DOI： 10.1016/j.wneu.2023.04.099

PubMed

DOI： 10.1002/epi4.12698

PubMed

DOI： 10.11441/shinshumedj.71.115

DOI： 10.3390/brainsci13030440

PubMed

DOI： 10.1007/s00701-023-05517-6

PubMed

<p>A 23-year-old left-handed woman developed frontal lobe epilepsy at the age of 10 years. Seizure frequency was initially yearly, although it increased to hourly after employment. Focal aware seizures with asymmetrical tonic posturing were frequently induced by somatosensory stimulation using the right fingers. Scalp electroencephalogram (EEG) showed only low voltage fast activity at the vertex area, and brain magnetic resonance imaging (MRI) showed cortical thickness in the left supplementary motor area (SMA). Based on the clinical symptoms and functional brain images, the SMA proper was considered the main epileptogenic zone. Depressive symptoms occurred with increasing seizure frequency, causing her to quit her work. At the age of 23 years, she was brought to the emergency room with a fall injury. After several multidisciplinary collaborations, she underwent placement of chronic subdural electrodes and corticectomy of mainly the left SMA proper 2 months after admission. Histopathology showed focal cortical dysplasia type IIa. She restarted working after surgery without seizures for 3 years. In patients with childhood-onset adolescent and young adult intractable epilepsy, multidisciplinary collaboration from an early stage to discuss future-oriented treatment strategies and address the psychosocial aspects of the disease is important.</p>

DOI： 10.3805/jjes.40.548

DOI： 10.3390/brainsci13010115

PubMed

症例は23歳左利き女性。10歳発症の前頭葉てんかん、年単位で経過した意識が保持される非対称性強直発作が就労後、右手指を用いた行為により時間単位で誘発された。頭皮脳波は頭蓋頂中心の低振幅速波活動のみ、頭部MRIで左補足運動野の皮質肥厚あり、臨床症状と各種脳機能画像から左固有補足運動野を主たるてんかん原性領域と考えた。発作増加に伴い抑うつ症状が出現し仕事を退職し、23歳時墜落外傷で緊急入院となった。多職種間でのカンファレンスを繰り返し入院2ヵ月後に慢性硬膜下電極留置後、焦点切除を行った。病理はfocal cortical dysplasia type IIa、術後3年発作なく就労を再開している。小児期発症adolescent and young adult世代の難治てんかん患者では、早期から多職種で連携し将来を見据えた治療方針の検討、心理社会的側面への対応が重要である。(著者抄録)

DOI： 10.11477/mf.1436204721

PubMed

<p>The use of robot-assisted frameless stereotactic electroencephalography (SEEG) is becoming more common. Among available robotic arms, Stealth Autoguide (SA) (Medtronic, Minneapolis, MN, USA) functions as an optional instrument of the neuronavigation system. The aims of this study were to present our primary experiences with SEEG using SA and to compare the accuracy of implantation between SA and navigation-guided manual adjustment (MA). Seventeen electrodes from two patients who underwent SEEG with SA and 18 electrodes from four patients with MA were retrospectively reviewed. We measured the distance between the planned location and the actual location at entry (De) and the target (Dt) in each electrode. The length of the trajectory did not show a strong correlation with Dt in SA (Pearson's correlation coefficient [r] = 0.099, p = 0.706) or MA (r = 0.233, p = 0.351). De and Dt in SA were shorter than those in MA (1.99 ± 0.90 vs 4.29 ± 1.92 mm, p = 0.0002; 3.59 ± 2.22 vs 5.12 ± 1.40 mm, p = 0.0065, respectively). SA offered higher accuracy than MA both at entry and target. Surgical times per electrode were 38.9 and 32 min in the two patients with SA and ranged from 51.6 to 88.5 min in the four patients with MA. During the implantation period of 10.3 ± 3.6 days, no patients experienced any complications.</p>

DOI： 10.2176/jns-nmc.2022-0010

PubMed

ニューロナビゲーションシステムであるロボットアームStealth Autoguide(SA)を用いた定位的頭蓋内脳波(SEEG)電極挿入術と、ナビゲーションガイド下手動制御(MA)による脳深部電極挿入術を行い、焦点局在の精度を比較した。2021年3月～6月までに、著者らの医療施設で、脳深部電極挿入術後にてんかん手術が行われた患者6例(男性1例、女性5例、年齢10～59歳)を対象に、SAを受けた患者2例の17電極と、MAを受けた患者4例の18電極を後方視的に調べた。術前計画による各電極の刺入点の位置と実際に電極が挿入された位置との距離(De)、目標点の位置と実際に電極が挿入された位置との距離(Dt)を測定した。その結果、SAを用いた患者ではDeとDtがMAを用いた患者よりも短く、刺入点、目標点の位置がともに高精度であった。また、SAを用いた患者の手術時間は32～38.9分と、MAを用いた患者の施術時間51.6～88.5分に比べ短時間で、有害事象の面でも、平均挿入期間10.3±3.6日の間に合併症を発症した患者も0例であった。以上より、SEEGにおいて、SAはナビゲーションガイド下MAよりも脳深部電極挿入の位置が高精度で、短時間の施術時間で、焦点局在診断が達成されることが確認された。

DOI： 10.3390/brainsci12070875

PubMed

DOI： 10.3171/2022.2.PEDS21522

PubMed

DOI： 10.1016/j.braindev.2022.02.003

PubMed

DOI： 10.1016/j.eplepsyres.2022.106870

PubMed

DOI： 10.1016/j.radcr.2022.01.014

PubMed

DOI： 10.1038/s41598-021-04216-5

PubMed

DOI： 10.1007/s00381-021-05399-y

PubMed

DOI： 10.3390/brainsci11121608

PubMed

DOI： 10.1684/epd.2021.1347

PubMed

DOI： 10.1093/ons/opab265

PubMed

DOI： 10.1007/s00401-021-02337-9

PubMed

DOI： 10.1016/j.inat.2021.101099

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.wneu.2021.01.012

PubMed

DOI： 10.1016/j.wneu.2021.01.012

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.3390/cancers13061415

PubMed

DOI： 10.3390/cancers13061415

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.3171/2020.9.PEDS20520

PubMed

DOI： 10.3171/2020.9.PEDS20520

PubMed

DOI： 10.18888/rp.0000001517

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.3389/fneur.2021.617291

PubMed

症例は50歳代女性で、突然の右側頭部痛があり、その後嘔吐を繰り返した。救急搬送時の単純CTで右側脳室三角部を中心とした4×3×3cm大の腫瘤性病変を認めた。腫瘤の形態は円形で境界明瞭であり、内部は均一かつ灰白質と等吸収で、石灰化は認めなかった。右側脳室内には出血を伴っていた。第6病日のMRIで右側脳室内腫瘤は、T1強調像で白質より軽度低信号、T2強調像で白質より高信号で、拡散強調像では高信号、ADC mapでは拡散は白質と同程度であった。磁化率強調像では腫瘤辺縁に点状または線状の低信号を認め、出血と考えられた。腫瘤は均一な造影効果を示し、右側脳室三角部周囲の白質に浮腫を認めた。画像所見から、髄膜腫、脳室内(脈絡叢)転移、solitary fibrous tumor/hemangiopericytomaが疑われた。手術では、栄養血管である前脈絡叢動脈を脳室内で凝固切断した。脳室壁と腫瘤を分けつつ、三角部の脈絡叢は腫瘤とともに摘出した。摘出検体の病理組織所見では、紡錘形の細胞が渦巻き状に増生している所見や、紡錘形の細胞が索状に配列している所見、楕円形の細胞が増生している所見を認めた。以上から、移行性髄膜腫grade Iと診断された。

Publishing type：Research paper (scientific journal)  

DOI： 10.3389/fonc.2020.596448

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.21873/anticanres.14766

PubMed

DOI： 10.21873/anticanres.14766

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.ebr.2021.100429

PubMed

DOI： 10.3389/fneur.2021.617291

PubMed

<p>  Since better outcomes for mesial temporal lobe epilepsy (MTLE) was reported in 2001, epilepsy surgeries have been established as a treatment for medically intractable epilepsy. Among them, five types of epilepsy surgery (amygdalohippocampectomy for MTLE, lesionectomy for focal epilepsy with or without apparent MRI lesions, hemispherotomy for hemispheric epilepsy, and callosotomy for drop attacks) are known as surgically remediable epileptic syndromes. Furthermore, in 2010, vagal nerve stimulation was approved as a palliative surgery for epilepsy in Japan.</p><p>  When the epileptogenic focus is undetermined in non-invasive evaluations such as scalp electroencephalography (EEG), MRI, and positron emission tomography, invasive evaluation using intracranial electrodes might be performed subsequently. Conventionally, subdural grid EEG was mainly used for detecting the epileptogenic focus ; however, the percentage of the use of depth electrodes with the stereotactic method of EEG implantation (SEEG) has been increasing recently. SEEG is supposed to be insufficient in terms of confirming cortical seizure propagation and performing functional mapping with electrical stimulation, but it has been widely adopted because of its low invasiveness. When planning the location of the electrodes, a hypothesis of the seizure focus and its propagation needs to be set up based on the anatomo-clinico-electrical correlation.</p><p>  When the epileptogenic focus is in a limited area of the brain, less invasive approaches should be selected for the removal of the lesion. On the other hand, when the epileptic network affects a wide part of the brain, surgeries based on the disconnection concept, such as corpus callosotomy, multi-lobe disconnection, and hemispherotomy, should be considered.</p><p>  Although unapproved in Japan, new concepts of surgery, such as focus coagulation, deep brain stimulation, and responsive neurostimulation, have become popular instead of focus resection, especially in cases of epilepsy originating from eloquent areas. Here, we describe the concept of epilepsy surgery and the current topics in this field.</p>

DOI： 10.7887/jcns.30.496

CiNii Article

DOI： 10.1016/j.ebr.2021.100429

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s40478-020-01078-2

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1371/journal.pone.0243272

PubMed

DOI： 10.1186/s40478-020-01078-2

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jocn.2020.10.019

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jocn.2020.10.019

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jocn.2020.07.026

PubMed

DOI： 10.1016/j.jocn.2020.07.026

PubMed

Publishing type：Research paper (scientific journal)  

BACKGROUND: When the epileptogenic foci skip the motor area, the epilepsy can be cured by surgery while preserving the motor function. This surgery has been reported as subtotal hemispherectomy. The disconnective variant of this surgery, subtotal hemispherotomy, is described. OBJECTIVE: To demonstrate each step clearly, a cadaveric brain, 3-dimensional reconstruction and simulation model, and intraoperative photographs were used. METHODS: A formalin-fixed cadaveric brain was dissected to show each step of this surgery. For the 3-dimensional model, several brain structures were reconstructed from preoperative images, and the surgery was simulated. Intraoperative photographs and postoperative magnetic resonance images were taken from the representative cases. RESULTS: Temporo-parieto-occipital disconnection is performed to disconnect these lobes and the insula, limbic system, and splenium of the corpus callosum. The postcentral sulcus is the anterior border of the disconnection. Next, prefrontal disconnection is performed to disconnect the frontal lobe and the insula, frontal lobe and basal ganglia, and the anterior part of the corpus callosum. The precentral sulcus is the posterior border of the disconnection. Finally, corpus callosotomy of the central part is performed. After these steps, subtotal hemispherotomy, with preservation of the pre- and postcentral gyrus, is achieved. The 3-dimensional model clearly shows the anatomic relationships between deep brain structures. In the representative cases, postoperative motor deterioration was transient or none, and seizure-free status was achieved after surgery. CONCLUSION: Subtotal hemispherotomy is generally difficult because of the complicated anatomy and narrow and deep surgical corridors. Combined use of these methods facilitates a clearer understanding of this surgery.

DOI： 10.1093/ons/opz354

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10014-020-00363-1

PubMed

DOI： 10.1007/s10014-020-00363-1

PubMed

Kansai Network(Kansai Molecular Diagnosis Network for CNS Tumors)コホートから、IDH野生型神経膠芽腫(GBM)と診断された高齢者症例(70歳以上)92例と若年者症例33例(50歳以下)を対象とし、加齢が予後不良因子となるか調査した。両群を比較した結果、高齢者群では若年者群と比べ、Karnofskyパフォーマンスステイタススコアが70以下の患者が多く認められ、生存期間も短かった。また、高齢者群では、MGMTプロモーターメチル化およびTERTプロモーター変異が高頻度に認められ、MGMTメチル化型とTERT野生型のサブグループでは、生存期間において年齢特異的な有意差が示され、さらに、PTEN欠失およびCDK4増幅によるDNAコピー数変化のプロファイルにおいても、高齢者群では若年群に比べ、有意に高値が示された。本検討により、分子プロファイルの変動により、神経膠芽腫における世代間の生存率の違いが説明された。

DOI： 10.3389/fonc.2020.596448

PubMed

DOI： 10.1371/journal.pone.0243272

PubMed

Publishing type：Research paper (scientific journal)  

BACKGROUND: Mixed germ cell tumors (MGCTs) usually occur in children. In the present report, we discuss an extremely rare case of adult-onset MGCT composed mainly of yolk sac tumor (YST) around the pineal gland. CASE DESCRIPTION: A 54-year-old Japanese man presented with disturbance of consciousness, Parinaud's syndrome, and gait disturbance. Magnetic resonance imaging revealed a pineal mass lesion, and subtotal resection of the tumor was achieved. The histologic diagnosis was MGCT, consisting mainly of YST. Although he underwent 5 courses of chemotherapy and craniospinal irradiation after surgery, tumor dissemination could not be controlled, and he died 10 months postoperatively. CONCLUSION: The present case highlights the need for clinicians to include YST in the differential diagnosis of acute progressive lesions around the pineal region, even in adult patients.

DOI： 10.1016/j.wneu.2019.08.079

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work  

BACKGROUND: When the epileptogenic foci skip the motor area, the epilepsy can be cured by surgery while preserving the motor function. This surgery has been reported as subtotal hemispherectomy. The disconnective variant of this surgery, subtotal hemispherotomy, is described. OBJECTIVE: To demonstrate each step clearly, a cadaveric brain, 3-dimensional reconstruction and simulation model, and intraoperative photographs were used. METHODS: A formalin-fixed cadaveric brain was dissected to show each step of this surgery. For the 3-dimensional model, several brain structures were reconstructed from preoperative images, and the surgery was simulated. Intraoperative photographs and postoperative magnetic resonance images were taken from the representative cases. RESULTS: Temporo-parieto-occipital disconnection is performed to disconnect these lobes and the insula, limbic system, and splenium of the corpus callosum. The postcentral sulcus is the anterior border of the disconnection. Next, prefrontal disconnection is performed to disconnect the frontal lobe and the insula, frontal lobe and basal ganglia, and the anterior part of the corpus callosum. The precentral sulcus is the posterior border of the disconnection. Finally, corpus callosotomy of the central part is performed. After these steps, subtotal hemispherotomy, with preservation of the pre- and postcentral gyrus, is achieved. The 3-dimensional model clearly shows the anatomic relationships between deep brain structures. In the representative cases, postoperative motor deterioration was transient or none, and seizure-free status was achieved after surgery. CONCLUSION: Subtotal hemispherotomy is generally difficult because of the complicated anatomy and narrow and deep surgical corridors. Combined use of these methods facilitates a clearer understanding of this surgery.

DOI： 10.1093/ons/opz354

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

We attempted to establish a magnetic resonance imaging (MRI)-based radiomic model for stratifying prognostic subgroups of newly diagnosed glioblastoma (GBM) patients and predicting O (6)-methylguanine-DNA methyltransferase promotor methylation (pMGMT-met) status of the tumor. Preoperative MRI scans from 201 newly diagnosed GBM patients were included in this study. A total of 489 texture features including the first-order feature, second-order features from 162 datasets, and location data from 182 datasets were collected. Supervised principal component analysis was used for prognostication and predictive modeling for pMGMT-met status was performed based on least absolute shrinkage and selection operator regression. 22 radiomic features that were correlated with prognosis were used to successfully stratify patients into high-risk and low-risk groups (p = 0.004, Log-rank test). The radiomic high- and low-risk stratification and pMGMT status were independent prognostic factors. As a matter of fact, predictive accuracy of the pMGMT methylation status was 67% when modeled by two significant radiomic features. A significant survival difference was observed among the combined high-risk group, combined intermediate-risk group (this group consists of radiomic low risk and pMGMT-unmet or radiomic high risk and pMGMT-met), and combined low-risk group (p = 0.0003, Log-rank test). Radiomics can be used to build a prognostic score for stratifying high- and low-risk GBM, which was an independent prognostic factor from pMGMT methylation status. On the other hand, predictive accuracy of the pMGMT methylation status by radiomic analysis was insufficient for practical use.

DOI： 10.1038/s41598-019-50849-y

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

We attempted to establish a magnetic resonance imaging (MRI)-based radiomic model for stratifying prognostic subgroups of newly diagnosed glioblastoma (GBM) patients and predicting O (6)-methylguanine-DNA methyltransferase promotor methylation (pMGMT-met) status of the tumor. Preoperative MRI scans from 201 newly diagnosed GBM patients were included in this study. A total of 489 texture features including the first-order feature, second-order features from 162 datasets, and location data from 182 datasets were collected. Supervised principal component analysis was used for prognostication and predictive modeling for pMGMT-met status was performed based on least absolute shrinkage and selection operator regression. 22 radiomic features that were correlated with prognosis were used to successfully stratify patients into high-risk and low-risk groups (p = 0.004, Log-rank test). The radiomic high- and low-risk stratification and pMGMT status were independent prognostic factors. As a matter of fact, predictive accuracy of the pMGMT methylation status was 67% when modeled by two significant radiomic features. A significant survival difference was observed among the combined high-risk group, combined intermediate-risk group (this group consists of radiomic low risk and pMGMT-unmet or radiomic high risk and pMGMT-met), and combined low-risk group (p = 0.0003, Log-rank test). Radiomics can be used to build a prognostic score for stratifying high- and low-risk GBM, which was an independent prognostic factor from pMGMT methylation status. On the other hand, predictive accuracy of the pMGMT methylation status by radiomic analysis was insufficient for practical use.

DOI： 10.1038/s41598-019-50849-y

PubMed

Publishing type：Research paper (scientific journal)  

難治性てんかんに対する半球離断術は、術後に脳室と脳表が広く交通することとなるため、硬膜下髄液貯留や水頭症の発生が危惧される。2015年2月から2017年10月までに施行した垂直法半球離断術6例のうち、2例で硬膜下髄液貯留がみられたが、無症候であったため経過観察とした。1例で手術側のモンロー孔閉鎖による非交通性水頭症を認め、内視鏡的脳室間ステントを行った。丹念な止血操作などの対策で両合併症の発生率の低下は期待できるが、依然として高い頻度で見られる合併症である。(著者抄録)

難治性てんかんに対する半球離断術は、術後に脳室と脳表が広く交通することとなるため、硬膜下髄液貯留や水頭症の発生が危惧される。2015年2月から2017年10月までに施行した垂直法半球離断術6例のうち、2例で硬膜下髄液貯留がみられたが、無症候であったため経過観察とした。1例で手術側のモンロー孔閉鎖による非交通性水頭症を認め、内視鏡的脳室間ステントを行った。丹念な止血操作などの対策で両合併症の発生率の低下は期待できるが、依然として高い頻度で見られる合併症である。(著者抄録)

Publishing type：Research paper (scientific journal)  

難治性てんかんに対する半球離断術は、術後に脳室と脳表が広く交通することとなるため、硬膜下髄液貯留や水頭症の発生が危惧される。2015年2月から2017年10月までに施行した垂直法半球離断術6例のうち、2例で硬膜下髄液貯留がみられたが、無症候であったため経過観察とした。1例で手術側のモンロー孔閉鎖による非交通性水頭症を認め、内視鏡的脳室間ステントを行った。丹念な止血操作などの対策で両合併症の発生率の低下は期待できるが、依然として高い頻度で見られる合併症である。(著者抄録)

Publishing type：Research paper (scientific journal)  

BACKGROUND: Mixed germ cell tumors (MGCTs) usually occur in children. In the present report, we discuss an extremely rare case of adult-onset MGCT composed mainly of yolk sac tumor (YST) around the pineal gland. CASE DESCRIPTION: A 54-year-old Japanese man presented with disturbance of consciousness, Parinaud's syndrome, and gait disturbance. Magnetic resonance imaging revealed a pineal mass lesion, and subtotal resection of the tumor was achieved. The histologic diagnosis was MGCT, consisting mainly of YST. Although he underwent 5 courses of chemotherapy and craniospinal irradiation after surgery, tumor dissemination could not be controlled, and he died 10 months postoperatively. CONCLUSION: The present case highlights the need for clinicians to include YST in the differential diagnosis of acute progressive lesions around the pineal region, even in adult patients.

