また、右前床突起部に均一に強く増強される直径2cmのdual tail signを伴う脳実質外腫瘍が認められた。前床突起小型髄膜症を合併した水頭症と診断され、右前頭側頭開頭で脳腫瘍摘出術が施行された。摘出標本の病理診断は髄膜細胞性髄膜腫(WHO grade 1)であった。術後、高値であった髄液蛋白濃度は正常化し、認知機能、歩行とも改善傾向を維持し、再発は認められていない。

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

頭蓋底手術における経頭蓋電気刺激による脳神経の運動誘発電位(motor evoked potential、以下MEP)モニタリングは、腫瘍が大きくて脳神経が確認されない早期の摘出段階でも記録が可能であり、また神経のどの部位の傷害でもその運動機能を反映しうるという利点がある。刺激部位と記録部位が近いので、刺激のアーチファクトを軽減するための刺激条件の設定やアースバンドの設置などの工夫が必要であり、また刺激によりmotion artifactを起こすことがあるので、手術操作中に刺激を入れるタイミングに注意する。眼輪筋、口輪筋のFacial MEPは摘出前後の振幅比が50%未満に低下した場合に術後に顔面運動機能の予後が不良になる可能性が高い。咽頭電極を用いたPharyngeal MEPは摘出後に振幅比が50%未満に低下すると術直後に嚥下障害が悪化する可能性が高く、また術後の点滴や経管栄養の中止時期が50%以上の症例に比べて有意に遅延する。Lingual MEPは術後早期の嚥下機能、発声機能に影響を及ぼす舌下神経機能と強い相関を示す。Facial、Pharyngeal、Lingual MEPモニタリングは術後の顔面神経、舌咽迷走神経、舌下神経の運動機能を予測する上で有用なモニタリングである。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J03414&link_issn=&doc_id=20160907330004&doc_link_id=10.11422%2Fjscn.44.196&url=https%3A%2F%2Fdoi.org%2F10.11422%2Fjscn.44.196&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

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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記述言語：日本語   出版者・発行元：新潟医学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00990&link_issn=&doc_id=20160803070019&doc_link_id=%2Fdg3nigta%2F2016%2Fs13003%2F011%2F0214-0214%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2016%2Fs13003%2F011%2F0214-0214%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：新潟医学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00990&link_issn=&doc_id=20160803070013&doc_link_id=%2Fdg3nigta%2F2016%2Fs13003%2F005%2F0210-0211%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2016%2Fs13003%2F005%2F0210-0211%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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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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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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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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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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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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記述言語：日本語   出版者・発行元：日本脳神経CI学会  

2012年4月〜11月に脳神経減圧術(MVD)を施行した14例(片側顔面痙攣(HFS)8例(男性1例、女性7例)、三叉神経痛(TN)6例(男性2例、女性4例)を対象に、三次元コンピュータグラフィック(3D-CG)モデルを用いたシミュレーション画像について概説し、脳神経減圧術(MVD)におけるその利点とピットフォールについて検討した。3D-CGモデルは3TMRIから小脳、脳幹、各神経、小脳テント、動脈を、64列CTの造影CTから骨と静脈を抽出し、サーフェースレンダリングで作成した。インタラクティブバーチャルシミュレーション(IVS)は触感型デバイスで操作する3D-CGモデリングソフトで開頭、術野の作成、減圧方法をシミュレーションした。主な微小解剖構造の同定は全例可能で、14例中13例で圧迫血管の同定が可能であった。14例中1例ではほぼ想定通りの判定になった。14例中4例で術前IVSから想定した減圧操作や術野が得られなかった。細い血管が圧迫に関与し圧迫血管が同定できなかった1例、穿通枝のため可動制限があった1例、錐体静脈により想定通りの減圧操作が行えなかった1例、細い錐体静脈により術野が狭く難渋した1例であった。IVSは術野での解剖学的な立体構造の想定に有用で、手術の安全性、確実性を高める方法と思われた。しかし、錐体静脈や穿通枝などの細い血管の描出には限度があり、留意して解析を行うことが重要と思われた。

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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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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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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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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記述言語：日本語   出版者・発行元：日本シミュレーション医療教育学会  

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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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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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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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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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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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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

記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

急性期頭部外傷で入院した85歳以上の超高齢者50例(男性19例、女性31例、平均87.6歳)を対象に、抗血小板・抗凝固治療との関連について検討した。主病名は急性硬膜下血腫、脳挫傷各19例、外傷性クモ膜下出血5例、急性硬膜外血腫1例、脳震盪4例、頭蓋骨骨折2例であった。治療は保存的加療46例、穿頭術、開頭術各2例、平均在院日数は14.1日であった。急性硬膜下血腫、脳挫傷、外傷性クモ膜下出血の計43例中抗血小板剤や抗凝固剤服用なし20例(A群)、低容量アスピリンのみ服用12例(B群)、それ以外服用11例(C群)に分け比較した。43例中14例が死亡し、A群4例、B群2例に比べC群8例と有意に多く、急性硬膜下血腫8例、脳挫傷6例に比べ外傷性クモ膜下出血0例と予後良好であった。C群の死亡例は抗血小板3剤併用2例中2例、抗凝固剤使用8例中6例であった。症例数が少なく、脳損傷による凝固異常との判別が困難で数値的検討は行わなかった。

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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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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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳卒中学会  

症例は73歳女性。右眼裂の狭小化にて発症。翌日歩行困難、めまい、嘔吐を伴い、3日目に当院救急外来を受診。右Horner徴候、右上下肢に測定障害、顔面を含む左半身の痛覚減弱、右上肢に軽度運動麻痺を認めた。来院数時間後、呼吸状態が不安定となり人工呼吸器管理となった。頭部MRI拡散強調画像において右延髄に梗塞巣を認めた。呼吸障害は遷延し1ヵ月半以上、人工呼吸器管理を行った。呼吸器離脱後も低酸素・高炭酸ガス血症を認め、酸素投与を要した。一般に、中枢性呼吸障害は両側性延髄障害で生じるといわれているが、本例は片側延髄梗塞であった。過去の文献例では遷延性呼吸障害を呈する片側延髄梗塞は嚥下障害を伴い疑核を含む病変が多く、片側でも疑核を含む病巣では遷延性呼吸障害が出現する可能性があり注意を要する。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

【目的】ヒトてんかん性組織に特徴的な興奮の易伝播性を可視化するために、フラビン蛋白蛍光イメージング(Flavoprotein fluorescence imaging:FFI)によりヒト脳組織内の神経活動伝播反応の観察を行い、さらに同組織におけるカルシウム結合蛋白の発現を免疫組織学的に検証し、FFI所見との整合性を検討することでその意義に関する検討を試みた。【方法】原発性脳腫瘍などの大脳局在病変に対し外科治療を行った10症例を対象とし、術前のてんかん発作症状の有無によりてんかん群(5例)、非てんかん群(5例)に分類した。各症例で摘出術に伴って得られた腫瘍周囲の大脳皮質組織の一部を培養した状態で実験室へ搬送し、標本作成を行った。FFIの実験では、bicucullineを加えた人工脳脊髄液で標本を灌流しながら皮質第IV層または第VI層の電気刺激を行い、青色光励起光(波長:470-490nm)の照射で励起される緑色自家蛍光(λ=510-550nm)をCCDカメラシステムにて撮影し、蛍光強度変化(ΔF/F0)をカラースケール表示した。同一標本から得られた切片を用いて、3種類のカルシウム結合蛋白(PV、CB、CR)の発現を陽性細胞の数として計測し、FFIの結果と免疫組織学的に比較検討を行った。【結果】てんかん群全例でFFIにて刺激部から強い蛍光反応が皮質に沿って水平方向に伝播してゆく特徴的な所見が観察され、非てんかん群ではこのような伝播所見は認めなかった。スライス標本上で計測した伝播域の広さは、非てんかん群よりてんかん群で有意に大きかったが(p=0.008)、ΔF/F0の最大値には差がなかった。免疫組織学的検討例でのPV陽性神経細胞の陽性率は、てんかん群で非てんかん群に比べて有意に低く(p=0.006)、FFIでの伝播域の広さとは負の相関を示す傾向を認めた(R=0.78、p=0.04)。【結論】ヒト脳組織のスライス標本上でFFI法を用いて、てんかん性皮質に特徴的な皮質活動の水平性伝播所見を明らかにした。FFIでの伝播域の広さと同部のカルシウム結合蛋白陽性細胞の発現率の低下に相関も得られ、本研究によりヒト脳組織における活動の易伝播性と皮質内抑制機構の欠落との密接な関連性が示唆された。(著者抄録)

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

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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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記述言語：日本語   出版者・発行元：(株)医学書院  