DOI： 10.1016/j.wneu.2019.08.079

PubMed

Publishing type：Research paper (scientific journal)  

OBJECTIVE: Sudden death in the bathtub occurs relatively frequently in Japan, particularly among elderly people. We hypothesize that sudden death in epilepsy occurring in the bathtub (SDEPB) can be distinguished from sudden death in nonepilepsy occurring in the bathtub (SDnonEPB), but is identical to sudden unexpected death in epilepsy (SUDEP). METHODS: Tokyo Medical Examiner's Office conducts postmortem examinations for all sudden and unexpected deaths in Tokyo. Clinical, social, and autopsy findings of 43 SDEPB were compared with 76 SDnonEPB, 50 SUDEP outside the bathtub, and Japanese forensic autopsy data as controls. RESULTS: Extension of the leg(s) outside the bathtub was seen in 33% of SDEPB, but none of SDnonEPB. Sitting position was seen less frequently in SDEPB (37%) than in SDnonEPB (64%). Lung weight and pleural effusion volume were significantly lower in SDEPB than in SDnonEPB. Age at death in SDEPB was significantly younger than that in SDnonEPB. Sudden death in epilepsy occurring in the bathtub showed no differences in lung weight and pleural effusion volume from SUDEP. Living with family was more frequent in SDEPB (73%) than in SUDEP (48%). Few antiepileptic drugs, infrequent seizures, and low rate of mental retardation were identical between SDEPB and SUDEP. Lung weight was significantly heavier in all three groups than in age- and sex- matched autopsy controls. CONCLUSIONS: Leg extension outside the bathtub, lower lung weight, and absence of pleural effusion distinguish SDEPB from SDnonEPB in elderly people. Sudden death in epilepsy occurring in the bathtub may represent a form of SUDEP occurring in the bathtub, rather than drowning despite submergence in the bathtub at discovery. Conditions for bathing require careful attention from physicians and relatives, even for patients with epilepsy with few medications and infrequent seizures, and without mental retardation.

DOI： 10.1016/j.yebeh.2019.04.009

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: Sudden death in the bathtub occurs relatively frequently in Japan, particularly among elderly people. We hypothesize that sudden death in epilepsy occurring in the bathtub (SDEPB) can be distinguished from sudden death in nonepilepsy occurring in the bathtub (SDnonEPB), but is identical to sudden unexpected death in epilepsy (SUDEP). METHODS: Tokyo Medical Examiner's Office conducts postmortem examinations for all sudden and unexpected deaths in Tokyo. Clinical, social, and autopsy findings of 43 SDEPB were compared with 76 SDnonEPB, 50 SUDEP outside the bathtub, and Japanese forensic autopsy data as controls. RESULTS: Extension of the leg(s) outside the bathtub was seen in 33% of SDEPB, but none of SDnonEPB. Sitting position was seen less frequently in SDEPB (37%) than in SDnonEPB (64%). Lung weight and pleural effusion volume were significantly lower in SDEPB than in SDnonEPB. Age at death in SDEPB was significantly younger than that in SDnonEPB. Sudden death in epilepsy occurring in the bathtub showed no differences in lung weight and pleural effusion volume from SUDEP. Living with family was more frequent in SDEPB (73%) than in SUDEP (48%). Few antiepileptic drugs, infrequent seizures, and low rate of mental retardation were identical between SDEPB and SUDEP. Lung weight was significantly heavier in all three groups than in age- and sex- matched autopsy controls. CONCLUSIONS: Leg extension outside the bathtub, lower lung weight, and absence of pleural effusion distinguish SDEPB from SDnonEPB in elderly people. Sudden death in epilepsy occurring in the bathtub may represent a form of SUDEP occurring in the bathtub, rather than drowning despite submergence in the bathtub at discovery. Conditions for bathing require careful attention from physicians and relatives, even for patients with epilepsy with few medications and infrequent seizures, and without mental retardation.

DOI： 10.1016/j.yebeh.2019.04.009

PubMed

Publishing type：Research paper (scientific journal)  

The diagnosis and prognostication of glioblastoma (GBM) remain to be solely dependent on histopathological
findings and few molecular markers, despite the clinical heterogeneity in this entity. To address this issue, we
investigated the prognostic impact of copy number alterations (CNAs) using two population-based IDH-wild-type
GBM cohorts: an original Japanese cohort and a dataset from The Cancer Genome Atlas (TCGA). The molecular
disproportions between these cohorts were dissected in light of cohort differences in GBM. The Japanese cohort
was collected from cases registered in Kansai Molecular Diagnosis Network for CNS tumors (KNBTG). The somatic
landscape around CNAs was analyzed for 212 KNBTG cases and 359 TCGA cases. Next, the clinical impacts of CNA
profiles were investigated for 140 KNBTG cases and 152 TCGA cases treated by standard adjuvant therapy using
temozolomide-based chemoradiation. The comparative profiling indicated unequal distribution of specific CNAs
such as EGFR, CDKN2A, and PTEN among the two cohorts. Especially, the triple overlap CNAs in these loci (triple
CNA) were much higher in frequency in TCGA (70.5%) than KNBTG (24.3%), and its prognostic impact was
independently validated in both cohorts. The KNBTG cohort significantly showed better prognosis than the TCGA
cohort (median overall survival 19.3 vs 15.6 months). This survival difference between the two cohorts completely
resolved after subclassifying all cases according to the triple CNA status. The prognostic significance of triple CNA
was identified in IDH-wild-type GBM. Distribution difference in prognostic CNA profiles potentially could cause
survival differences across cohorts in clinical studies.

DOI： 10.1186/s40478-019-0749-8

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

The diagnosis and prognostication of glioblastoma (GBM) remain to be solely dependent on histopathological findings and few molecular markers, despite the clinical heterogeneity in this entity. To address this issue, we investigated the prognostic impact of copy number alterations (CNAs) using two population-based IDH-wild-type GBM cohorts: an original Japanese cohort and a dataset from The Cancer Genome Atlas (TCGA). The molecular disproportions between these cohorts were dissected in light of cohort differences in GBM. The Japanese cohort was collected from cases registered in Kansai Molecular Diagnosis Network for CNS tumors (KNBTG). The somatic landscape around CNAs was analyzed for 212 KNBTG cases and 359 TCGA cases. Next, the clinical impacts of CNA profiles were investigated for 140 KNBTG cases and 152 TCGA cases treated by standard adjuvant therapy using temozolomide-based chemoradiation. The comparative profiling indicated unequal distribution of specific CNAs such as EGFR, CDKN2A, and PTEN among the two cohorts. Especially, the triple overlap CNAs in these loci (triple CNA) were much higher in frequency in TCGA (70.5%) than KNBTG (24.3%), and its prognostic impact was independently validated in both cohorts. The KNBTG cohort significantly showed better prognosis than the TCGA cohort (median overall survival 19.3 vs 15.6 months). This survival difference between the two cohorts completely resolved after subclassifying all cases according to the triple CNA status. The prognostic significance of triple CNA was identified in IDH-wild-type GBM. Distribution difference in prognostic CNA profiles potentially could cause survival differences across cohorts in clinical studies.

DOI： 10.1186/s40478-019-0749-8

PubMed

Publishing type：Research paper (scientific journal)  

OBJECTIVE: Sphenoorbital meningioma (SOM) is a rare intracranial tumor that arises at the sphenoid wing, extends into the orbit and associated with hyperostosis of the sphenoid bone. These tumors often invade important neurovascular structures around the orbital apex, superior orbital fissure (SOF), and cavernous sinus. Aggressive tumor removal could achieve acceptable control, however, residual tumor can regrow. Herein, we describe our surgical management and long-term outcomes. METHOD: Retrospectively, 12 cases with SOM who treated surgically over a 21-year period were included. The clinical features and long-term tumor control were evaluated. RESULTS: Participants comprised 12 patients (5 males, 7 females). Mean follow-up was 74.4 months (range, 10-262 months). Ten cases (83%) were identified as World Health Organization grade 1 (WHO-I), and 2 cases (17%) were identified as WHO grade 2 (WHO-II). We encountered 4 recurrences, two of which needed additional surgeries. One WHO-I case (10%) recurred 10 years after the initial surgery and required a second surgery. Two WHO-I cases (20%) showed slight regrowth of residual tumor around the SOF, nevertheless, additive therapy was not recommended. Interestingly, despite of radical tumor resection including the eyeball and adjunctive radiotherapy for one WHO-II patient, tumor recurrence in the posterior fossa was documented 19 years following the initial aggressive surgery. CONCLUSIONS: SOM follows a relatively benign clinical course given the invasive radiological findings into consideration. Abnormal bone resection is paramount to prevent early-stage recurrence. Despite intradural residual tumor might regrow, additional surgery could achieve reasonable long-term tumor control with better outcome.

DOI： 10.1016/j.wneu.2019.02.123

PubMed

Publishing type：Research paper (scientific journal)  

OBJECTIVEThe endoscopic endonasal approach (EEA) for skull base tumors has become an important topic in recent years, but its use, merits, and demerits are still being debated. Herein, the authors describe the nuances and efficacy of the endoscopic endonasal extradural posterior clinoidectomy for maximal tumor exposure.METHODSThe surgical technique included extradural posterior clinoidectomy following lateral retraction of the paraclival internal carotid artery and extradural pituitary transposition. In cases with prominent posterior clinoid process, a midline sellar dura cut was added to facilitate extradural exposure. Forty-four consecutive patients, in whom this technique was performed between 2016 and 2018 at Osaka City University Hospital, were reviewed. The pathology included 19 craniopharyngiomas, 7 chordomas, 6 meningiomas, 6 pituitary adenomas, 4 chondrosarcomas, and 2 miscellaneous. Utilization and effectiveness of this approach were further demonstrated with neuroimaging.RESULTSExtradural posterior clinoidectomies were successfully applied in all patients without permanent neurovascular injury and with better maneuverability and greater resection rate of the tumors. Four patients experienced transient postoperative abducens nerve paresis, and 1 patient experienced transient postoperative oculomotor nerve paresis; however, the patients with deficits recovered within 3 months. On radiological examination, the surgical field was 2.2 times wider in cases with bilateral posterior clinoidectomy than in cases without posterior clinoidectomy.CONCLUSIONSThe extended EEA with extradural posterior clinoidectomy creates an extra working space and allows adequate accessibility with safe surgical maneuverability to remove tumors that extend behind the posterior clinoid and dorsum sellae.

DOI： 10.3171/2019.2.JNS183278

PubMed

Publishing type：Research paper (scientific journal)  

OBJECTIVEThe endoscopic endonasal approach (EEA) for skull base tumors has become an important topic in recent years, but its use, merits, and demerits are still being debated. Herein, the authors describe the nuances and efficacy of the endoscopic endonasal extradural posterior clinoidectomy for maximal tumor exposure.METHODSThe surgical technique included extradural posterior clinoidectomy following lateral retraction of the paraclival internal carotid artery and extradural pituitary transposition. In cases with prominent posterior clinoid process, a midline sellar dura cut was added to facilitate extradural exposure. Forty-four consecutive patients, in whom this technique was performed between 2016 and 2018 at Osaka City University Hospital, were reviewed. The pathology included 19 craniopharyngiomas, 7 chordomas, 6 meningiomas, 6 pituitary adenomas, 4 chondrosarcomas, and 2 miscellaneous. Utilization and effectiveness of this approach were further demonstrated with neuroimaging.RESULTSExtradural posterior clinoidectomies were successfully applied in all patients without permanent neurovascular injury and with better maneuverability and greater resection rate of the tumors. Four patients experienced transient postoperative abducens nerve paresis, and 1 patient experienced transient postoperative oculomotor nerve paresis; however, the patients with deficits recovered within 3 months. On radiological examination, the surgical field was 2.2 times wider in cases with bilateral posterior clinoidectomy than in cases without posterior clinoidectomy.CONCLUSIONSThe extended EEA with extradural posterior clinoidectomy creates an extra working space and allows adequate accessibility with safe surgical maneuverability to remove tumors that extend behind the posterior clinoid and dorsum sellae.

DOI： 10.3171/2019.2.JNS183278

PubMed

Publishing type：Research paper (scientific journal)  

BACKGROUND: Schwannomas not related to cranial nerves are very rare. Here, we present a case of a schwannoma that originated from the falx cerebri and review reported cases in the literature. CASE DESCRIPTION: A 36-year-old male experienced generalized seizures following right hemiparesis predominantly in his lower extremity. Magnetic resonance imaging revealed a round tumor attached to the falx cerebri on the left side. Radiologically, the tumor appeared to be a falx meningioma. We performed gross total removal of the tumor. Pathology showed a schwannoma that originated from the falx cerebri. Right hemiparesis disappeared soon after surgery. CONCLUSION: Although distinguishing a schwannoma of the falx cerebri from a falx meningioma and metastasis is difficult preoperatively, inclusion of schwannoma of the falx cerebri in the differential diagnosis is important, especially when the patient is relatively young and/or the tumor lacks dural tail sign.

DOI： 10.1016/j.wneu.2018.12.122

PubMed

Publishing type：Research paper (scientific journal)  

OBJECTIVE: Sphenoorbital meningioma (SOM) is a rare intracranial tumor that arises at the sphenoid wing, extends into the orbit and associated with hyperostosis of the sphenoid bone. These tumors often invade important neurovascular structures around the orbital apex, superior orbital fissure (SOF), and cavernous sinus. Aggressive tumor removal could achieve acceptable control, however, residual tumor can regrow. Herein, we describe our surgical management and long-term outcomes. METHOD: Retrospectively, 12 cases with SOM who treated surgically over a 21-year period were included. The clinical features and long-term tumor control were evaluated. RESULTS: Participants comprised 12 patients (5 males, 7 females). Mean follow-up was 74.4 months (range, 10-262 months). Ten cases (83%) were identified as World Health Organization grade 1 (WHO-I), and 2 cases (17%) were identified as WHO grade 2 (WHO-II). We encountered 4 recurrences, two of which needed additional surgeries. One WHO-I case (10%) recurred 10 years after the initial surgery and required a second surgery. Two WHO-I cases (20%) showed slight regrowth of residual tumor around the SOF, nevertheless, additive therapy was not recommended. Interestingly, despite of radical tumor resection including the eyeball and adjunctive radiotherapy for one WHO-II patient, tumor recurrence in the posterior fossa was documented 19 years following the initial aggressive surgery. CONCLUSIONS: SOM follows a relatively benign clinical course given the invasive radiological findings into consideration. Abnormal bone resection is paramount to prevent early-stage recurrence. Despite intradural residual tumor might regrow, additional surgery could achieve reasonable long-term tumor control with better outcome.

DOI： 10.1016/j.wneu.2019.02.123

PubMed

Publishing type：Research paper (scientific journal)  

AIM: To investigate clinicopathological significance of autophagy and its association with genetic alterations in gliomas. MATERIALS AND METHODS: The expression of three autophagy-related proteins, light chain-3 (LC3), beclin 1, and p62 was immunohistochemically analyzed in 32 low-grade gliomas and 65 high-grade gliomas. RESULTS: LC3, beclin 1, and p62 expression was positive in 70/94 (74%), 51/94 (54%) and 55/96 (57%) gliomas, respectively. High expression of LC3, beclin 1 and p62 was significantly more frequent in high-grade gliomas than in low-grade. Positive expression of LC3, beclin 1 and p62 were significantly positively correlated with overall survival, methylation of O(6)-methylyguanine-DNA methyltransferase (MGMT) promoter, mutations of isocitrate dehydrogenase 1 (IDH1) and telomerase reverse transcriptase (TERT) promoter, and 1p/19q co-deletion. Kaplan-Meier analyses revealed that LC3, p62 and autophagy status (positivity for at least two of the three proteins) were significantly associated with poorer survival. CONCLUSION: Autophagy might be associated with the progression of glioma, particularly high-grade, and thus might be a useful prognostic factor in patients with glioma.

DOI： 10.21873/anticanres.13233

PubMed

Publishing type：Research paper (scientific journal)  

AIM: To investigate clinicopathological significance of autophagy and its association with genetic alterations in gliomas. MATERIALS AND METHODS: The expression of three autophagy-related proteins, light chain-3 (LC3), beclin 1, and p62 was immunohistochemically analyzed in 32 low-grade gliomas and 65 high-grade gliomas. RESULTS: LC3, beclin 1, and p62 expression was positive in 70/94 (74%), 51/94 (54%) and 55/96 (57%) gliomas, respectively. High expression of LC3, beclin 1 and p62 was significantly more frequent in high-grade gliomas than in low-grade. Positive expression of LC3, beclin 1 and p62 were significantly positively correlated with overall survival, methylation of O(6)-methylyguanine-DNA methyltransferase (MGMT) promoter, mutations of isocitrate dehydrogenase 1 (IDH1) and telomerase reverse transcriptase (TERT) promoter, and 1p/19q co-deletion. Kaplan-Meier analyses revealed that LC3, p62 and autophagy status (positivity for at least two of the three proteins) were significantly associated with poorer survival. CONCLUSION: Autophagy might be associated with the progression of glioma, particularly high-grade, and thus might be a useful prognostic factor in patients with glioma.

DOI： 10.21873/anticanres.13233

PubMed

Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Glioblastoma (GBM) is one of the most lethal solid cancers due to its highly invasive nature. The malignant potential of GBM cells might be partially regulated by surrounding normal cells, such as oligodendrocytes or fibroblasts. The aim of this study was to examine the interaction between stromal cells and GBM cells. MATERIALS AND METHODS: Two GBM cell lines were used. The effect of stromal cells, oligodendrocytes or fibroblasts, on the invasive ability of GBM cells was examined by wound-healing assay and invasion assay. RESULTS: Oligodendrocytes, in contrast to fibroblasts, significantly increased the migration and invasive ability of GBM cells. Angiopoietin-2 levels were high in the conditioned medium obtained from oligodendrocytes. Angiopoietin-2 significantly increased the motility of GBM, and the motility-stimulating activity of the oligodendrocytes-derived conditioned medium was significantly decreased by anti-angiopoietin-2-neutralizing antibody. CONCLUSION: Glioma stromal cells, oligodendrocytes, might up-regulate the invasiveness of GBM cells via angiopoietin-2 signaling.

DOI： 10.21873/anticanres.13150

PubMed

Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Glioblastoma (GBM) is one of the most lethal solid cancers due to its highly invasive nature. The malignant potential of GBM cells might be partially regulated by surrounding normal cells, such as oligodendrocytes or fibroblasts. The aim of this study was to examine the interaction between stromal cells and GBM cells. MATERIALS AND METHODS: Two GBM cell lines were used. The effect of stromal cells, oligodendrocytes or fibroblasts, on the invasive ability of GBM cells was examined by wound-healing assay and invasion assay. RESULTS: Oligodendrocytes, in contrast to fibroblasts, significantly increased the migration and invasive ability of GBM cells. Angiopoietin-2 levels were high in the conditioned medium obtained from oligodendrocytes. Angiopoietin-2 significantly increased the motility of GBM, and the motility-stimulating activity of the oligodendrocytes-derived conditioned medium was significantly decreased by anti-angiopoietin-2-neutralizing antibody. CONCLUSION: Glioma stromal cells, oligodendrocytes, might up-regulate the invasiveness of GBM cells via angiopoietin-2 signaling.

DOI： 10.21873/anticanres.13150

PubMed

Publishing type：Research paper (scientific journal)  

BACKGROUND: Schwannomas not related to cranial nerves are very rare. Here, we present a case of a schwannoma that originated from the falx cerebri and review reported cases in the literature. CASE DESCRIPTION: A 36-year-old male experienced generalized seizures following right hemiparesis predominantly in his lower extremity. Magnetic resonance imaging revealed a round tumor attached to the falx cerebri on the left side. Radiologically, the tumor appeared to be a falx meningioma. We performed gross total removal of the tumor. Pathology showed a schwannoma that originated from the falx cerebri. Right hemiparesis disappeared soon after surgery. CONCLUSION: Although distinguishing a schwannoma of the falx cerebri from a falx meningioma and metastasis is difficult preoperatively, inclusion of schwannoma of the falx cerebri in the differential diagnosis is important, especially when the patient is relatively young and/or the tumor lacks dural tail sign.