術中AMRモニタリング下で神経減圧術を施行した片側顔面痙攣症例102例を対象に術中AMR所見が手術操作に与える影響と術後予後との関係について検討した。AMR所見はMooijらの分類を参考に、AMR所見によって手術操作を加えた群(Guiding群)、減圧操作完了後にAMRが消失した群(Confirming群)、AMRが減圧操作完了前に消失した群(Indirect confirming群)、減圧操作完了後もAMRに変化がないかあるいは最終的にAMRが残存した群(Inconclusive群)の4群に分けた。その結果、1)術後の症状消失率は、Guiding群で92.9%(13/14)、Confirming群で96.4%(53/55)、Indirect confirming群で86.7%(13/15)、Inconclusive群で83.3%(15/18)と、Guiding群、Confirming群で高い傾向にあった。2)今回の検討では、減圧操作後のAMR消失例に加え、早期消失例でもその後の再出現がない症例、残存例でも振幅が明らかに低下した症例では、術後良好な予後を予測し得る結果が得られた。特に顔面神経遠位部圧迫例、複数血管圧迫例では責任血管の同定に有用であり、手術操作に与える影響は大きいものと考えられた。

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

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記述言語：日本語   出版者・発行元：日本シミュレーション外科学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

外側後頭下開頭法により小脳橋角部へのアプローチを行った48例を対象に、3次元造影CTのvolumetric renderingを用いた術前評価法を施行し、その評価法の実際と評価結果を報告した。全例で術前評価により想定した手順通りの開頭を施行し、各血管系の止血処理を確実に行うことで皮下・筋層の剥離の進行が可能であった。またasterionとTransverse-sigmoid sinusの走行の位置関係の把握により、開頭時の静脈洞損傷の回避や開頭時の骨削除を最小限にとどめることができた。更に後頭動脈(OA)と上下項線の関係の把握により、上下項線それぞれに起因する筋群の剥離の際、順次OAを露出し処理することができた。骨を貫通して静脈洞と後頸部静脈叢を交通する導出静脈のmastoid emissary veinsとposterior condylar emissery veinsは、それぞれ22例と41例で術前に確認でき、良く発達していると評価した6例と7例では術中特に注意を払った。

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記述言語：日本語   出版者・発行元：(株)医学書院  

56歳男。起床後より歩行困難が出現し、翌日、症状が進行したため近医神経内科へ入院となった。MRIのDWIで小脳、左前頭葉から後頭葉、頭頂葉に梗塞像を認め、MRAで右椎骨動脈の描出が不良であった。塞栓症の診断で、2病日よりヘパリンおよびエダラボンの点滴加療を開始された。3病日、胸痛などの随伴症状はなく、SpO2が90%へ低下した。画像所見で腕頭動脈から右鎖骨下動脈、腕頭動脈から右総頸動脈に血栓化した解離腔があり、左総頸動脈にはintimal flapを認めた。胸部外科による外科的治療が必要な可能性があるため、5病日に当院転院となった。頸動脈エコーで右総頸動脈ではlow echogenicな血栓化した偽腔を認め、左総頸動脈では頸動脈分岐部までintimal flapと一部血栓化した部位を観察した。神経症状の増悪がなく、動脈瘤形態に変化を認めないことから、抗凝固療法を続け、定期的に画像検査を行うこととした。杖歩行可能となったが、右上肢に強い麻痺が残存したため29病日にリハビリテーション病院へ転院となった。発症後1年間の経過観察で、限局性弓部大動脈解離性動脈瘤および解離腔の形態変化は認めず、症状の増悪や新たな病巣の出現もなかった。

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

14歳女。患者は頭痛、発熱が出現し、2日後より頭痛の増強・嘔吐が出現した。更に発熱から4日後には頭痛と頂部硬直が認められた。頭蓋内圧亢進症状を伴う脳膿瘍との診断で、減圧開頭術および定位膿瘍吸引ドレナージ術が施行されることとなったが、術前の骨条件のCTで左眼窩内側壁より篩骨洞を経由して前頭葉下面に低吸収域の棒状の異物が確認された。これは5歳時に振り向いた際に、友人の箸が左眼窩内側に刺さった既往であることが判明し、そこで、残存箸の除去と頭蓋底の硬膜欠損部修復および頭蓋形成術を目的に手術を行った。その結果、残存骨片は脳内に埋没しており、摘出しない方針となり、術後は軽度の嗅覚低下を認めたものの、その他の神経学的異常は認めず、独歩退院となった。現在、約2年間経過で再発は認められていない。

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

48歳女.歩行時のふらつきと呂律が回らないことを主訴とした.頭部MRIで小脳・橋の萎縮とT2強調水平断像での橋横走線維の高信号化(いわゆる十字サイン)を認めたため標記萎縮症と診断した.その後の遺伝子診断でCACNA1A遺伝子におけるCAGリピートの伸長(SCA6遺伝子変異)を認めた

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