DOI： 10.1016/j.wneu.2018.12.122

PubMed

Publishing type：Research paper (scientific journal)  

Calcifying pseudoneoplasms of the neuraxis (CAPNON) are rare pathological lesions that can present anywhere in the central nervous system. Symptoms vary depending on the location, though they often include seizures, especially in intracranial and supratentorial lesions. A case of intracranial supratentorial CAPNON presenting with drug-resistant left temporal lobe epilepsy is reported. The patient had a history of drug-resistant focal seizures for over 36years. The lesion was located in the left mesial temporal lobe, but hippocampal sclerosis and hippocampal invasion were not apparent. The lesion was removed without hippocampectomy, and the patient has been seizure-free for one year.

DOI： 10.1016/j.ebcr.2019.02.002

PubMed

Publishing type：Research paper (scientific journal)  

Calcifying pseudoneoplasms of the neuraxis (CAPNON) are rare pathological lesions that can present anywhere in the central nervous system. Symptoms vary depending on the location, though they often include seizures, especially in intracranial and supratentorial lesions. A case of intracranial supratentorial CAPNON presenting with drug-resistant left temporal lobe epilepsy is reported. The patient had a history of drug-resistant focal seizures for over 36years. The lesion was located in the left mesial temporal lobe, but hippocampal sclerosis and hippocampal invasion were not apparent. The lesion was removed without hippocampectomy, and the patient has been seizure-free for one year.

DOI： 10.1016/j.ebcr.2019.02.002

PubMed

Publishing type：Research paper (scientific journal)  

Extensive molecular analyses of ependymal tumors have revealed that supratentorial and posterior fossa ependymomas have distinct molecular profiles and are likely to be different diseases. The presence of C11orf95-RELA fusion genes in a subset of supratentorial ependymomas (ST-EPN) indicated the existence of molecular subgroups. However, the pathogenesis of RELA fusion-negative ependymomas remains elusive. To investigate the molecular pathogenesis of these tumors and validate the molecular classification of ependymal tumors, we conducted thorough molecular analyses of 113 locally diagnosed ependymal tumors from 107 patients in the Japan Pediatric Molecular Neuro-Oncology Group. All tumors were histopathologically reviewed and 12 tumors were re-classified as non-ependymomas. A combination of RT-PCR, FISH, and RNA sequencing identified RELA fusion in 19 of 29 histologically verified ST-EPN cases, whereas another case was diagnosed as ependymoma RELA fusion-positive via the methylation classifier (68.9%). Among the 9 RELA fusion-negative ST-EPN cases, either the YAP1 fusion, BCOR tandem duplication, EP300-BCORL1 fusion, or FOXO1-STK24 fusion was detected in single cases. Methylation classification did not identify a consistent molecular class within this group. Genome-wide methylation profiling successfully sub-classified posterior fossa ependymoma (PF-EPN) into PF-EPN-A (PFA) and PF-EPN-B (PFB). A multivariate analysis using Cox regression confirmed that PFA was the sole molecular marker which was independently associated with patient survival. A clinically applicable pyrosequencing assay was developed to determine the PFB subgroup with 100% specificity using the methylation status of 3 genes, CRIP1, DRD4 and LBX2. Our results emphasized the significance of molecular classification in the diagnosis of ependymomas.

DOI： 10.1186/s40478-018-0630-1

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Extensive molecular analyses of ependymal tumors have revealed that supratentorial and posterior fossa ependymomas have distinct molecular profiles and are likely to be different diseases. The presence of C11orf95-RELA fusion genes in a subset of supratentorial ependymomas (ST-EPN) indicated the existence of molecular subgroups. However, the pathogenesis of RELA fusion-negative ependymomas remains elusive. To investigate the molecular pathogenesis of these tumors and validate the molecular classification of ependymal tumors, we conducted thorough molecular analyses of 113 locally diagnosed ependymal tumors from 107 patients in the Japan Pediatric Molecular Neuro-Oncology Group. All tumors were histopathologically reviewed and 12 tumors were re-classified as non-ependymomas. A combination of RT-PCR, FISH, and RNA sequencing identified RELA fusion in 19 of 29 histologically verified ST-EPN cases, whereas another case was diagnosed as ependymoma RELA fusion-positive via the methylation classifier (68.9%). Among the 9 RELA fusion-negative ST-EPN cases, either the YAP1 fusion, BCOR tandem duplication, EP300-BCORL1 fusion, or FOXO1-STK24 fusion was detected in single cases. Methylation classification did not identify a consistent molecular class within this group. Genome-wide methylation profiling successfully sub-classified posterior fossa ependymoma (PF-EPN) into PF-EPN-A (PFA) and PF-EPN-B (PFB). A multivariate analysis using Cox regression confirmed that PFA was the sole molecular marker which was independently associated with patient survival. A clinically applicable pyrosequencing assay was developed to determine the PFB subgroup with 100% specificity using the methylation status of 3 genes, CRIP1, DRD4 and LBX2. Our results emphasized the significance of molecular classification in the diagnosis of ependymomas. RELA fusion-negative ST-EPN appear to be a heterogeneous group of tumors that do not fall into any of the existing molecular subgroups and are unlikely to form a single category.

DOI： 10.1186/s40478-018-0630-1

PubMed

Publishing type：Research paper (scientific journal)  

15歳以下の小児難治性てんかんに対する脳梁離断術(CC)の治療成績を報告する。CCの適応は、転倒発作(DA)、ACTH療法の効果が乏しいてんかん性スパズム(ES)とした。2014年4月以降で半年以上の術後観察期間を経た21例を解析した。14例で50%以上の発作軽減が得られ3例で発作が消失した。発作予後良好群と不良群の間で有意差をもった予後因子は得られなかった。50%以下の発作軽減であった7例はESに対する手術であり、このうち4例で焦点離断術を追加した。難治に経過するDAやESでは、CCを含めた外科治療が有効である可能性がある。(著者抄録)

Publishing type：Research paper (scientific journal)  

BACKGROUND: Posterior quadrant disconnection is a surgery for refractory unilateral temporoparieto-occipital epilepsy to limit propagation of epileptic discharges. As incomplete disconnection can lead to residual seizures, detailed procedures are presented using a cadaveric brain, three-dimensional (3D) reconstruction and simulation models, and intraoperative photographs. METHODS: A formalin-fixed adult cadaveric brain was dissected to show each step in posterior quadrant disconnection. Using 3D preoperative planning software, we reconstructed 3D models of operative views from computed tomography and magnetic resonance imaging. Intraoperative photographs were taken from the case of a 7-year-old girl with temporoparieto-occipital epilepsy. RESULTS: Frontotemporoparietal craniotomy was performed. The Sylvian fissure was widely dissected, and the insular cortex was exposed. The temporal stem was disconnected along the inferior peri-insular sulcus. The disconnection was extended from the limen insulae to the atrium of the lateral ventricle. The fibers between the head of the hippocampus and the amygdala were disconnected. The parietal lobe was disconnected along the postcentral sulcus, and the disconnection was connected to the atrium of the lateral ventricle. At the medial surface of the parietal lobe, the disconnection was continued to the corpus callosum. The splenium of the corpus callosum was disconnected via the medial wall of the lateral ventricle. The fornix was divided in the atrium of the lateral ventricle. After these steps, disconnection of the unilateral tempoparieto-occipital lobe was achieved while preserving the arteries and veins. CONCLUSIONS: Inclusion of views from cadaveric brain, 3D reconstruction and simulation models, and intraoperative photographs facilitates a clearer anatomic understanding of posterior quadrant disconnection.

DOI： 10.1016/j.wneu.2018.08.168

PubMed

15歳以下の小児難治性てんかんに対する脳梁離断術(CC)の治療成績を報告する。CCの適応は、転倒発作(DA)、ACTH療法の効果が乏しいてんかん性スパズム(ES)とした。2014年4月以降で半年以上の術後観察期間を経た21例を解析した。14例で50%以上の発作軽減が得られ3例で発作が消失した。発作予後良好群と不良群の間で有意差をもった予後因子は得られなかった。50%以下の発作軽減であった7例はESに対する手術であり、このうち4例で焦点離断術を追加した。難治に経過するDAやESでは、CCを含めた外科治療が有効である可能性がある。(著者抄録)

Publishing type：Research paper (scientific journal)  

15歳以下の小児難治性てんかんに対する脳梁離断術(CC)の治療成績を報告する。CCの適応は、転倒発作(DA)、ACTH療法の効果が乏しいてんかん性スパズム(ES)とした。2014年4月以降で半年以上の術後観察期間を経た21例を解析した。14例で50%以上の発作軽減が得られ3例で発作が消失した。発作予後良好群と不良群の間で有意差をもった予後因子は得られなかった。50%以下の発作軽減であった7例はESに対する手術であり、このうち4例で焦点離断術を追加した。難治に経過するDAやESでは、CCを含めた外科治療が有効である可能性がある。(著者抄録)

Publishing type：Research paper (scientific journal)  

BACKGROUND: Posterior quadrant disconnection is a surgery for refractory unilateral temporoparieto-occipital epilepsy to limit propagation of epileptic discharges. As incomplete disconnection can lead to residual seizures, detailed procedures are presented using a cadaveric brain, three-dimensional (3D) reconstruction and simulation models, and intraoperative photographs. METHODS: A formalin-fixed adult cadaveric brain was dissected to show each step in posterior quadrant disconnection. Using 3D preoperative planning software, we reconstructed 3D models of operative views from computed tomography and magnetic resonance imaging. Intraoperative photographs were taken from the case of a 7-year-old girl with temporoparieto-occipital epilepsy. RESULTS: Frontotemporoparietal craniotomy was performed. The Sylvian fissure was widely dissected, and the insular cortex was exposed. The temporal stem was disconnected along the inferior peri-insular sulcus. The disconnection was extended from the limen insulae to the atrium of the lateral ventricle. The fibers between the head of the hippocampus and the amygdala were disconnected. The parietal lobe was disconnected along the postcentral sulcus, and the disconnection was connected to the atrium of the lateral ventricle. At the medial surface of the parietal lobe, the disconnection was continued to the corpus callosum. The splenium of the corpus callosum was disconnected via the medial wall of the lateral ventricle. The fornix was divided in the atrium of the lateral ventricle. After these steps, disconnection of the unilateral tempoparieto-occipital lobe was achieved while preserving the arteries and veins. CONCLUSIONS: Inclusion of views from cadaveric brain, 3D reconstruction and simulation models, and intraoperative photographs facilitates a clearer anatomic understanding of posterior quadrant disconnection.

DOI： 10.1016/j.wneu.2018.08.168

PubMed

Publishing type：Research paper (scientific journal)  

【背景】てんかん性スパズムは、しばしば薬剤抵抗性に経過する事が知られる発作型であるが、発作が焦点性てんかんの発作型として表われている場合には、外科的治療による発作根治の可能性がある。薬剤抵抗性のてんかん性スパズムに対して、全脳梁離断術を行うも再発をきたし右前頭葉離断術を施行した症例を報告する。【症例】2歳8ヵ月に急性リンパ性白血病を発症し多剤併用化学療法を行った。骨髄移植で用いたタクロリムスに関連すると考えられる脳症を呈した。4歳11ヵ月時に後方へ倒れる発作が出現してんかんと診断の上、内服治療を開始した。7歳2ヵ月時より前方へ転倒する発作が徐々に難治化し発達の遅れもみられた。眼球を上転し頭部を前屈させ、上肢を伸展挙上させる発作であり、発作時脳波も併せててんかん性スパズムと診断した。間欠期頭皮脳波では両側前頭極優位の高振幅棘徐波がみられた。脳磁図では右大脳半球広範囲に信号源が推定された。MRIでは全般的な脳萎縮がみられ、発作時のFDG-PETでは右頭頂葉の糖代謝亢進、発作時脳血流SPECTでは右前頭葉で血流上昇がみられた。13歳時に発作の緩和を目的として全脳梁離断術を施行した。発作は一旦抑制されたが、全脳梁離断術後8ヵ月で再発し、その後、頻度が増加した。この際には発作型は左肩の挙上が右上肢に先行するスパズムに変化していた。発作間欠期脳波では右前頭部、側頭部に棘徐波が側方化、限局化していた。脳磁図では右半球広範囲に信号源が推定されたが、全脳梁離断前より、前頭葉に局在して信号源推定がなされた。発作の根治を目的として、14歳時に右前頭葉前半部離断術を行った。術後8ヵ月での頭皮脳波で右前頭部に時折徐波をみとめるのみに改善しており、術後1年の経過でてんかん性スパズムは消失している。(著者抄録)

Publishing type：Research paper (scientific journal)  

INTRODUCTION: This study investigates the current state of clinical practice and molecular analysis for elderly patients with diffuse gliomas and aims to elucidate treatment outcomes and prognostic factors of patients with glioblastomas. METHODS: We collected elderly cases (>/= 70 years) diagnosed with primary diffuse gliomas and enrolled in Kansai Molecular Diagnosis Network for CNS Tumors. Clinical and pathological characteristics were analyzed retrospectively. Various factors were evaluated in univariate and multivariate models to examine their effects on overall survival. RESULTS: Included in the study were 140 elderly patients (WHO grade II: 7, III: 19, IV: 114), median age was 75 years. Sixty-seven patients (47.9%) had preoperative Karnofsky Performance Status score of >/= 80. All patients underwent resection (gross-total: 20.0%, subtotal: 14.3%, partial: 39.3%, biopsy: 26.4%). Ninety-six of the patients (68.6%) received adjuvant treatment consisting of radiotherapy (RT) with temozolomide (TMZ). Seventy-eight of the patients (75.0%) received radiation dose of >/= 50 Gy. MGMT promoter was methylated in 68 tumors (48.6%), IDH1/2 was wild-type in 129 tumors (92.1%), and TERT promoter was mutated in 78 of 128 tumors (60.9%). Median progression-free and overall survival of grade IV cases was 8.2 and 13.6 months, respectively. Higher age (>/= 80 years) and TERT promoter mutated were associated with shorter survival. Resection and adjuvant RT + TMZ were identified as independent factors for good prognosis. CONCLUSIONS: This community-based study reveals characteristics and outcomes of elderly glioma patients in a real-world setting. Elderly patients have several potential factors for poor prognosis, but resection followed by RT + TMZ could lengthen duration of survival.

DOI： 10.1007/s11060-018-2957-7

PubMed

Publishing type：Research paper (scientific journal)  

【背景】てんかん性スパズムは、しばしば薬剤抵抗性に経過する事が知られる発作型であるが、発作が焦点性てんかんの発作型として表われている場合には、外科的治療による発作根治の可能性がある。薬剤抵抗性のてんかん性スパズムに対して、全脳梁離断術を行うも再発をきたし右前頭葉離断術を施行した症例を報告する。【症例】2歳8ヵ月に急性リンパ性白血病を発症し多剤併用化学療法を行った。骨髄移植で用いたタクロリムスに関連すると考えられる脳症を呈した。4歳11ヵ月時に後方へ倒れる発作が出現してんかんと診断の上、内服治療を開始した。7歳2ヵ月時より前方へ転倒する発作が徐々に難治化し発達の遅れもみられた。眼球を上転し頭部を前屈させ、上肢を伸展挙上させる発作であり、発作時脳波も併せててんかん性スパズムと診断した。間欠期頭皮脳波では両側前頭極優位の高振幅棘徐波がみられた。脳磁図では右大脳半球広範囲に信号源が推定された。MRIでは全般的な脳萎縮がみられ、発作時のFDG-PETでは右頭頂葉の糖代謝亢進、発作時脳血流SPECTでは右前頭葉で血流上昇がみられた。13歳時に発作の緩和を目的として全脳梁離断術を施行した。発作は一旦抑制されたが、全脳梁離断術後8ヵ月で再発し、その後、頻度が増加した。この際には発作型は左肩の挙上が右上肢に先行するスパズムに変化していた。発作間欠期脳波では右前頭部、側頭部に棘徐波が側方化、限局化していた。脳磁図では右半球広範囲に信号源が推定されたが、全脳梁離断前より、前頭葉に局在して信号源推定がなされた。発作の根治を目的として、14歳時に右前頭葉前半部離断術を行った。術後8ヵ月での頭皮脳波で右前頭部に時折徐波をみとめるのみに改善しており、術後1年の経過でてんかん性スパズムは消失している。(著者抄録)

【背景】てんかん性スパズムは、しばしば薬剤抵抗性に経過する事が知られる発作型であるが、発作が焦点性てんかんの発作型として表われている場合には、外科的治療による発作根治の可能性がある。薬剤抵抗性のてんかん性スパズムに対して、全脳梁離断術を行うも再発をきたし右前頭葉離断術を施行した症例を報告する。【症例】2歳8ヵ月に急性リンパ性白血病を発症し多剤併用化学療法を行った。骨髄移植で用いたタクロリムスに関連すると考えられる脳症を呈した。4歳11ヵ月時に後方へ倒れる発作が出現してんかんと診断の上、内服治療を開始した。7歳2ヵ月時より前方へ転倒する発作が徐々に難治化し発達の遅れもみられた。眼球を上転し頭部を前屈させ、上肢を伸展挙上させる発作であり、発作時脳波も併せててんかん性スパズムと診断した。間欠期頭皮脳波では両側前頭極優位の高振幅棘徐波がみられた。脳磁図では右大脳半球広範囲に信号源が推定された。MRIでは全般的な脳萎縮がみられ、発作時のFDG-PETでは右頭頂葉の糖代謝亢進、発作時脳血流SPECTでは右前頭葉で血流上昇がみられた。13歳時に発作の緩和を目的として全脳梁離断術を施行した。発作は一旦抑制されたが、全脳梁離断術後8ヵ月で再発し、その後、頻度が増加した。この際には発作型は左肩の挙上が右上肢に先行するスパズムに変化していた。発作間欠期脳波では右前頭部、側頭部に棘徐波が側方化、限局化していた。脳磁図では右半球広範囲に信号源が推定されたが、全脳梁離断前より、前頭葉に局在して信号源推定がなされた。発作の根治を目的として、14歳時に右前頭葉前半部離断術を行った。術後8ヵ月での頭皮脳波で右前頭部に時折徐波をみとめるのみに改善しており、術後1年の経過でてんかん性スパズムは消失している。(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: This study investigates the current state of clinical practice and molecular analysis for elderly patients with diffuse gliomas and aims to elucidate treatment outcomes and prognostic factors of patients with glioblastomas. METHODS: We collected elderly cases (≥ 70 years) diagnosed with primary diffuse gliomas and enrolled in Kansai Molecular Diagnosis Network for CNS Tumors. Clinical and pathological characteristics were analyzed retrospectively. Various factors were evaluated in univariate and multivariate models to examine their effects on overall survival. RESULTS: Included in the study were 140 elderly patients (WHO grade II: 7, III: 19, IV: 114), median age was 75 years. Sixty-seven patients (47.9%) had preoperative Karnofsky Performance Status score of ≥ 80. All patients underwent resection (gross-total: 20.0%, subtotal: 14.3%, partial: 39.3%, biopsy: 26.4%). Ninety-six of the patients (68.6%) received adjuvant treatment consisting of radiotherapy (RT) with temozolomide (TMZ). Seventy-eight of the patients (75.0%) received radiation dose of ≥ 50 Gy. MGMT promoter was methylated in 68 tumors (48.6%), IDH1/2 was wild-type in 129 tumors (92.1%), and TERT promoter was mutated in 78 of 128 tumors (60.9%). Median progression-free and overall survival of grade IV cases was 8.2 and 13.6 months, respectively. Higher age (≥ 80 years) and TERT promoter mutated were associated with shorter survival. Resection and adjuvant RT + TMZ were identified as independent factors for good prognosis. CONCLUSIONS: This community-based study reveals characteristics and outcomes of elderly glioma patients in a real-world setting. Elderly patients have several potential factors for poor prognosis, but resection followed by RT + TMZ could lengthen duration of survival.

DOI： 10.1007/s11060-018-2957-7

PubMed

Publishing type：Research paper (scientific journal)  

Background and objective: Phase difference enhanced imaging (PADRE), a new phase-related MRI technique, can enhance both paramagnetic and diamagnetic substances, and select which phases to be enhanced. Utilizing these characteristics, we developed color map of PADRE (Color PADRE), which enables simultaneous visualization of myelin-rich structures and veins. Our aim was to determine whether Color PADRE is sufficient to delineate the characteristics of non-gadolinium-enhancing T2-hyperintense regions related with metastatic tumors (MTs), diffuse astrocytomas (DAs) and glioblastomas (GBs), and whether it can contribute to the differentiation of MTs from GBs. Methods: Color PADRE images of 11 patients with MTs, nine with DAs and 17 with GBs were created by combining tissue-enhanced, vessel-enhanced and magnitude images of PADRE, and then retrospectively reviewed. First, predominant visibility of superficial white matter and deep medullary veins within non-gadolinium-enhancing T2-hyperintense regions were compared among the three groups. Then, the discriminatory power to differentiate MTs from GBs was assessed using receiver operating characteristic analysis. Results: The degree of visibility of superficial white matter was significantly better in MTs than in GBs (p = 0.017), better in GBs than in DAs (p = 0.014), and better in MTs than in DAs (p = 0.0021). On the contrary, the difference in the visibility of deep medullary veins was not significant (p = 0.065). The area under the receiver operating characteristic curve to discriminate MTs from GBs was 0.76 with a sensitivity of 80% and specificity of 64%. Conclusion: Visibility of superficial white matter on Color PADRE reflects inferred differences in the proportion of vasogenic edema and tumoral infiltration within non-gadolinium-enhancing T2-hyperintense regions of MTs, DAs and GBs. Evaluation of peritumoral areas on Color PADRE can help to distinguish MTs from GBs.

DOI： 10.3389/fneur.2018.00788

PubMed

Publishing type：Research paper (scientific journal)  

Epileptic spasms (ES) are a unique seizure type, comprising of
sudden tonic movements of predominantly proximal and truncal
muscles. In the revised operational classification of seizure types
by the International League Against Epilepsy (ILAE) (Fisher et al.,
2017), ES are classified as into focal, generalized, and unknown
onset categories. Iimura et al. reported that ten of 23 patients
who underwent subtotal hemispherectomy or multilobar resection
presented with ES (Iimura et al., 2017). They found extensively distributed interictal epileptogenic high-frequency oscillations
(HFOs) which skipped the motor area. Abnormal cortico-cortical
connections in multilobar epileptogenic zones are speculated to
be responsible for the semiology of ES. Cortico-cortical evoked
potentials (CCEPs) are recorded from adjacent and remote cortices by averaging electrocorticograms (ECoG) time-locked to single pulse stimuli. CCEPs have contributed to understanding of cortico-cortical connections involved in functional brain systems
and epileptogenic networks (Matsumoto et al., 2004; Kobayashi
et al., 2017). In the present patient, we recorded widely distributedinterictal and ictal HFOs (skipping the motor area) by extraoperative intracranial video electroencephalography (IVEEG), and performed intraoperative CCEP recordings during subtotal hemispherotomy. We hypothesized that intraoperative CCEPs may demonstrate disconnection of the motor cortex from epileptogenic networks during subtotal hemispherotomy in a subset of patients with ES.

DOI： 10.1016/j.clinph.2017.11.026

PubMed

Publishing type：Research paper (scientific journal)  

Epileptic spasms (ES) are a unique seizure type, comprising of
sudden tonic movements of predominantly proximal and truncal
muscles. In the revised operational classification of seizure types
by the International League Against Epilepsy (ILAE) (Fisher et al.,
2017), ES are classified as into focal, generalized, and unknown
onset categories. Iimura et al. reported that ten of 23 patients
who underwent subtotal hemispherectomy or multilobar resection
presented with ES (Iimura et al., 2017). They found extensively distributed interictal epileptogenic high-frequency oscillations
(HFOs) which skipped the motor area. Abnormal cortico-cortical
connections in multilobar epileptogenic zones are speculated to
be responsible for the semiology of ES. Cortico-cortical evoked
potentials (CCEPs) are recorded from adjacent and remote cortices by averaging electrocorticograms (ECoG) time-locked to single pulse stimuli. CCEPs have contributed to understanding of cortico-cortical connections involved in functional brain systems
and epileptogenic networks (Matsumoto et al., 2004; Kobayashi
et al., 2017). In the present patient, we recorded widely distributedinterictal and ictal HFOs (skipping the motor area) by extraoperative intracranial video electroencephalography (IVEEG), and performed intraoperative CCEP recordings during subtotal hemispherotomy. We hypothesized that intraoperative CCEPs may demonstrate disconnection of the motor cortex from epileptogenic networks during subtotal hemispherotomy in a subset of patients with ES.

DOI： 10.1016/j.clinph.2017.11.026

PubMed

Publishing type：Research paper (scientific journal)  

<p>  Meningiomas are one of the most frequent intracranial tumors and are basically treated with the surgical excision. But precisely how to treat residual and recurrent meningiomas remains a controversial point in several aspects such as repeated surgical excision and additional radiotherapy. Recent clinical studies have shown a significant relation between extent of tumor removal and recurrence-free survival and overall survival in all pathological grades of meningiomas. On the other hand, excessive removal of the tumor often caused unintended neurological deficits to the patients, which consequently exhausts additional treatment options. As a non-surgical option, radiotherapy apparently extended recurrence-free survival time in cases with WHO gradeⅠmeningiomas. But there are few reports suggesting the effectiveness of radiotherapy to extension of overall survival in all subtypes of meningioma. In this article, optimal treatment to residual and recurrent meningiomas is discussed based on clinical reviews and our experiences especially focusing on the extent of tumor removal and radiotherapy.</p>

DOI： 10.7887/jcns.27.441

CiNii Article

Publishing type：Research paper (scientific journal)  

Background: In the surgical treatment of temporal lobe epilepsy with mesial temporal lobe tumor, whether to remove the hippocampus aiming for a better seizure outcome in addition to removing the tumor is a dilemma. Two pediatric cases treated successfully with tumor removal alone are presented. Case Description: The first case was an 11-year-old girl with a ganglioglioma in the left uncus, and the second case was a 9-year-old girl with a pleomorphic xanthoastrocytoma in the left parahippocampal gyrus. In both cases, the hippocampus was not invaded, merely compressed by the tumor. Tumor removal was performed under intraoperative electrocorticography (ECoG) monitoring. After tumor removal, abnormal discharges remained at the hippocampus and adjacent temporal cortices, but further surgical interventions were not performed. The seizures disappeared completely in both cases. Conclusions: When we must decide whether to remove the hippocampus, the side of the lesion, the severity and chronicity of the seizures, and the presence of invasion to the hippocampus are the factors that should be considered. Abnormal discharges on ECoG at the hippocampus or adjacent cortices are one of the factors related to epileptogenicity, but it is simply a result of interictal irritation, and it is not an absolute indication for additional surgical intervention.

DOI： 10.4103/sni.sni_61_18

PubMed

Publishing type：Research paper (scientific journal)  

<p>  Meningiomas are one of the most frequent intracranial tumors and are basically treated with the surgical excision. But precisely how to treat residual and recurrent meningiomas remains a controversial point in several aspects such as repeated surgical excision and additional radiotherapy. Recent clinical studies have shown a significant relation between extent of tumor removal and recurrence-free survival and overall survival in all pathological grades of meningiomas. On the other hand, excessive removal of the tumor often caused unintended neurological deficits to the patients, which consequently exhausts additional treatment options. As a non-surgical option, radiotherapy apparently extended recurrence-free survival time in cases with WHO gradeⅠmeningiomas. But there are few reports suggesting the effectiveness of radiotherapy to extension of overall survival in all subtypes of meningioma. In this article, optimal treatment to residual and recurrent meningiomas is discussed based on clinical reviews and our experiences especially focusing on the extent of tumor removal and radiotherapy.</p>

DOI： 10.7887/jcns.27.441

CiNii Article

Publishing type：Research paper (scientific journal)  

Background: In the surgical treatment of temporal lobe epilepsy with mesial temporal lobe tumor, whether to remove the hippocampus aiming for a better seizure outcome in addition to removing the tumor is a dilemma. Two pediatric cases treated successfully with tumor removal alone are presented. Case Description: The first case was an 11-year-old girl with a ganglioglioma in the left uncus, and the second case was a 9-year-old girl with a pleomorphic xanthoastrocytoma in the left parahippocampal gyrus. In both cases, the hippocampus was not invaded, merely compressed by the tumor. Tumor removal was performed under intraoperative electrocorticography (ECoG) monitoring. After tumor removal, abnormal discharges remained at the hippocampus and adjacent temporal cortices, but further surgical interventions were not performed. The seizures disappeared completely in both cases. Conclusions: When we must decide whether to remove the hippocampus, the side of the lesion, the severity and chronicity of the seizures, and the presence of invasion to the hippocampus are the factors that should be considered. Abnormal discharges on ECoG at the hippocampus or adjacent cortices are one of the factors related to epileptogenicity, but it is simply a result of interictal irritation, and it is not an absolute indication for additional surgical intervention.

DOI： 10.4103/sni.sni_61_18

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Background and objective: Phase difference enhanced imaging (PADRE), a new phase-related MRI technique, can enhance both paramagnetic and diamagnetic substances, and select which phases to be enhanced. Utilizing these characteristics, we developed color map of PADRE (Color PADRE), which enables simultaneous visualization of myelin-rich structures and veins. Our aim was to determine whether Color PADRE is sufficient to delineate the characteristics of non-gadolinium-enhancing T2-hyperintense regions related with metastatic tumors (MTs), diffuse astrocytomas (DAs) and glioblastomas (GBs), and whether it can contribute to the differentiation of MTs from GBs. Methods: Color PADRE images of 11 patients with MTs, nine with DAs and 17 with GBs were created by combining tissue-enhanced, vessel-enhanced and magnitude images of PADRE, and then retrospectively reviewed. First, predominant visibility of superficial white matter and deep medullary veins within non-gadolinium-enhancing T2-hyperintense regions were compared among the three groups. Then, the discriminatory power to differentiate MTs from GBs was assessed using receiver operating characteristic analysis. Results: The degree of visibility of superficial white matter was significantly better in MTs than in GBs (p = 0.017), better in GBs than in DAs (p = 0.014), and better in MTs than in DAs (p = 0.0021). On the contrary, the difference in the visibility of deep medullary veins was not significant (p = 0.065). The area under the receiver operating characteristic curve to discriminate MTs from GBs was 0.76 with a sensitivity of 80% and specificity of 64%. Conclusion: Visibility of superficial white matter on Color PADRE reflects inferred differences in the proportion of vasogenic edema and tumoral infiltration within non-gadolinium-enhancing T2-hyperintense regions of MTs, DAs and GBs. Evaluation of peritumoral areas on Color PADRE can help to distinguish MTs from GBs.

DOI： 10.3389/fneur.2018.00788

PubMed

Publishing type：Research paper (scientific journal)  

MetPET has recently been used for evaluating brain tumors. However, there have been few studies regarding the relationships between prognosis and MET accumulation in Low grade glioma, particularly diffuse astrocytoma. This study was performed to determine whether MET-PET can be used to predict recurrence or progression of DA.

L-メチル-11C-メチオニン(MET)-PETによってびまん性星細胞腫(DA)の再発・増殖を予測することができるか検討した。1999～2011年に当院で病理学的にテント上DAと診断し、手術を施行した患者27例(男性14例、女性13例、平均34.0±13.9歳)を後ろ向きに調査した。手術前にMET-PETを行い、再発・増殖時に再度MET-PETを行った。MET集積はSUVとL/N ratioを指標とした。再発群と非再発群に分類し、MET集積を比較した。その結果、27例のうち13例が再発・増大を来した。再発群と非再発群間でMET集積に差は認められず、再発時のL/N ratioは初回より有意に高かった。再発・増殖における予後因子の単変量解析の結果、不明瞭な腫瘍境界が予後不良因子であると考えられた。

Publishing type：Research paper (scientific journal)  

MetPET has recently been used for evaluating brain tumors. However, there have been few studies regarding the relationships between prognosis and MET accumulation in Low grade glioma, particularly diffuse astrocytoma. This study was performed to determine whether MET-PET can be used to predict recurrence or progression of DA.

Publishing type：Research paper (scientific journal)  

BACKGROUND: Electrocorticogram (ECoG) spike activity is enhanced under general anesthesia with 1.5 minimum alveolar concentration (MAC) sevoflurane compared with lower concentrations in adult patients with epilepsy. However, the effect of concentration of sevoflurane on ECoG in children with epilepsy is less known. AIMS: The primary endpoint was to investigate the effects of sevoflurane on ECoG spike activity in pediatric patients undergoing epilepsy surgery. The secondary endpoint was to examine its effects on baseline ECoG including burst suppression. METHODS: Children of age 3-18 years with medically intractable epilepsy undergoing corpus callosotomy or resection of the epileptic foci (n = 11) were enrolled. Electrodes were placed on the brain surface and ECoG was recorded under anesthesia with endtidal carbon dioxide tension at 30 mmHg and sevoflurane at 2.5%, followed by age-adjusted 1.5 MAC (3.1-3.4%) for 10 min. The number of leads with spikes, the average number of spikes per lead per minute, median frequency of ECoG, and duration of suppression of ECoG >/= 1 s were compared between 2.5% and 1.5 MAC sevoflurane. RESULTS: The number of leads with spikes increased [11 vs 14, P = 0.003, difference in mean (95% CI) is 3 (2-5)], and the average number of spikes increased [9 vs 14.lead-1 .min-1 , P = 0.003, difference in mean (95% CI) is 5 (2-8) lead-1 .min-1 ] under anesthesia with 1.5 MAC compared with 2.5% sevoflurane. Median frequency was decreased [2.8 Hz vs 2.0 Hz, P = 0.003, difference in mean (95% CI) is 0.8 (0.4-1.2) Hz], and the duration of suppression was increased [105 s vs 262 s, P < 0.001, difference in mean (95% CI) is 156 (90-223) s] with 1.5 MAC compared with 2.5% sevoflurane. CONCLUSIONS: Sevoflurane at 1.5 MAC significantly increased the extent and the number of spikes, prolonged the duration of suppression, and decreased median frequency of ECoG compared with those at 2.5% sevoflurane.

DOI： 10.1111/pan.13111

PubMed

Publishing type：Research paper (scientific journal)  

Background: Electrocorticogram (ECoG) spike activity is enhanced under general anesthesia with 1.5 minimum alveolar concentration (MAC) sevoflurane compared with lower concentrations in adult patients with epilepsy. However, the effect of concentration of sevoflurane on ECoG in children with epilepsy is less known. Aims: The primary endpoint was to investigate the effects of sevoflurane on ECoG spike activity in pediatric patients undergoing epilepsy surgery. The secondary endpoint was to examine its effects on baseline ECoG including burst suppression. Methods: Children of age 3–18 years with medically intractable epilepsy undergoing corpus callosotomy or resection of the epileptic foci (n = 11) were enrolled. Electrodes were placed on the brain surface and ECoG was recorded under anesthesia with endtidal carbon dioxide tension at 30 mmHg and sevoflurane at 2.5%, followed by age-adjusted 1.5 MAC (3.1–3.4%) for 10 min. The number of leads with spikes, the average number of spikes per lead per minute, median frequency of ECoG, and duration of suppression of ECoG ≥ 1 s were compared between 2.5% and 1.5 MAC sevoflurane. Results: The number of leads with spikes increased [11 vs 14, P = 0.003, difference in mean (95% CI) is 3 (2–5)], and the average number of spikes increased [9 vs 14·lead−1·min−1, P = 0.003, difference in mean (95% CI) is 5 (2–8) lead−1·min−1] under anesthesia with 1.5 MAC compared with 2.5% sevoflurane. Median frequency was decreased [2.8 Hz vs 2.0 Hz, P = 0.003, difference in mean (95% CI) is 0.8 (0.4–1.2) Hz], and the duration of suppression was increased [105 s vs 262 s, P &lt
0.001, difference in mean (95% CI) is 156 (90–223) s] with 1.5 MAC compared with 2.5% sevoflurane. Conclusions: Sevoflurane at 1.5 MAC significantly increased the extent and the number of spikes, prolonged the duration of suppression, and decreased median frequency of ECoG compared with those at 2.5% sevoflurane.

DOI： 10.1111/pan.13111

PubMed

Publishing type：Research paper (scientific journal)  

The KCNT1 gene encodes the sodium-dependent potassium channel, with quinidine being a partial antagonist of the KCNT1 channel. Gain-of-function KCNT1 mutations cause early onset epileptic encephalopathies including migrating partial seizures of infancy (MPSI). At 5months of age, our patient presented with epileptic spasms and hypsarrhythmia by electroencephalogram. Psychomotor retardation was observed from early infancy. The patient was diagnosed with West syndrome. Consequently, various anti-epileptic drugs, adrenocorticotropic hormone therapy (twice), and ketogenic diet therapy were tried. However, the epileptic spasms were intractable. Whole exome sequencing identified a KCNT1 mutation (c.1955G>T; p.G652V). At 2years and 6months, the patient had daily epileptic spasms despite valproate and lamotrigine treatment, and was therefore admitted for quinidine therapy. With quinidine therapy, decreased epileptic spasms and decreased epileptiform paroxysmal activity were observed by interictal EEG. Regarding development, babbling, responsiveness, oral feeding and muscle tone were ameliorated. Only transient diarrhea was observed as an adverse effect. Thus, quinidine therapy should be attempted in patients with West syndrome caused by KCNT1 mutations, as reported for MPSI.

DOI： 10.1016/j.braindev.2016.08.002

PubMed

Publishing type：Research paper (scientific journal)  

The KCNT1 gene encodes the sodium-dependent potassium channel, with quinidine being a partial antagonist of the KCNT1 channel. Gain-of-function KCNT1 mutations cause early onset epileptic encephalopathies including migrating partial seizures of infancy (MPSI). At 5 months of age, our patient presented with epileptic spasms and hypsarrhythmia by electroencephalogram. Psychomotor retardation was observed from early infancy. The patient was diagnosed with West syndrome. Consequently, various anti-epileptic drugs, adrenocorticotropic hormone therapy (twice), and ketogenic diet therapy were tried. However, the epileptic spasms were intractable. Whole exome sequencing identified a KCNT1 mutation (c.1955G&gt
T
p.G652V). At 2 years and 6 months, the patient had daily epileptic spasms despite valproate and lamotrigine treatment, and was therefore admitted for quinidine therapy. With quinidine therapy, decreased epileptic spasms and decreased epileptiform paroxysmal activity were observed by interictal EEG. Regarding development, babbling, responsiveness, oral feeding and muscle tone were ameliorated. Only transient diarrhea was observed as an adverse effect. Thus, quinidine therapy should be attempted in patients with West syndrome caused by KCNT1 mutations, as reported for MPSI.

DOI： 10.1016/j.braindev.2016.08.002

PubMed

症例は男児で、満期産にて体重2990gで出生し、てんかんの家族歴は聴取されなかった。出生時から全身の低緊張が認められ、その後も精神運動発達遅延が見られた。5ヵ月齢時にてんかん発作が出現し、発作間欠時脳波ではヒプスアリスミアが著明で、発作時脳波では全般性徐波と、速波に続く振幅低下を認めた。これらの所見からWest症候群と診断された。バルプロ酸を始めとする各種抗てんかん薬治療および副腎皮質刺激ホルモン療法にも不応であった。16ヵ月齢よりケトン食療法を導入し発作頻度は減少したものの、ケトン食療法を続けるのは困難であったため3ヵ月間で終了した。全エクソームシーケンス解析から、KCNT1遺伝子の新規変異(NM_020822.2:c.1955G>T;NP_065873.2:p.G652V)のヘテロ接合型であることが示され、この変異は病原性変異が多く報告されているC末端ドメインに位置していた。2歳6ヵ月にてキニジン治療目的で入院し、キニジンの投与を2mg/kgから開始し60mg/kgまで漸増したところ、てんかん発作は10～30回/日まで減少し、発作間欠時脳波上もてんかん様活動の減少が見られ、さらに発達遅延の改善が認められた。心電図検査では補正QT間隔がキニジン治療前の368msから407msへ延長したが、正常域内であり不整脈も見られなかった。キニジンとバルプロ酸にててんかん発作の管理を続けている。

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work  

OBJECTIVES: 18F-fluciclovine (trans-1-amino-3-[18F] fluorocyclobutanecarboxylic acid, [FACBC]) is an artificial amino acid radiotracer used for positron emission tomography (PET) studies, which is metabolically stable in vivo and has a long half-life. It has already been shown that FACBC-PET is useful for glioma imaging. However, there have been no reports evaluating the efficiency of FACBC-PET in the diagnosis of brain tumors in comparison with other PET tracers in clinical studies. The purpose of this study was to investigate the efficacy of FACBC-PET imaging in glioma diagnosis, compared to L-methyl- 11 C-methionine (MET)-PET. METHODS: Six consecutive patients (four male, two female), who were clinically suspected of having high- or low-grade glioma, received both FACBC-PET and MET-PET within a two-week interval. T1-weighted, contrast-enhanced, T1-weighted, and fluid-attenuated inversion recovery magnetic resonance imaging was performed to assist with subsequent tissue resection. Visual findings and semi-quantitative analyses of FACBC and MET uptake, using standardized uptake values (SUVs) and lesion-to-contralateral normal brain tissue (LN) ratios, were evaluated to compare PET images. RESULTS: SUVs for FACBC were lower than those for MET in the non-lesion cerebral cortex, brain stem, and cerebellar hemisphere. There was a weak positive correlation between FACBC and MET uptake in glioma tissue, although L/N ratios for FACBC were higher than those for MET in all the cases. CONCLUSION: FACBC-PET showed higher contrast than MET-PET by both visual and semi-quantitative analyses and may therefore provide better assessment for the detection of glioma. This study was registered as clinical trial (No. JapicCTI-132289).

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVES: 18F-fluciclovine (trans-1-amino-3-[18F] fluorocyclobutanecarboxylic acid, [FACBC]) is an artificial amino acid radiotracer used for positron emission tomography (PET) studies, which is metabolically stable in vivo and has a long half-life. It has already been shown that FACBC-PET is useful for glioma imaging. However, there have been no reports evaluating the efficiency of FACBC-PET in the diagnosis of brain tumors in comparison with other PET tracers in clinical studies. The purpose of this study was to investigate the efficacy of FACBC-PET imaging in glioma diagnosis, compared to L-methyl- 11 C-methionine (MET)-PET. METHODS: Six consecutive patients (four male, two female), who were clinically suspected of having high- or low-grade glioma, received both FACBC-PET and MET-PET within a two-week interval. T1-weighted, contrast-enhanced, T1-weighted, and fluid-attenuated inversion recovery magnetic resonance imaging was performed to assist with subsequent tissue resection. Visual findings and semi-quantitative analyses of FACBC and MET uptake, using standardized uptake values (SUVs) and lesion-to-contralateral normal brain tissue (LN) ratios, were evaluated to compare PET images. RESULTS: SUVs for FACBC were lower than those for MET in the non-lesion cerebral cortex, brain stem, and cerebellar hemisphere. There was a weak positive correlation between FACBC and MET uptake in glioma tissue, although L/N ratios for FACBC were higher than those for MET in all the cases. CONCLUSION: FACBC-PET showed higher contrast than MET-PET by both visual and semi-quantitative analyses and may therefore provide better assessment for the detection of glioma. This study was registered as clinical trial (No. JapicCTI-132289).

DOI： 10.22038/aojnmb.2017.8843

PubMed

Publishing type：Research paper (scientific journal)  

PURPOSE: Quantitative imaging of neuromagnetic fields based on automated region of interest (ROI) setting was analyzed to determine the characteristics of cerebral neural activity in ischemic areas. METHODS: Magnetoencephalography (MEG) was used to evaluate spontaneous neuromagnetic fields in the ischemic areas of 37 patients with unilateral internal carotid artery (ICA) occlusive disease. Voxel-based time-averaged intensity of slow waves was obtained in two frequency bands (0.3-4 Hz and 4-8 Hz) using standardized low-resolution brain electromagnetic tomography (sLORETA) modified for a quantifiable method (sLORETA-qm). ROIs were automatically applied to the anterior cerebral artery (ACA), anterior middle cerebral artery (MCAa), posterior middle cerebral artery (MCAp), and posterior cerebral artery (PCA) using statistical parametric mapping (SPM). Positron emission tomography with 15O-gas inhalation (15O-PET) was also performed to evaluate cerebral blood flow (CBF) and oxygen extraction fraction (OEF). Statistical analyses were performed using laterality index of MEG and 15O-PET in each ROI with respect to distribution and intensity. RESULTS: MEG revealed statistically significant laterality in affected MCA regions, including 4-8 Hz waves in MCAa, and 0.3-4 Hz and 4-8 Hz waves in MCAp (95% confidence interval: 0.020-0.190, 0.030-0.207, and 0.034-0.213), respectively. We found that 0.3-4 Hz waves in MCAp were highly correlated with CBF in MCAa and MCAp (r = 0.74, r = 0.68, respectively), whereas 4-8 Hz waves were moderately correlated with CBF in both the MCAa and MCAp (r = 0.60, r = 0.63, respectively). We also found that 4-8 Hz waves in MCAp were statistically significant for misery perfusion identified on 15O-PET (p<0.05). CONCLUSIONS: Quantitatively imaged spontaneous neuromagnetic fields using the automated ROI setting enabled clear depiction of cerebral ischemic areas. Frequency analysis may reveal unique neural activity that is distributed in the impaired vascular metabolic territory, in which the cerebral infarction has not yet been completed.

DOI： 10.1371/journal.pone.0168588

PubMed

Publishing type：Research paper (scientific journal)  

BACKGROUND: Vertical hemispherotomy is performed in hemispheric epilepsy to disconnect commissural fibers, projecting fibers, and limbic system from the affected side of the brain with minimal parenchyma removal. However, anatomic understanding of this surgery is generally difficult. OBJECTIVE: To present the vertical hemispherotomy procedures using cadaveric brains and intraoperative photographs. METHODS: Two formalin-fixed adult cadaveric brains were used to demonstrate vertical hemispherotomy. Intraoperative photographs were taken of a 19-year-old man with intractable epilepsy due to head trauma in infancy. RESULTS: After coronal skin incision along the coronal suture, bifrontal craniotomy and a C-shaped dural incision from lateral to medial to the midline are performed. The interhemispheric fissure is dissected from anterior to posterior. Interhemispheric total corpus callosotomy is performed to disconnect commissural fibers. Corticotomy on the cingulate gyrus is performed to approach the lateral ventricle. The lateral border of the thalamus is cut from posterior to anterior until exposing the inferior horn of the lateral ventricle and hippocampal head to disconnect projecting fibers. At the anteromedial side of the hippocampus, the inferior part of the amygdala and uncal gyrus is removed, exposing the basal cistern to disconnect the hippocampus and amygdala. The posterior column of the fornix at the trigone of the lateral ventricle is resected to disconnect the limbic system. Projecting fibers from the anterior frontal lobe are disconnected. CONCLUSION: A step-by-step procedure using cadaveric brains and intraoperative photographs provide a better anatomic understanding of vertical hemispherotomy.

DOI： 10.1227/NEU.0000000000001272

PubMed

Publishing type：Research paper (scientific journal)  

側頭葉てんかんでは、けいれん重積や熱性けいれんの既往、前兆のある複雑部分発作や自動症を認めることが知られている。今回、明らかな既往なく、前頭葉てんかん様の症状を繰り返しながら難治に経過した3歳発症の側頭葉てんかん症例を経験したので報告する。症例は8歳女児。3歳時に夜間入眠後の発作で発症した。発作間欠期脳波で右優位の全般性棘徐波を認め、CBZで一旦発作は消失した。しかし5歳時に再発し、ZNS、VPA、CLB、LEVでもコントロール困難となった。8歳時のビデオ脳波検査で睡眠中に前兆なく突然四肢の強直や、頭部から体幹を右に回転させる動き、自動症様の上肢の不規則で時に激しい動きで始まり、突然終わる発作を確認。発作時脳波は右側頭部の棘徐波複合を呈した。さらに頭部MRI、SPECT、PET、脳磁図で同部位の焦点を示唆する所見が得られた。発作はTPMを追加、増量で速やかに消失した。本症例の発作は前頭葉てんかんを想起させるものであったが、側頭葉から前頭葉に投射する経路を介して発作波が伝播し、小児期の多彩な側頭葉てんかん症状の一環として前頭葉てんかん様の発作が出現していたものではないかと考えた。今後、再発時には外科的治療も視野において経過観察していく方針である。(著者抄録)

側頭葉てんかんでは、けいれん重積や熱性けいれんの既往、前兆のある複雑部分発作や自動症を認めることが知られている。今回、明らかな既往なく、前頭葉てんかん様の症状を繰り返しながら難治に経過した3歳発症の側頭葉てんかん症例を経験したので報告する。症例は8歳女児。3歳時に夜間入眠後の発作で発症した。発作間欠期脳波で右優位の全般性棘徐波を認め、CBZで一旦発作は消失した。しかし5歳時に再発し、ZNS、VPA、CLB、LEVでもコントロール困難となった。8歳時のビデオ脳波検査で睡眠中に前兆なく突然四肢の強直や、頭部から体幹を右に回転させる動き、自動症様の上肢の不規則で時に激しい動きで始まり、突然終わる発作を確認。発作時脳波は右側頭部の棘徐波複合を呈した。さらに頭部MRI、SPECT、PET、脳磁図で同部位の焦点を示唆する所見が得られた。発作はTPMを追加、増量で速やかに消失した。本症例の発作は前頭葉てんかんを想起させるものであったが、側頭葉から前頭葉に投射する経路を介して発作波が伝播し、小児期の多彩な側頭葉てんかん症状の一環として前頭葉てんかん様の発作が出現していたものではないかと考えた。今後、再発時には外科的治療も視野において経過観察していく方針である。(著者抄録)

Publishing type：Research paper (scientific journal)  

側頭葉てんかんでは、けいれん重積や熱性けいれんの既往、前兆のある複雑部分発作や自動症を認めることが知られている。今回、明らかな既往なく、前頭葉てんかん様の症状を繰り返しながら難治に経過した3歳発症の側頭葉てんかん症例を経験したので報告する。症例は8歳女児。3歳時に夜間入眠後の発作で発症した。発作間欠期脳波で右優位の全般性棘徐波を認め、CBZで一旦発作は消失した。しかし5歳時に再発し、ZNS、VPA、CLB、LEVでもコントロール困難となった。8歳時のビデオ脳波検査で睡眠中に前兆なく突然四肢の強直や、頭部から体幹を右に回転させる動き、自動症様の上肢の不規則で時に激しい動きで始まり、突然終わる発作を確認。発作時脳波は右側頭部の棘徐波複合を呈した。さらに頭部MRI、SPECT、PET、脳磁図で同部位の焦点を示唆する所見が得られた。発作はTPMを追加、増量で速やかに消失した。本症例の発作は前頭葉てんかんを想起させるものであったが、側頭葉から前頭葉に投射する経路を介して発作波が伝播し、小児期の多彩な側頭葉てんかん症状の一環として前頭葉てんかん様の発作が出現していたものではないかと考えた。今後、再発時には外科的治療も視野において経過観察していく方針である。(著者抄録)

Publishing type：Research paper (scientific journal)  

BACKGROUND: Vertical hemispherotomy is performed in hemispheric epilepsy to disconnect commissural fibers, projecting fibers, and limbic system from the affected side of the brain with minimal parenchyma removal. However, anatomic understanding of this surgery is generally difficult. OBJECTIVE: To present the vertical hemispherotomy procedures using cadaveric brains and intraoperative photographs. METHODS: Two formalin-fixed adult cadaveric brains were used to demonstrate vertical hemispherotomy. Intraoperative photographs were taken of a 19-year-old man with intractable epilepsy due to head trauma in infancy. RESULTS: After coronal skin incision along the coronal suture, bifrontal craniotomy and a C-shaped dural incision from lateral to medial to the midline are performed. The interhemispheric fissure is dissected from anterior to posterior. Interhemispheric total corpus callosotomy is performed to disconnect commissural fibers. Corticotomy on the cingulate gyrus is performed to approach the lateral ventricle. The lateral border of the thalamus is cut from posterior to anterior until exposing the inferior horn of the lateral ventricle and hippocampal head to disconnect projecting fibers. At the anteromedial side of the hippocampus, the inferior part of the amygdala and uncal gyrus is removed, exposing the basal cistern to disconnect the hippocampus and amygdala. The posterior column of the fornix at the trigone of the lateral ventricle is resected to disconnect the limbic system. Projecting fibers from the anterior frontal lobe are disconnected. CONCLUSION: A step-by-step procedure using cadaveric brains and intraoperative photographs provide a better anatomic understanding of vertical hemispherotomy.

DOI： 10.1227/neu.0000000000001272

Publishing type：Research paper (scientific journal)  

Purpose Quantitative imaging of neuromagnetic fields based on automated region of interest (ROI) setting was analyzed to determine the characteristics of cerebral neural activity in ischemic areas. Methods Magnetoencephalography (MEG) was used to evaluate spontaneous neuromagnetic fields in the ischemic areas of 37 patients with unilateral internal carotid artery (ICA) occlusive disease. Voxel-based time-averaged intensity of slow waves was obtained in two frequency bands (0.3-4 Hz and 4-8 Hz) using standardized low-resolution brain electromagnetic tomography (sLORETA) modified for a quantifiable method (sLORETA-qm). ROIs were automatically applied to the anterior cerebral artery (ACA), anterior middle cerebral artery (MCAa), posterior middle cerebral artery (MCAp), and posterior cerebral artery (PCA) using statistical parametric mapping (SPM). Positron emission tomography with15 O-gas inhalation (15 O-PET) was also performed to evaluate cerebral blood flow (CBF) and oxygen extraction fraction (OEF). Statistical analyses were performed using laterality index of MEG and15 O-PET in each ROI with respect to distribution and intensity. Results MEG revealed statistically significant laterality in affected MCA regions, including 4-8 Hz waves in MCAa, and 0.3-4 Hz and 4-8 Hz waves in MCAp (95% confidence interval: 0.020-0.190, 0.030-0.207, and 0.034-0.213), respectively. We found that 0.3-4 Hz waves in MCAp were highly correlated with CBF in MCAa and MCAp (r = 0.74, r = 0.68, respectively), whereas 4-8 Hz waves were moderately correlated with CBF in both the MCAa and MCAp (r = 0.60, r = 0.63, respectively). We also found that 4-8 Hz waves in MCAp were statistically significant for misery perfusion identified on15 O-PET (p&lt
0.05). Conclusions Quantitatively imaged spontaneous neuromagnetic fields using the automated ROI setting enabled clear depiction of cerebral ischemic areas. Frequency analysis may reveal unique neural activity that is distributed in the impaired vascular metabolic territory, in which the cerebral infarction has not yet been completed.

DOI： 10.1371/journal.pone.0168588

PubMed

Publishing type：Research paper (scientific journal)  

The present study examined the relationship between residual discharges from the temporal neocortex postoperatively and seizure outcomes, in mesial temporal lobe epilepsy (MTLE) patients with hippocampal sclerosis (HS) who were treated with selective amygdalohippocampectomy (SelAH). Abnormal discharges from the temporal neocortex are often observed and remain postoperatively. However, no recommendations have been made regarding whether additional procedures to eliminate these discharges should be performed for seizure relief. We retrospectively analyzed 28 patients with unilateral MTLE and HS, who underwent transsylvian SelAH. The mean follow-up period was 29months (range: 16-49). In the pre- and postresection states, electrocorticography (ECoG) was recorded for the temporal base and lateral temporal cortex. The extent of resection was not influenced by the results of the preresection ECoG. Even if residual abnormal discharges were identified on the temporal neocortex, no additional procedures were undertaken to eliminate these abnormalities. The postresection spike counts were examined to determine the postresective alterations in spike count, and the frequency of residual spike count. The seizure outcomes were evaluated in all patients using the Engel classification. The postoperative seizure-free rate was 92.9%. No significant correlations were seen between a decreasing spike count and seizure outcomes (p=0.9259), or between the absence of residual spikes and seizure outcomes (p=1.000). Residual spikes at the temporal neocortex do not appear to influence seizure outcomes. Only mesial temporal structures should be removed, and additional procedures to eliminate residual spikes are not required.

DOI： 10.1016/j.jocn.2015.03.063

PubMed

Publishing type：Research paper (scientific journal)  

The present study examined the relationship between residual discharges from the temporal neocortex postoperatively and seizure outcomes, in mesial temporal lobe epilepsy (MTLE) patients with hippocampal sclerosis (HS) who were treated with selective amygdalohippocampectomy (SelAH). Abnormal discharges from the temporal neocortex are often observed and remain postoperatively. However, no recommendations have been made regarding whether additional procedures to eliminate these discharges should be performed for seizure relief. We retrospectively analyzed 28 patients with unilateral MTLE and HS, who underwent transsylvian SelAH. The mean follow-up period was 29 months (range: 16-49). In the pre- and postresection states, electrocorticography (ECoG) was recorded for the temporal base and lateral temporal cortex. The extent of resection was not influenced by the results of the preresection ECoG. Even if residual abnormal discharges were identified on the temporal neocortex, no additional procedures were undertaken to eliminate these abnormalities. The postresection spike counts were examined to determine the postresective alterations in spike count, and the frequency of residual spike count. The seizure outcomes were evaluated in all patients using the Engel classification. The postoperative seizure-free rate was 92.9%. No significant correlations were seen between a decreasing spike count and seizure outcomes (p = 0.9259), or between the absence of residual spikes and seizure outcomes (p = 1.000). Residual spikes at the temporal neocortex do not appear to influence seizure outcomes. Only mesial temporal structures should be removed, and additional procedures to eliminate residual spikes are not required. (C) 2015 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jocn.2015.03.063

PubMed

Publishing type：Research paper (scientific journal)  

シミュレーションソフトウェア導入以降に摘出術を行った術前に摘出が困難と予想された頭蓋底腫瘍を対象とした。MRI、CT画像をもとに画像解析ソフトを用いて三次元融合画像を作成した。三次元融合画像を三次元デジタルクレイモデラーを用いて、開頭から腫瘍摘出まで一連の手術シミュレーションを行い、解剖学位置関係の把握、手術到達法の決定およびリスク予測について検討した。頭蓋底手術88例中49例(55.7%)でモデルを作成した。疾患の内訳は、頭蓋咽頭腫17例、髄膜腫15例、神経鞘腫11例、その他6例であった。全例で実際の術野とほぼ同じ三次元融合画像を得られた。術前カンファレンスで実際にシミュレーションを提示しながら症例検討を行うことで、他者との情報共有が得られ、適切な手術到達法の選択が可能であった。手術到達側の静脈還流や病巣を中心とした三次元解剖を容易に把握することができ、リスク予測と合併症回避に有用であった。

Publishing type：Research paper (scientific journal)  

シミュレーションソフトウェア導入以降に摘出術を行った術前に摘出が困難と予想された頭蓋底腫瘍を対象とした。MRI、CT画像をもとに画像解析ソフトを用いて三次元融合画像を作成した。三次元融合画像を三次元デジタルクレイモデラーを用いて、開頭から腫瘍摘出まで一連の手術シミュレーションを行い、解剖学位置関係の把握、手術到達法の決定およびリスク予測について検討した。頭蓋底手術88例中49例(55.7%)でモデルを作成した。疾患の内訳は、頭蓋咽頭腫17例、髄膜腫15例、神経鞘腫11例、その他6例であった。全例で実際の術野とほぼ同じ三次元融合画像を得られた。術前カンファレンスで実際にシミュレーションを提示しながら症例検討を行うことで、他者との情報共有が得られ、適切な手術到達法の選択が可能であった。手術到達側の静脈還流や病巣を中心とした三次元解剖を容易に把握することができ、リスク予測と合併症回避に有用であった。

シミュレーションソフトウェア導入以降に摘出術を行った術前に摘出が困難と予想された頭蓋底腫瘍を対象とした。MRI、CT画像をもとに画像解析ソフトを用いて三次元融合画像を作成した。三次元融合画像を三次元デジタルクレイモデラーを用いて、開頭から腫瘍摘出まで一連の手術シミュレーションを行い、解剖学位置関係の把握、手術到達法の決定およびリスク予測について検討した。頭蓋底手術88例中49例(55.7%)でモデルを作成した。疾患の内訳は、頭蓋咽頭腫17例、髄膜腫15例、神経鞘腫11例、その他6例であった。全例で実際の術野とほぼ同じ三次元融合画像を得られた。術前カンファレンスで実際にシミュレーションを提示しながら症例検討を行うことで、他者との情報共有が得られ、適切な手術到達法の選択が可能であった。手術到達側の静脈還流や病巣を中心とした三次元解剖を容易に把握することができ、リスク予測と合併症回避に有用であった。

Publishing type：Research paper (scientific journal)  

OBJECTIVE: Amygdala enlargement (AE) has been suggested to be a subtype of mesial temporal lobe epilepsy (MTLE). However, most reports related to AE have referred to imaging studies, and there have been few reports regarding surgical and pathological findings. The present study was performed to clarify the surgical outcomes and pathology of AE. METHODS: Eighty patients with drug-resistant MTLE were treated surgically at the Tokyo Metropolitan Neurological Hospital between April 2010 and July 2013. Of these patients, 11 were diagnosed as AE based on presurgical MRI. Nine patients with AE underwent selective amygdalohippocampectomy, while the remaining two patients underwent selective amygdalotomy with hippocampal transection. Intraoperative EEG was routinely performed. The histopathology of the resected amygdala tissue was evaluated and compared with the amygdala tissue of patients with hippocampal sclerosis. RESULTS: Pathological findings indicated that 10 of 11 specimens had closely clustering hypertrophic neurons with vacuolisation of the background matrix. Slight gliosis was seen in nine specimens, while the remaining two showed no gliotic changes. Intraoperative EEG showed abnormal sharp waves that seemed to originate not from the amygdala but from the hippocampus in all cases. Ten patients became seizure-free during the postoperative follow-up period. CONCLUSIONS: Histopathologically, clustering hypertrophic neurons and vacuolation with slight gliosis or without gliosis were considered to be pathological characteristics of AE. Amygdalohippocampectomy or hippocampal transection with amygdalotomy is effective for seizure control in patients with AE.

DOI： 10.1136/jnnp-2014-308383

PubMed

Publishing type：Research paper (scientific journal)  

Objective Amygdala enlargement (AE) has been suggested to be a subtype of mesial temporal lobe epilepsy (MILE). However, most reports related to AE have referred to imaging studies, and there have been few reports regarding surgical and pathological findings. The present study was performed to clarify the surgical outcomes and pathology of AE.
Methods Eighty patients with drug-resistant MILE were treated surgically at the Tokyo Metropolitan Neurological Hospital between April 2010 and July 2013. Of these patients, 11 were diagnosed as AE based on presurgical MRI. Nine patients with AE underwent selective amygdalohippocampectomy, while the remaining two patients underwent selective amygdalotomy with hippocampal transection. Intraoperative EEG was routinely performed. The histopathology of the resected amygdala tissue was evaluated and compared with the amygdala tissue of patients with hippocampal sclerosis.
Results Pathological findings indicated that 10 of 11 specimens had closely clustering hypertrophic neurons with vacuolisation of the background matrix. Slight gliosis was seen in nine specimens, while the remaining two showed no gliotic changes. Intraoperative EEG showed abnormal sharp waves that seemed to originate not from the amygdala but from the hippocampus in all cases. Ten patients became seizure-free during the postoperative follow-up period.
Conclusions Histopathologically, clustering hypertrophic neurons and vacuolation with slight gliosis or without gliosis were considered to be pathological characteristics of AE. Amygdalohippocampectomy or hippocampal transection with amygdalotomy is effective for seizure control in patients with AE.

DOI： 10.1136/jnnp-2014-308383

Publishing type：Research paper (scientific journal)  

Background: The clinical significance of diffusion tensor (DT) magnetic resonance imaging (MRI) parameters was analyzed to predict postoperative functional recovery in patients with cervical myelopathy. Materials and Methods: Sixteen patients with cervical myelopathy caused by cervical spondylosis, disk herniation or ossification of the posterior longitudinal ligament who underwent surgical intervention in our institute were enrolled in this retrospective study. There were 7 men and 9 women, with a mean age of 62.8 years. Clinical assessment was done before surgery and at least 3 months after surgery. All patients underwent whole-body 3.0-Tesla MRI before surgery. DT images (DTIs) were obtained using a single-shot fast spin-echo-based sequence. Mean values of mean diffusivity (MD) and fractional anisotropy (FA) at 6 disk levels of the cervical spine were measured using manual setting of regions of interest. The MD and FA values at the most compressed part were analyzed. Absolute MD and FA values at the most compressed spinal level in patients were transformed into the normalized values with a z-score analysis. Results: MD-z may decrease with the severity of cervical myelopathy. Receiver operating characteristic analysis of MD-z and FA-z suggested that both MD-z and FA-z have clinical validity for predicting the efficacy of surgical intervention, but MD-z was considered to be the most appropriate value to predict the efficacy of surgery. Conclusions: DTIs may be a promising modality to predict functional recovery after surgery. MD changes may reflect spinal cord condition and its reversibility.

DOI： 10.4103/0974-8237.161593

PubMed

Publishing type：Research paper (scientific journal)  

BACKGROUND: The clinical significance of diffusion tensor (DT) magnetic resonance imaging (MRI) parameters was analyzed to predict postoperative functional recovery in patients with cervical myelopathy. MATERIALS AND METHODS: Sixteen patients with cervical myelopathy caused by cervical spondylosis, disk herniation or ossification of the posterior longitudinal ligament who underwent surgical intervention in our institute were enrolled in this retrospective study. There were 7 men and 9 women, with a mean age of 62.8 years. Clinical assessment was done before surgery and at least 3 months after surgery. All patients underwent whole-body 3.0-Tesla MRI before surgery. DT images (DTIs) were obtained using a single-shot fast spin-echo-based sequence. Mean values of mean diffusivity (MD) and fractional anisotropy (FA) at 6 disk levels of the cervical spine were measured using manual setting of regions of interest. The MD and FA values at the most compressed part were analyzed. Absolute MD and FA values at the most compressed spinal level in patients were transformed into the normalized values with a z-score analysis. RESULTS: MD-z may decrease with the severity of cervical myelopathy. Receiver operating characteristic analysis of MD-z and FA-z suggested that both MD-z and FA-z have clinical validity for predicting the efficacy of surgical intervention, but MD-z was considered to be the most appropriate value to predict the efficacy of surgery. CONCLUSIONS: DTIs may be a promising modality to predict functional recovery after surgery. MD changes may reflect spinal cord condition and its reversibility.

DOI： 10.4103/0974-8237.161593

PubMed

Publishing type：Research paper (scientific journal)  

A 45-year-old man came to our clinic due to refractory general tonic seizure and an attack of unintended yelling. Magnetic resonance imaging (MRI) demonstrated mild cortical hyperintensity on fluid attenuated inversion recovery (FLAIR) image in the left basal frontal area. Enlargement of the left olfactory nerve was also detected below the affected gyrus. Subtotal resection of the MRI-visible epileptogenic lesion was performed without any neurological deficit. The final pathological diagnosis was focal cortical dysplasia (FCD) type IIa. Seizures and yelling attacks subsided after surgery. Extracerebral abnormalities, including cranial nerve enlargement, are common in patients with hemimegalencephaly. However, such abnormalities are rare with FCD.

DOI： 10.2176/nmc.cr.2013-0173

PubMed

Publishing type：Research paper (scientific journal)  

A 45-year-old man came to our clinic due to refractory general tonic seizure and an attack of unintended yelling. Magnetic resonance imaging (MRI) demonstrated mild cortical hyperintensity on fluid attenuated inversion recovery (FLAIR) image in the left basal frontal area. Enlargement of the left olfactory nerve was also detected below the affected gyrus. Subtotal resection of the MRI-visible epileptogenic lesion was performed without any neurological deficit. The final pathological diagnosis was focal cortical dysplasia (FCD) type IIa. Seizures and yelling attacks subsided after surgery. Extracerebral abnormalities, including cranial nerve enlargement, are common in patients with hemimegalencephaly. However, such abnormalities are rare with FCD.

45歳男。難治性強直性てんかんと叫び声発作のため受診した。最初の発作は10歳時で、意識消失後に強直性てんかんが出現した。抗痙攣薬を開始し、多剤併用したが発作は難治性であった。MRI fluid attenuated inversion recovery(FLAIR)画像で左基底前頭領域に軽度皮質高信号を認め、病変脳回の下に左嗅神経の腫大も認めた。左眼窩前頭葉を切除し、嗅覚に関連する領域は保存した。術後神経学的障害は認めず、病理学的診断は局所皮質異形成(FCD)IIa型であった。術後、てんかんと叫び声発作は軽快した。

Publishing type：Research paper (scientific journal)  

脳磁図（Magnetoencephalography：MEG）での自発脳磁場データから，てんかん間歇期異常波を半自動的に解析することを最終目的とし，空間フィルター法の一解析手法であるsLORETAqm（sLORETAの定量化応用）の有効性を確かめる為にダイポール推定法（ECD法）との比較を行った。対象をてんかん患者から得られた発作間歇期の50棘波としMEG及び同時計測した脳波波形から解析時刻を決定した。ECD法では20個のセンサーを選択し90％以上のGOFが得られたダイポールを採用した。sLORETAqmでは，全センサーを用いボクセルサイズを5mmとして解析した。電流源の位置と強度を比較した結果，電流源
の位置は両手法間で有意差を認めなかった。また，電流強度は両手法間で強い相関関係が認められた。sLORETAqmは恣意性が少ない定量解析手法として有用と考えられた。

Publishing type：Research paper (scientific journal)  

BACKGROUND: In this era of minimally invasive treatment, it is important to make operative scars as inconspicuous as possible, and there is a great deal of room for improvement in daily practice. Zigzag incision with coronal incision has been described mainly in the field of plastic surgery, and its applicability for skin incision in general neurosurgery has not been reported. METHODS: Zigzag incision with 1.5-layer method was applied to 14 patients with unruptured cerebral aneurysm between April 2011 and August 2012. A questionnaire survey was administered among patients with unruptured aneurysm using SF-36v2 since April 2010. The results were compared between patients with zigzag incision and a previous cohort with traditional incision. RESULTS: There were no cases of complications associated with the operative wound. In the questionnaire survey, all parameters tended to be better in the patients with zigzag incision, and role social component score (RCS) was significantly higher in the zigzag group than in the traditional incision group (P =0.0436). CONCLUSION: Zigzag incision using the 1.5-layer method with frontotemporal craniotomy seems to represent an improvement over the conventional curvilinear incision with regard to cosmetic outcome and RCS.

DOI： 10.4103/2152-7806.132562

PubMed

Publishing type：Research paper (scientific journal)  

脳磁図（Magnetoencephalography：MEG）での自発脳磁場データから，てんかん間歇期異常波を半自動的に解析することを最終目的とし，空間フィルター法の一解析手法であるsLORETAqm（sLORETAの定量化応用）の有効性を確かめる為にダイポール推定法（ECD法）との比較を行った。対象をてんかん患者から得られた発作間歇期の50棘波としMEG及び同時計測した脳波波形から解析時刻を決定した。ECD法では20個のセンサーを選択し90％以上のGOFが得られたダイポールを採用した。sLORETAqmでは，全センサーを用いボクセルサイズを5mmとして解析した。電流源の位置と強度を比較した結果，電流源
の位置は両手法間で有意差を認めなかった。また，電流強度は両手法間で強い相関関係が認められた。sLORETAqmは恣意性が少ない定量解析手法として有用と考えられた。

Publishing type：Research paper (scientific journal)  

BACKGROUND: In this era of minimally invasive treatment, it is important to make operative scars as inconspicuous as possible, and there is a great deal of room for improvement in daily practice. Zigzag incision with coronal incision has been described mainly in the field of plastic surgery, and its applicability for skin incision in general neurosurgery has not been reported. METHODS: Zigzag incision with 1.5-layer method was applied to 14 patients with unruptured cerebral aneurysm between April 2011 and August 2012. A questionnaire survey was administered among patients with unruptured aneurysm using SF-36v2 since April 2010. The results were compared between patients with zigzag incision and a previous cohort with traditional incision. RESULTS: There were no cases of complications associated with the operative wound. In the questionnaire survey, all parameters tended to be better in the patients with zigzag incision, and role social component score (RCS) was significantly higher in the zigzag group than in the traditional incision group (P =0.0436). CONCLUSION: Zigzag incision using the 1.5-layer method with frontotemporal craniotomy seems to represent an improvement over the conventional curvilinear incision with regard to cosmetic outcome and RCS.

DOI： 10.4103/2152-7806.132562

PubMed

Publishing type：Research paper (scientific journal)  

Object Amygdalohippocampectomy is a well-established, standard surgery for medically intractable mesial temporal lobe epilepsy (MTLE). However, in the case of MTLE without hippocampal atrophy or sclerosis, amygdalohippocampectomy is associated with decreased postoperative memory function. Hippocampal transection (HT) has been developed to overcome this problem. In HT the hippocampus is not removed; rather, the longitudinal hippocampal circuits of epileptic activities are disrupted by transection of the pyramidal layer of the hippocampus. The present study describes a less invasive modification of HT (transsylvian HT) and presents the seizure and memory outcomes for this procedure. Methods Thirty-seven patients with MTLE (18 men and 19 women; age range 9-63 years; 19 with surgery on the right side and 18 with surgery on the left side; seizure onset from 3 to 34 years) who were treated with transsylvian HT were retrospectively analyzed. All patients had left-side language dominance, and follow-up periods ranged from 12 to 94 months (median 49 months). Seizure outcomes were evaluated for all patients by using the Engel classification. Memory function was evaluated for 22 patients based on 3 indices (verbal memory, nonverbal memory, and delayed recall), with those scores obtained using the Wechsler Memory Scale-Revised. Patients underwent evaluation of the memory function before and after surgery (6 months-1 year). Results Engel Class I (completely seizure free) was achieved in 25 patients (67.6%). Class II and Class III designation was achieved in 10 (27%) and 2 patients (5.4%), respectively. There were differences in memory outcome between the sides of operation. On the right side, verbal memory significantly increased postoperatively (p = 0.003) but nonverbal memory and delayed recall showed no significant change after the operation (p = 0.718 and p = 0.210, respectively). On the left side, all 3 indices (verbal memory, nonverbal memory, and delayed recall) showed no significant change (p = 0.331, p = 0.458, and p = 0.366, respectively). Conclusions Favorable seizure outcome and preservation of verbal memory were achieved with transsylvian HT for the treatment of MTLE without hippocampal atrophy or sclerosis.

DOI： 10.3171/2013.6.JNS13244

PubMed

Publishing type：Research paper (scientific journal)  

Object: Amygdalohippocampectomy is a well-established, standard surgery for medically intractable mesial temporal lobe epilepsy (MTLE). However, in the case of MTLE without hippocampal atrophy or sclerosis, amygdalohippocampectomy is associated with decreased postoperative memory function. Hippocampal transection (HT) has been developed to overcome this problem. In HT the hippocampus is not removed
rather, the longitudinal hippocampal circuits of epileptic activities are disrupted by transection of the pyramidal layer of the hippocampus. The present study describes a less invasive modification of HT (transsylvian HT) and presents the seizure and memory outcomes for this procedure. Methods: Thirty-seven patients with MTLE (18 men and 19 women
age range 9-63 years
19 with surgery on the right side and 18 with surgery on the left side
seizure onset from 3 to 34 years) who were treated with transsylvian HT were retrospectively analyzed. All patients had left-side language dominance, and follow-up periods ranged from 12 to 94 months (median 49 months). Seizure outcomes were evaluated for all patients by using the Engel classification. Memory function was evaluated for 22 patients based on 3 indices (verbal memory, nonverbal memory, and delayed recall), with those scores obtained using the Wechsler Memory Scale-Revised. Patients underwent evaluation of the memory function before and after surgery (6 months-1 year). Results: Engel Class I (completely seizure free) was achieved in 25 patients (67.6%). Class II and Class III designation was achieved in 10 (27%) and 2 patients (5.4%), respectively. There were differences in memory outcome between the sides of operation. On the right side, verbal memory significantly increased postoperatively (p = 0.003) but nonverbal memory and delayed recall showed no significant change after the operation (p = 0.718 and p = 0.210, respectively). On the left side, all 3 indices (verbal memory, nonverbal memory, and delayed recall) showed no significant change (p = 0.331, p = 0.458, and p = 0.366, respectively). Conclusions: Favorable seizure outcome and preservation of verbal memory were achieved with transsylvian HT for the treatment of MTLE without hippocampal atrophy or sclerosis. © AANS, 2013.

DOI： 10.3171/2013.6.JNS13244

PubMed

Publishing type：Research paper (scientific journal)  

手術を行った内側側頭葉てんかん患者8例(男6例、女2例、27〜53歳)を対象に、術前および術後1年にFDG-PETでの評価を行った。術前における健常データベースとの比較統計画像において、グレースケールおよびカラーマップを用いた視覚的評価では判断が難しい症例でも、低下領域の広がりを視覚的に判断することができた。画像変換と重畳過程でのゆがみは10例中3例に認めたが、いずれも後頭部であり評価に影響はなかった。術前後の差分画像では、手術により摘出された部位(側頭葉内側)で集積が消失するのに加え、摘出部位の周辺(側頭葉底部、外側)においても集積の低下がみられた。一方、手術部位とは異なる領域、特に同側の島回や前頭葉円蓋部では集積の上昇がみられた。

Publishing type：Research paper (scientific journal)  

手術を行った内側側頭葉てんかん患者8例(男6例、女2例、27〜53歳)を対象に、術前および術後1年にFDG-PETでの評価を行った。術前における健常データベースとの比較統計画像において、グレースケールおよびカラーマップを用いた視覚的評価では判断が難しい症例でも、低下領域の広がりを視覚的に判断することができた。画像変換と重畳過程でのゆがみは10例中3例に認めたが、いずれも後頭部であり評価に影響はなかった。術前後の差分画像では、手術により摘出された部位(側頭葉内側)で集積が消失するのに加え、摘出部位の周辺(側頭葉底部、外側)においても集積の低下がみられた。一方、手術部位とは異なる領域、特に同側の島回や前頭葉円蓋部では集積の上昇がみられた。

手術を行った内側側頭葉てんかん患者8例(男6例、女2例、27～53歳)を対象に、術前および術後1年にFDG-PETでの評価を行った。術前における健常データベースとの比較統計画像において、グレースケールおよびカラーマップを用いた視覚的評価では判断が難しい症例でも、低下領域の広がりを視覚的に判断することができた。画像変換と重畳過程でのゆがみは10例中3例に認めたが、いずれも後頭部であり評価に影響はなかった。術前後の差分画像では、手術により摘出された部位(側頭葉内側)で集積が消失するのに加え、摘出部位の周辺(側頭葉底部、外側)においても集積の低下がみられた。一方、手術部位とは異なる領域、特に同側の島回や前頭葉円蓋部では集積の上昇がみられた。

Publishing type：Research paper (scientific journal)  

STUDY DESIGN.: Cross-sectional study. OBJECTIVE.: To assess spinal cord condition in patients with cervical spondylosis (CS), using diffusion tensor imaging parameter. SUMMARY OF BACKGROUND DATA.: Although myelopathy is a common symptom after CS, clinically objective assessment for determination of surgical intervention is not straightforward. METHODS.: Twenty-six patients with CS and 30 normal control subjects were enrolled. Diffusion tensor imaging was obtained using a single-shot fast spin-echo-based sequence at 3.0 T. Mean diffusivity (MD) and fractional anisotropy (FA) were measured in the axial plane at 6 spinal levels. To evaluate MD and FA in patients with CS considering the normal variation at each spinal level and between spinal levels, MD and FA at the most compressed spinal level were transformed to normalized values with a z score. Presence of myelopathy was predicted with the MD and FA z scores. Diagnostic validity of MD and FA was compared with receiver operating characteristic analysis. More effective parameter and the optimal cutoff value for prediction were determined. RESULTS.: In normal subjects, MD and FA were significantly different between spinal levels. In patients with myelopathy, an MD increase or an FA decrease was demonstrated in most cases. Although both an MD increase and an FA decrease had diagnostic validity for myelopathy, receiver operating characteristic analysis demonstrated a higher sensitivity and specificity for prediction of an MD increase than an FA decrease (areas under the curve for MD and FA were 0.903 and 0.760, respectively). An MD z score of 1.40 was considered to be the best diagnostic cutoff value with 100% sensitivity and 75% specificity. CONCLUSION.: Myelopathy can be predicted with high accuracy with diffusion tensor imaging parameter, with the MD z score at the most compressed spinal level.Level of Evidence: 3.

CiNii Article

CiNii Article

Publishing type：Research paper (scientific journal)  

Study Design. Cross-sectional study.
Objective. To assess spinal cord condition in patients with cervical spondylosis (CS), using diffusion tensor imaging parameter. Summary of Background Data. Although myelopathy is a common symptom after CS, clinically objective assessment for determination of surgical intervention is not straightforward.
Methods. Twenty-six patients with CS and 30 normal control subjects were enrolled. Diffusion tensor imaging was obtained using a single-shot fast spin-echo-based sequence at 3.0 T. Mean diffusivity (MD) and fractional anisotropy (FA) were measured in the axial plane at 6 spinal levels. To evaluate MD and FA in patients with CS considering the normal variation at each spinal level and between spinal levels, MD and FA at the most compressed spinal level were transformed to normalized values with a z score. Presence of myelopathy was predicted with the MD and FA z scores. Diagnostic validity of MD and FA was compared with receiver operating characteristic analysis. More effective parameter and the optimal cutoff value for prediction were determined.
Results. In normal subjects, MD and FA were significantly different between spinal levels. In patients with myelopathy, an MD increase or an FA decrease was demonstrated in most cases. Although both an MD increase and an FA decrease had diagnostic validity for myelopathy, receiver operating characteristic analysis demonstrated a higher sensitivity and specificity for prediction of an MD increase than an FA decrease (areas under the curve for MD and FA were 0.903 and 0.760, respectively). An MD z score of 1.40 was considered to be the best diagnostic cutoff value with 100% sensitivity and 75% specificity.
Conclusion. Myelopathy can be predicted with high accuracy with diffusion tensor imaging parameter, with the MD z score at the most compressed spinal level.

DOI： 10.1097/BRS.0b013e31826f25a3

PubMed

Publishing type：Research paper (scientific journal)  

Herpes simplex virus (HSV) is the most common cause of
fatal encephalitis. After the primary infection, the viral
DNA establishes a lifelong latent infection in the cell
nucleus and reactivation of HSV may occur at any time in
the patient’s life. Here, we report an unusual case of a
20-year-old woman with a history of HSV encephalitis who
suffered a relapse of encephalitis after surgical treatment
for mesial temporal lobe epilepsy (MTLE).

DOI： 10.1007/s00415-012-6735-8

PubMed

Publishing type：Research paper (scientific journal)  

Herpes simplex virus (HSV) is the most common cause of
fatal encephalitis. After the primary infection, the viral
DNA establishes a lifelong latent infection in the cell
nucleus and reactivation of HSV may occur at any time in
the patient’s life. Here, we report an unusual case of a
20-year-old woman with a history of HSV encephalitis who
suffered a relapse of encephalitis after surgical treatment
for mesial temporal lobe epilepsy (MTLE).

DOI： 10.1007/s00415-012-6735-8

PubMed

Publishing type：Research paper (scientific journal)  

前回（都薬雑誌Vol.35 No.4），てんかんの概要，抗てんかん薬の最近の話題と基本的な使い方，運転免許関連の話題について述べた。今回は，てんかんの外科治療の最近の話題について述べる。

Publishing type：Research paper (scientific journal)  

てんかんとは脳の一部の神経細胞が異常発火し，それが脳の一部あるいは全体に伝播することにより引き起こされる一過性の発作が反復する疾患とされている。症状としては，全身の強直，けいれん，脱力，しびれ，意識減損などが一過性に出現する。てんかんは，頻度の高い神経疾患であり，有病率は約1 ％と言われている。日本の総人口から勘案すると，実に100万人以上のてんかん患者が存在
することとなる。てんかんの治療は，有害事象なしに発作が
消失することを目標として行われるが，治療手段としては，まず，抗てんかん薬による薬剤治療が基本となる。しかし，適切な抗てん
かん薬の使用によっても，約10％（10～20万人）の患者は，発作が抗てんかん薬の服用で抑制できずに慢性化する難治性てんかんであ
るとされる。このような難治性てんかんの治療においては，外科的治療が注目されている。本稿では，抗てんかん薬による治療および外科的治療について，近年の流れを踏まえて報告する。

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work  

It remains unclear whether selective amygdalohippocampectomy, an operative technique developed for use in epilepsy surgery to spare unaffected brain tissue and thus minimize the cognitive consequences of temporal lobe surgery, actually leads to a better memory outcome. The present study was performed to investigate the effects of selective surgery on memory outcome in patients with intractable mesial temporal lobe epilepsy due to hippocampal sclerosis treated by transsylvian selective amygdalohippocampectomy (TSA). The results of the present study indicated that left TSA for hippocampal sclerosis tends to improve verbal memory function with preservation of other memory function. Right TSA for hippocampal sclerosis can lead to signifi cant improvement in verbal and nonverbal memory function, with the memory improvement observed one month after right TSA persisting until one year after surgery.

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work  

前回（都薬雑誌Vol.35 No.4），てんかんの概要，抗てんかん薬の最近の話題と基本的な使い方，運転免許関連の話題について述べた。今回は，てんかんの外科治療の最近の話題について述べる。

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work  

てんかんとは脳の一部の神経細胞が異常発火し，それが脳の一部あるいは全体に伝播することにより引き起こされる一過性の発作が反復する疾患とされている。症状としては，全身の強直，けいれん，脱力，しびれ，意識減損などが一過性に出現する。てんかんは，頻度の高い神経疾患であり，有病率は約1 ％と言われている。日本の総人口から勘案すると，実に100万人以上のてんかん患者が存在
することとなる。てんかんの治療は，有害事象なしに発作が
消失することを目標として行われるが，治療手段としては，まず，抗てんかん薬による薬剤治療が基本となる。しかし，適切な抗てん
かん薬の使用によっても，約10％（10～20万人）の患者は，発作が抗てんかん薬の服用で抑制できずに慢性化する難治性てんかんであ
るとされる。このような難治性てんかんの治療においては，外科的治療が注目されている。本稿では，抗てんかん薬による治療および外科的治療について，近年の流れを踏まえて報告する。

Publishing type：Research paper (scientific journal)  

前回（都薬雑誌Vol.35 No.4），てんかんの概要，抗てんかん薬の最近の話題と基本的な使い方，運転免許関連の話題について述べた。今回は，てんかんの外科治療の最近の話題について述べる。

Publishing type：Research paper (scientific journal)  

てんかんとは脳の一部の神経細胞が異常発火し，それが脳の一部あるいは全体に伝播することにより引き起こされる一過性の発作が反復する疾患とされている。症状としては，全身の強直，けいれん，脱力，しびれ，意識減損などが一過性に出現する。てんかんは，頻度の高い神経疾患であり，有病率は約1 ％と言われている。日本の総人口から勘案すると，実に100万人以上のてんかん患者が存在
することとなる。てんかんの治療は，有害事象なしに発作が
消失することを目標として行われるが，治療手段としては，まず，抗てんかん薬による薬剤治療が基本となる。しかし，適切な抗てん
かん薬の使用によっても，約10％（10～20万人）の患者は，発作が抗てんかん薬の服用で抑制できずに慢性化する難治性てんかんであ
るとされる。このような難治性てんかんの治療においては，外科的治療が注目されている。本稿では，抗てんかん薬による治療および外科的治療について，近年の流れを踏まえて報告する。

Publishing type：Research paper (scientific journal)  

It remains unclear whether selective amygdalohippocampectomy, an operative technique developed for use in epilepsy surgery to spare unaffected brain tissue and thus minimize the cognitive consequences of temporal lobe surgery, actually leads to a better memory outcome. The present study was performed to investigate the effects of selective surgery on memory outcome in patients with intractable mesial temporal lobe epilepsy due to hippocampal sclerosis treated by transsylvian selective amygdalohippocampectomy (TSA). The results of the present study indicated that left TSA for hippocampal sclerosis tends to improve verbal memory function with preservation of other memory function. Right TSA for hippocampal sclerosis can lead to signifi cant improvement in verbal and nonverbal memory function, with the memory improvement observed one month after right TSA persisting until one year after surgery.

Publishing type：Research paper (scientific journal)  

Cervical intervertebral disc replacement using a rectangular titanium stand-alone cage has become a standard procedure for anterior cervical discectomy and fusion (ACDF). We examined outcomes resulting from the contemporary use of rectangular titanium stand-alone cages for ACDF, particularly focusing on cage subsidence and subsequent kyphotic malalignment. Patient data were collected prospectively, and a total of 47 consecutive patients who underwent periodic follow-up of at least 1 year's duration after ACDF were studied retrospectively. Sixty-three rectangular titanium cages were implanted during 31 1-level and 16 2-level procedures. None of the patients developed surgery-related complications (including cage displacement or extrusion). Mean Neurosurgical Cervical Spine Scale scores were significantly improved at 1 year after surgery. Twelve of the 63 inserted cages (19.0%) were found to have cage subsidence, occurring in 11 of 47 patients (23.4%). There was no significant difference in functional recovery between patients with and without cage subsidence. Logistic regression analysis indicated that fusion level, cage size and cage position were significantly related to cage subsidence. The distraction ratio among patients with cage subsidence was significantly higher than that among patients without cage subsidence. Cage subsidence resulted in early deterioration of local angle and total alignment of the cervical spine. Although a longer follow-up is warranted, a good surgical outcome with negligible complications appears to justify the use of rectangular titanium stand-alone cages in 1- and 2-level ACDF. Excessive distraction at the fusion level should be avoided, and cage position should be adjusted to the anterior vertical line.

DOI： 10.1016/j.jocn.2011.11.043

PubMed

Publishing type：Research paper (scientific journal)  

Cervical intervertebral disc replacement using a rectangular titanium stand-alone cage has become a standard procedure for anterior cervical discectomy and fusion (ACDF). We examined outcomes resulting from the contemporary use of rectangular titanium stand-alone cages for ACDF, particularly focusing on cage subsidence and subsequent kyphotic malalignment. Patient data were collected prospectively, and a total of 47 consecutive patients who underwent periodic follow-up of at least 1 year's duration after ACDF were studied retrospectively. Sixty-three rectangular titanium cages were implanted during 31 1-level and 16 2-level procedures. None of the patients developed surgery-related complications (including cage displacement or extrusion). Mean Neurosurgical Cervical Spine Scale scores were significantly improved at 1 year after surgery. Twelve of the 63 inserted cages (19.0%) were found to have cage subsidence, occurring in 11 of 47 patients (23.4%). There was no significant difference in functional recovery between patients with and without cage subsidence. Logistic regression analysis indicated that fusion level, cage size and cage position were significantly related to cage subsidence. The distraction ratio among patients with cage subsidence was significantly higher than that among patients without cage subsidence. Cage subsidence resulted in early deterioration of local angle and total alignment of the cervical spine. Although a longer follow-up is warranted, a good surgical outcome with negligible complications appears to justify the use of rectangular titanium stand-alone cages in 1- and 2-level ACDF. Excessive distraction at the fusion level should be avoided, and cage position should be adjusted to the anterior vertical line. © 2012 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jocn.2011.11.043

PubMed

Publishing type：Research paper (scientific journal)  

Measuring local cerebral blood flow and metabolism by various mapping methods such as positron emission tomography or perfusion computed tomography helps us to evaluate detailed functions of brain areas containing a focal ischemic lesion, but does not necessarily represent neural activities of the areas. Scalp electroencephalography (EEG), reflecting volume-conducted neural activities, demonstrates that slow wave activity is dominant in an acute ischemic cerebral region; but, this technique presents major problems with the lack of objective indices for brain functions and low spatial resolution. Magnetoencephalography (MEG), an important new method in neuroscience to directly detect neural activities with high spatial resolution, has been applied in stroke patients. However, the usefulness of MEG for assessing neural activities in an ischemic brain area has not been fully established as yet. The present study reviewed MEG studies of cerebral stroke using internet searches of the bibliography to identify scientific evidence for the clinical effectiveness of MEG. We searched for stroke-related manuscripts published before July 2010 on MEDLINE using the keywords (stroke OR cerebral ischemia) AND (MEG OR magnetoencephalography), and retrieved 58 papers. We narrowed the search to 25 papers based on the levels of evidence and abstract contents. Then, we selected 12 papers with evidence level higher than 2 to assess the clinical utility of MEG. Most papers stressed the clinical usefulness of MEG, but a few claimed the superiority of MEG compared to EEG for the diagnosis or treatment indication for ischemic conditions. Therefore, more objective analysis of MEG findings in ischemic conditions is needed for future development.

DOI： 10.11422/jscn.40.195

CiNii Article

Publishing type：Research paper (scientific journal)  

OBJECTIVE: To determine whether quantitative modification of a standardised low-resolution brain electromagnetic tomography (sLORETA-qm) could be used as a reliable tool for quantitative analysis of magnetoencephalography (MEG) for analysis of the interictal epileptic spike. To verify the performance of sLORETA-qm, magnetic source location and quantity were compared with the equivalent current dipole (ECD) method. METHODS: A total of 50 sources from 10 patients with epilepsy were obtained. Analyses were performed after the MEG data were 3-70Hz band-pass filtered. Time points for analysis were selected referring to waveform patterns and the isofield contour map. With the same spherical model, source estimation was conducted with two methods of analysis: ECD and sLORETA-qm. Distance from the centre of the spherical model and intensities were compared between the methods. RESULTS: There were no significant differences between the methods in the distance from the spherical model (paired t-test, p=0.8761). Source intensities between the methods were strongly correlated (Spearman's Rho=0.9803, p<0.001). CONCLUSIONS: sLORETA-qm was closely correlated with ECD concerning point source location and quantity in analysis of the interictal epileptic spike. SIGNIFICANCE: sLORETA-qm is a reliable quantifiable method without arbitrariness for analysis of the interictal epileptic spike.

DOI： 10.1016/j.clinph.2011.12.008

虚血性脳疾患における脳磁図臨床研究の動向を把握するため、PubMedを用いて文献レビューを行った。キーワードを(stroke OR cerebral ischemia)AND(MEG OR magnetoencephalography)として1990～2010年の文献を検索し、抽出された58編の中からアブストラクトの内容に基づいて25編を選出し、脳磁図がどのように利用されているかを調べた。さらに、エビデンスレベルが2b以上の文献12編に絞り込み、分析を行った。結果、総じて虚血脳での脳磁図の変化を報告した文献が多く、診断・治療方針決定に関してはエビデンスレベルの高い論文もあったが、ごく少数に限られていた。論文の内容は以下の3点にまとめることができた。1)脳梗塞患者の患側では徐波の出現がみられる。2)閉塞性血管障害患者では、血流の少ない部位で徐波がみられる。3)虚血病変のある半球では、体性感覚誘発磁場において第1ピークの減弱・消失・変異がみられる。

Publishing type：Research paper (scientific journal)  

Objective: To determine whether quantitative modification of a standardised low-resolution brain electromagnetic tomography (sLORETA-qm) could be used as a reliable tool for quantitative analysis of magnetoencephalography (MEG) for analysis of the interictal epileptic spike. To verify the performance of sLORETA-qm, magnetic source location and quantity were compared with the equivalent current dipole (ECD) method. Methods: A total of 50 sources from 10 patients with epilepsy were obtained. Analyses were performed after the MEG data were 3-70. Hz band-pass filtered. Time points for analysis were selected referring to waveform patterns and the isofield contour map. With the same spherical model, source estimation was conducted with two methods of analysis: ECD and sLORETA-qm. Distance from the centre of the spherical model and intensities were compared between the methods. Results: There were no significant differences between the methods in the distance from the spherical model (paired t-test, p= 0.8761). Source intensities between the methods were strongly correlated (Spearman's Rho = 0.9803, p&lt
0.001). Conclusions: sLORETA-qm was closely correlated with ECD concerning point source location and quantity in analysis of the interictal epileptic spike. Significance: sLORETA-qm is a reliable quantifiable method without arbitrariness for analysis of the interictal epileptic spike. © 2011 International Federation of Clinical Neurophysiology.

DOI： 10.1016/j.clinph.2011.12.008

PubMed

Publishing type：Research paper (scientific journal)  

Quantifiable modification of standardized low-resolution brain electromagnetic tomography (sLORETA-qm), which is one of the non-adaptive beamformer spatial filtering techniques, has been applied to source localization and quantification of evoked field or oscillatory changes in magnetoencephalography (MEG). Here, we extended this technique to induced oscillatory brain activity changes, so-called event-related desynchronization or event-related synchronization. For localizing of significantly activated brain areas at the whole-brain level, permutation tests and multiple comparison corrections with false discovery rate were applied. Induced beta- and gamma-band oscillatory changes by right hand clenching task were demonstrated as an example of simple induced brain activity.

DOI： 10.2174/1874440001206010037

PubMed

Publishing type：Research paper (scientific journal)  

Measuring local cerebral blood flow and metabolism by various mapping methods such as positron emission tomography or perfusion computed tomography helps us to evaluate detailed functions of brain areas containing a focal ischemic lesion, but does not necessarily represent neural activities of the areas. Scalp electroencephalography (EEG), reflecting volume-conducted neural activities, demonstrates that slow wave activity is dominant in an acute ischemic cerebral region; but, this technique presents major problems with the lack of objective indices for brain functions and low spatial resolution. Magnetoencephalography (MEG), an important new method in neuroscience to directly detect neural activities with high spatial resolution, has been applied in stroke patients. However, the usefulness of MEG for assessing neural activities in an ischemic brain area has not been fully established as yet. The present study reviewed MEG studies of cerebral stroke using internet searches of the bibliography to identify scientific evidence for the clinical effectiveness of MEG. We searched for stroke-related manuscripts published before July 2010 on MEDLINE using the keywords (stroke OR cerebral ischemia) AND (MEG OR magnetoencephalography), and retrieved 58 papers. We narrowed the search to 25 papers based on the levels of evidence and abstract contents. Then, we selected 12 papers with evidence level higher than 2 to assess the clinical utility of MEG. Most papers stressed the clinical usefulness of MEG, but a few claimed the superiority of MEG compared to EEG for the diagnosis or treatment indication for ischemic conditions. Therefore, more objective analysis of MEG findings in ischemic conditions is needed for future development.

DOI： 10.11422/jscn.40.195

CiNii Article

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Quantifiable modification of standardized low-resolution brain electromagnetic tomography (sLORETA-qm), which is one of the non-adaptive beamformer spatial filtering techniques, has been applied to source localization and quantification of evoked field or oscillatory changes in magnetoencephalography (MEG). Here, we extended this technique to induced oscillatory brain activity changes, so-called event-related desynchronization or event-related synchronization. For localizing of significantly activated brain areas at the whole-brain level, permutation tests and multiple comparison corrections with false discovery rate were applied. Induced beta- and gamma-band oscillatory changes by right hand clenching task were demonstrated as an example of simple induced brain activity.

DOI： 10.2174/1874440001206010037

PubMed

Publishing type：Research paper (scientific journal)  

CiNii Article

Publishing type：Research paper (scientific journal)  

脊髄変性疾患における脊髄障害の評価は、主観的神経症状の点数評価が一般的である。MRIでの解剖学的な脊髄圧迫所見は脊髄障害の評価には有用であるが、解剖学的な脊髄圧迫所見と脊髄障害の程度に相関は乏しいため、感度および特異度がより高い客観的画像診断が望まれる。本研究では拡散テンソルパラメーターであるMean diffusicivityとFractional anisotropyを用いて脊髄障害の客観的評価を行うことを試みた。

Publishing type：Research paper (scientific journal)  

CiNii Article

Publishing type：Research paper (scientific journal)  

術前脳機能マッピング目的でfMRIを行った21例(男性18例、女性3例、平均41.3歳)を対象に、sensorimotor cortexの同定、言語優位半球決定と言語関連部位同定をStatistical Parametric Mapping version 8(SPM8)にて解析した。疾患内訳は脳腫瘍10例、難治性てんかん11例であった。脳腫瘍3例を除いた18例で有意な賦活が病変側のsensorimotor areaにみられた。賦活を認めない3例中2例は一次運動野を占拠する病変または非常に近接する病変で、他の1例は前頭葉に6cm大のmassを呈した多形性膠芽腫の症例であった。言語野の同定では、主に前頭葉言語野で大きなvoxel数を伴う賦活を認め、側頭葉言語野、頭頂葉言語野では有意であるが小さな賦活が多かった。言語優位半球数は左半球優位16例、右半球優位3例、2例で優位性判定できず、bilatralと判断した。

CiNii Article

術前脳機能マッピング目的でfMRIを行った21例(男性18例、女性3例、平均41.3歳)を対象に、sensorimotor cortexの同定、言語優位半球決定と言語関連部位同定をStatistical Parametric Mapping version 8(SPM8)にて解析した。疾患内訳は脳腫瘍10例、難治性てんかん11例であった。脳腫瘍3例を除いた18例で有意な賦活が病変側のsensorimotor areaにみられた。賦活を認めない3例中2例は一次運動野を占拠する病変または非常に近接する病変で、他の1例は前頭葉に6cm大のmassを呈した多形性膠芽腫の症例であった。言語野の同定では、主に前頭葉言語野で大きなvoxel数を伴う賦活を認め、側頭葉言語野、頭頂葉言語野では有意であるが小さな賦活が多かった。言語優位半球数は左半球優位16例、右半球優位3例、2例で優位性判定できず、bilatralと判断した。

Publishing type：Research paper (scientific journal)  

Background: The authors have focused their attention to the radiological durability of cervical sagittal alignment after anterior cervical discectomy and fusion (ACDF) using autologous bone grafting. Materials and Methods: Among the patients who underwent ACDF with trans-unco-discal (TUD) approach between 1976 and 1997, 22 patients (16 males and 6 females) made return visits for a clinical evaluation. Patients with trauma or previously treated by anterior cervical fusion or by posterior decompression were excluded from the present study. Clinical evaluation included adjacent segment degeneration (ASD), osseous fusion, local angle at the fused segments and C2-7 angle of cervical spine. Results: The duration after ACDF ranged from 13 to 34 years with an average of 21.3 7.0 years. A single level fusion was done on 8 patients, 2 levels on 11 patients, 3 levels on 2 patients, and 4 levels on 1 patient. Imaging studies indicated that 12 of the 22 patients (54.5%) were graded as having symptomatic ASD. Osseous bony fusion at ACDF was recognized in all cases. None of the patients demonstrated kyphotic malalignment of the cervical spine. Average degrees of local angle at the fused segments and the C2-7 angle were 7.06 and 17.6, respectively. Statistical analysis indicated a significant relationship between the local at the fused segments and C2-7 angles. Conclusions: Sagittal alignment of the cervical spine was durable long after ACDF when the local angle at the fused segments was well stabilized.

DOI： 10.4103/0974-8237.100054

Publishing type：Research paper (scientific journal)  

Background: The authors have focused their attention to the radiological durability of cervical sagittal alignment after anterior cervical discectomy and fusion (ACDF) using autologous bone grafting. Materials and Methods: Among the patients who underwent ACDF with trans-unco-discal (TUD) approach between 1976 and 1997, 22 patients (16 males and 6 females) made return visits for a clinical evaluation. Patients with trauma or previously treated by anterior cervical fusion or by posterior decompression were excluded from the present study. Clinical evaluation included adjacent segment degeneration (ASD), osseous fusion, local angle at the fused segments and C2-7 angle of cervical spine. Results: The duration after ACDF ranged from 13 to 34 years with an average of 21.3 7.0 years. A single level fusion was done on 8 patients, 2 levels on 11 patients, 3 levels on 2 patients, and 4 levels on 1 patient. Imaging studies indicated that 12 of the 22 patients (54.5%) were graded as having symptomatic ASD. Osseous bony fusion at ACDF was recognized in all cases. None of the patients demonstrated kyphotic malalignment of the cervical spine. Average degrees of local angle at the fused segments and the C2-7 angle were 7.06 and 17.6, respectively. Statistical analysis indicated a significant relationship between the local at the fused segments and C2-7 angles. Conclusions: Sagittal alignment of the cervical spine was durable long after ACDF when the local angle at the fused segments was well stabilized.

DOI： 10.4103/0974-8237.100054

PubMed

Publishing type：Research paper (scientific journal)  

Aims: The purposes of the present study were to clarify the normal variation and to determine the normal reference values of diffusion tensor (DT) parameters (mean diffusivity [MD] and fractional anisotropy [FA]) of the spinal cord in single-shot fast spin-echo-based sequence at 3.0-Tesla (3T). Materials and Methods: Thirty healthy subjects (mean age = 44.2 years, range = 20-72 years) were enrolled for this study. Mean values of MD and FA in six spinal levels (C2/3, C3/4, C4/5, C5/6, C6/7, and C7/Th1) were measured. Mean values, variances, and distributions of the MD and FA in each spinal level were analyzed. Age-dependent change of MD and FA as well as correlation between MD and FA was also analyzed. Results: At all spinal levels, the values can be considered to be Gaussian distribution in MD but not in FA. A significant statistical negative correlation was observed between aging and the values of MD (r = 0.429, P = 0.018), but insignificant between the values of FA (P = 0.234). A slight significant statistical negative correlation was observed between the values of MD and FA (r = 0.156, P = 0.037). One way repeated measures analysis of variance indicated the significant difference between the spinal levels in both MD (P = 0.003) and FA (P &lt
0.0001). Conclusions: The analyzed data in the present study would be helpful for comparison when investigating the spinal condition of spinal disorders.

DOI： 10.4103/0974-8237.100060

PubMed

Publishing type：Research paper (scientific journal)  

Background : Pre-operative evaluation to localize function within the cerebral cortices is essential before brain surgery. Blood oxygenation level-dependent functional magnetic resonance imaging (fMRI) has been used for this purpose. Aims : To obtain clearer and more understandable functional images. Patients and Methods : Ten patients with brain tumors underwent fMRI including hand-gripping and word generation tasks. The statistical parametric mapping (SPM) approach was used for subsequent analysis to localize the motor or language functions. SPM includes image pre-processing, statistical computation, and significance testing. In order to demonstrate a spatial relationship between the lesions and a functioning area in the individual structural MR images, normalization to the Montreal Neurological Institute coordinates was intentionally not performed. Results : In seven cases out of 10, the patient's motor area was clearly visualized. Language areas were also demonstrated in seven cases. Conclusions : We conclude that application of SPM (version 8) analysis to non-normalized individual data for the purpose of performing pre-operative fMRI is a useful method for investigation of functional localization.

DOI： 10.4103/0028-3886.82714

PubMed

Publishing type：Research paper (scientific journal)  

The aim of this study was to determine the uptake of L-[methyl-(11)C]-methionine ((11)C-MET) in the normal brain of patients younger than 20 y, to facilitate more accurate diagnoses in young patients. METHODS: Eighty-two patients were categorized into 4 groups according to their age. They underwent (11)C-MET PET, and a standardized uptake value (SUV) was determined for different brain regions including the frontal lobe, parietal lobe, cerebellum, and brain stem. RESULTS: Compared with all other parts of the brain, the cerebellum had the highest SUV. A tendency for a positive relationship between SUV and age was found in all regions, and a significant relationship with SUV was found in the frontal lobe and cerebellum. CONCLUSION: The character of SUV in the normal brains of children is different from that of adults, and these normal SUV data will play an important role as a critical reference value.

DOI： 10.2967/jnumed.110.082875

PubMed

Publishing type：Research paper (scientific journal)  

The aim of this study was to determine the uptake of L-[methyl- 11C]-methionine (11C-MET) in the normal brain of patients younger than 20 y, to facilitate more accurate diagnoses in young patients. Methods: Eighty-two patients were categorized into 4 groups according to their age. They underwent 11C-MET PET, and a standardized uptake value (SUV) was determined for different brain regions including the frontal lobe, parietal lobe, cerebellum, and brain stem. Results: Compared with all other parts of the brain, the cerebellum had the highest SUV. A tendency for a positive relationship between SUV and age was found in all regions, and a significant relationship with SUV was found in the frontal lobe and cerebellum. Conclusion: The character of SUV in the normal brains of children is different from that of adults, and these normal SUV data will play an important role as a critical reference value. Copyright © 2011 by the Society of Nuclear Medicine, Inc.

DOI： 10.2967/jnumed.110.082875

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work  

Background : The authors have focused their attention to the radiological durability of cervical sagittal alignment after anterior cervical discectomy and fusion (ACDF) using autologous bone grafting. Materials and Methods : Among the patients who underwent ACDF with trans-unco-discal (TUD) approach between 1976 and 1997, 22 patients (16 males and 6 females) made return visits for a clinical evaluation. Patients with trauma or previously treated by anterior cervical fusion or by posterior decompression were excluded from the present study. Clinical evaluation included adjacent segment degeneration (ASD), osseous fusion, local angle at the fused segments and C2-7 angle of cervical spine. Results: The duration after ACDF ranged from 13 to 34 years with an average of 21.3 &#177; 7.0 years. A single level fusion was done on 8 patients, 2 levels on 11 patients, 3 levels on 2 patients, and 4 levels on 1 patient. Imaging studies indicated that 12 of the 22 patients (54.5%) were graded as having symptomatic ASD. Osseous bony fusion at ACDF was recognized in all cases. None of the patients demonstrated kyphotic malalignment of the cervical spine. Average degrees of local angle at the fused segments and the C2-7 angle were 7.06 and 17.6, respectively. Statistical analysis indicated a significant relationship between the local at the fused segments and C2-7 angles. Conclusions : Sagittal alignment of the cervical spine was durable long after ACDF when the local angle at the fused segments was well stabilized.

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work  

Aims: The purposes of the present study were to clarify the normal variation and to determine the normal reference values of diffusion tensor (DT) parameters (mean diffusivity [MD] and fractional anisotropy [FA]) of the spinal cord in single-shot fast spin-echo-based sequence at 3.0-Tesla (3T). Materials and Methods: Thirty healthy subjects (mean age = 44.2 years, range = 20-72 years) were enrolled for this study. Mean values of MD and FA in six spinal levels (C2/3, C3/4, C4/5, C5/6, C6/7, and C7/Th1) were measured. Mean values, variances, and distributions of the MD and FA in each spinal level were analyzed. Age-dependent change of MD and FA as well as correlation between MD and FA was also analyzed. Results: At all spinal levels, the values can be considered to be Gaussian distribution in MD but not in FA. A significant statistical negative correlation was observed between aging and the values of MD, but insignificant between the values of FA. A slight significant statistical negative correlation was observed between the values of MD and FA. One way repeated measures analysis of variance indicated the significant difference between the spinal levels in both MD and FA. Conclusions: The analyzed data in the present study would be helpful for comparison when investigating the spinal condition of spinal disorders.

DOI： 10.4103/0974-8237.100060

Publishing type：Research paper (scientific journal)  

Background : Pre-operative evaluation to localize function within the cerebral cortices is essential before brain surgery. Blood oxygenation level-dependent functional magnetic resonance imaging (fMRI) has been used for this purpose. Aims : To obtain clearer and more understandable functional images. Patients and Methods : Ten patients with brain tumors underwent fMRI including hand-gripping and word generation tasks. The statistical parametric mapping (SPM) approach was used for subsequent analysis to localize the motor or language functions. SPM includes image pre-processing, statistical computation, and significance testing. In order to demonstrate a spatial relationship between the lesions and a functioning area in the individual structural MR images, normalization to the Montreal Neurological Institute coordinates was intentionally not performed. Results : In seven cases out of 10, the patient's motor area was clearly visualized. Language areas were also demonstrated in seven cases. Conclusions : We conclude that application of SPM (version 8) analysis to non-normalized individual data for the purpose of performing pre-operative fMRI is a useful method for investigation of functional localization.

DOI： 10.4103/0028-3886.82714

PubMed

DOI： 10.2531/spinalsurg.25.295

CiNii Article

Publishing type：Research paper (scientific journal)  

A 67-year-old man was admitted for evaluation of left homonymous hemianopsia. Carotid ultrasonography showed that the right common carotid artery (CCA) was occluded up to just proximal to the carotid bifurcation, and the patent external carotid artery showed retrograde flow to the patent internal carotid artery via the carotid bifurcation. The Doppler waveform pattern of the external carotid artery showed high end-diastolic flow velocity and low pulsatility index. The diagnosis was Riles type 1A CCA occlusion. Digital subtraction angiography and iodine-123 N-isopropyl-p-iodoamphetamine single photon emission computed tomography were performed to confirm the collateral circulation and adequate intracranial hemodynamic sufficiency. Nonsurgical treatment with antiplatelet therapy was performed for the CCA occlusion. No stroke events have occurred within the 2-year follow-up period.<br>

DOI： 10.2176/nmc.50.1091

CiNii Article

67歳男。左同名半盲を主訴に受診した。頸動脈エコーで分岐部直近における右総頸動脈の閉塞を認め、開存した外頸動脈(ECA)から分岐部を介して内頸動脈への逆流を認めた。ECAのドプラー波形パターンでは高い拡張期終期血流速度と低いpulsatility indexを認めた。Rile 1A型層頸動脈閉塞症と診断した。Digital subtraction angiographyとiodine-123-N-isopropyl-p-iodoamphetamine SPECTで側副血行と十分な頭蓋内血行動態能力を確認した。外科的手術は行わず、抗血小板剤による治療を開始した。2年間の経過観察で脳卒中発作は生なかった。

Publishing type：Research paper (scientific journal)  

The aim of this study was to determine the normal l-[methyl-(11)C]-methionine ((11)C-methionine) uptake and the extent of variation using standardized uptake value (SUV). METHODS: Five healthy volunteers and 58 adult patients with normal (11)C-methionine uptake were included in the interindividual analysis and 22 patients in the intraindividual analysis. SUVs in different brain regions, age-associated changes, correlation between 2 correction methods (for body weight [w-SUV] or body surface area [s-SUV]), and intraindividual reproducibility were examined. RESULTS: w-SUVs were statistically different between the brain regions. The frontal or parietal cortex showed lower coefficients of variation than did the cerebellum or brain stem. There was no significant age-associated change. w-SUVs showed lower coefficients of variation in interindividual analysis and lower symmetric percentage change in intraindividual reproducibility than did s-SUVs. CONCLUSION: SUVs in the normal brain show inter- and intraindividual variation, and our proposed normal w-SUVs represent an important reference value.

DOI： 10.2967/jnumed.109.068783

PubMed

Publishing type：Research paper (scientific journal)  

The aim of this study was to determine the normal L-[methyl-C-11]-methionine (C-11-methionine) uptake and the extent of variation using standardized uptake value (SUV). Methods: Five healthy volunteers and 58 adult patients with normal C-11-methionine uptake were included in the interindividual analysis and 22 patients in the intraindividual analysis. SUVs in different brain regions, age-associated changes, correlation between 2 correction methods (for body weight [w-SUV] or body surface area [s-SUV]), and intraindividual reproducibility were examined. Results: w-SUVs were statistically different between the brain regions. The frontal or parietal cortex showed lower coefficients of variation than did the cerebellum or brain stem. There was no significant age-associated change. w-SUVs showed lower coefficients of variation in interindividual analysis and lower symmetric percentage change in intraindividual reproducibility than did s-SUVs. Conclusion: SUVs in the normal brain show inter-and intraindividual variation, and our proposed normal w-SUVs represent an important reference value.

DOI： 10.2967/jnumed.109.068783

PubMed

Publishing type：Research paper (scientific journal)  

A 67-year-old man was admitted for evaluation of left homonymous hemianopsia. Carotid ultrasonography showed that the right common carotid artery (CCA) was occluded up to just proximal to the carotid bifurcation, and the patent external carotid artery showed retrograde flow to the patent internal carotid artery via the carotid bifurcation. The Doppler waveform pattern of the external carotid artery showed high end-diastolic flow velocity and low pulsatility index. The diagnosis was Riles type 1A CCA occlusion. Digital subtraction angiography and iodine-123 N-isopropyl-p-iodoamphetamine single photon emission computed tomography were performed to confirm the collateral circulation and adequate intracranial hemodynamic sufficiency. Nonsurgical treatment with antiplatelet therapy was performed for the CCA occlusion. No stroke events have occurred within the 2-year follow-up period.<br>

DOI： 10.2176/nmc.50.1091

PubMed

CiNii Article

Publishing type：Research paper (scientific journal)  

66歳男。突然の頭痛、嘔気で救急搬送された。頭部CTで後頭蓋窩にやや強いFisher group IIIのくも膜下出血を認め、CT angiographyでは右椎骨動脈の閉塞と、左右椎骨動脈合流部付近の左椎骨動脈に狭窄が疑われる像を認めたが、digital subtraction angiographyでは狭窄は認めなかった。明らかな出血源は同定できなかったが、右椎骨動脈解離性動脈瘤(VADA)の可能性を考え、慎重な経過観察を行った。発症3日目のCT angiographyで右椎骨動脈は再開通しており、posterior inferior cerebellar artery(PICA)-involved VADAの所見が得られた。再破裂の危険が高いと判断し、同日PICA起始部を含んだendovascular internal trappingを行った。術後嗄声、嚥下障害、右ホンネル症候群、右小脳失調、左体幹四肢の感覚低下を、MRIで右延髄外側および小脳に脳梗塞巣を認め、右PICA領域の脳梗塞と診断した。10ヵ月の経過観察でmRS grade 3、GOS 3の状態となり、自宅で軽介助の生活を送っている。

DOI： 10.11477/mf.1436101056

Publishing type：Research paper (scientific journal)  

We report a rare case of a ruptured vertebral artery dissecting aneurysm (VADA) with affected vertebral artery (VA) occlusion. A 66-year-old hypertensive man presented with subarachnoid hemorrhage. No cerebeller sign or cranial nerve palsy was found on admission. Initial CT angiography and digital subtraction angiography (DSA) revealed the right VA occlusion. On the three days after onset, the right VA was recanalized and visualized as a posterior inferior cerebellar artery (PICA)-involved VADA. Endovascular internal trapping of the right VA including PICA origin was performed. In conclusion, it is essential that patients of VA occlusion associated with subarachnoid hemorrhage should be carefully diagnosed considering the possibility of VADA.

PubMed

Publishing type：Research paper (scientific journal)  

OBJECT: It remains unclear whether selective amygdalohippocampectomy, an operative technique developed for use in epilepsy surgery to spare unaffected brain tissue and thus minimize the cognitive consequences of temporal lobe surgery, actually leads to a better memory outcome. The present study was performed to determine the effects of selective surgery on memory outcome in patients with intractable mesial temporal lobe epilepsy due to hippocampal sclerosis treated using transsylvian selective amygdalohippocampectomy (TSA). METHODS: The study population consisted of 62 patients with left hemisphere language dominance who underwent left-(31 patients) or right-sided (31 patients) TSA. All patients underwent comprehensive neuropsychological testing before and 1 month and 1 year after unilateral TSA. Verbal Memory I, Nonverbal Memory I, Total Memory, Attention, and Delayed Recall were assessed using the Wechsler Memory Scale-Revised, whereas Verbal Memory II was assessed using the Miyake Verbal Retention Test (MVRT), and Nonverbal Memory II was assessed using the Benton Visual Retention Test. Separate repeated-measures multivariate analysis of variance (MANOVA) were performed for these intervals with memory scores. RESULTS: The results of MANOVA indicated that patients who underwent right-sided TSA showed significant improvements in Verbal Memory I (preoperatively vs 1 month postoperatively, p < 0.0001; and preoperatively vs 1 year postoperatively, p = 0.0002), Nonverbal Memory I (preoperatively vs 1 month postoperatively, p = 0.0003; and preoperatively vs 1 year postoperatively, p = 0.006), and Delayed Recall (preoperatively vs 1 month postoperatively, p = 0.028) at both 1-month and 1-year follow-ups. In addition, Verbal Memory II (MVRT) was also significantly improved 1 year after surgery (p = 0.001). In the group of patients who underwent left-sided TSA, both Verbal Memory I and II were maintained at the same level 1 month after surgery, whereas the Verbal Memory I score 1 year after surgery increased with marginal significance (p = 0.074). In addition, Verbal Memory II showed significant improvement 1 year after surgery (p = 0.049). There were no significant changes in Nonverbal Memory I and II, Attention, or Delayed Recall at either the 1-month or 1-year follow-up. CONCLUSIONS: Results of the present study indicated that left-sided TSA for hippocampal sclerosis tends to improve verbal memory function with the preservation of other types of memory function. Moreover, right-sided TSA for hippocampal sclerosis can lead to significant improvement in memory function, with memory improvement observed 1 month after right-sided TSA and persisting 1 year after surgery.

DOI： 10.3171/2008.9.JNS08247

PubMed

Publishing type：Research paper (scientific journal)  

Object. It remains unclear whether selective amygdalohippocampectomy, an operative technique developed for use in epilepsy surgery to spare unaffected brain tissue and thus minimize the cognitive consequences of temporal lobe surgery, actually leads to a better memory Outcome. The present study was performed to determine the effects of selective surgery on memory outcome in patients with intractable mesial temporal lobe epilepsy due to hippocampal sclerosis treated using transsylvian selective amygdalohippocampectomy (TSA).
Methods. The study population consisted of 62 patients with left hemisphere language dominance who underwent left- (31 patients) or right-sided (31 patients) TSA. All patients underwent comprehensive neuropsychological testing before and 1 month and 1 year after unilateral TSA. Verbal Memory 1, Nonverbal Memory 1, Total Memory, Attention, and Delayed Recall were assessed using the Wechsler Memory Scale-Revised, whereas Verbal Memory II was assessed using the Miyake Verbal Retention Test (MVRT), and Nonverbal Memory II was assessed using the Benton Visual Retention Test. Separate repeated-measures multivariate analysis of variance (MANOVA) were performed for these intervals with memory scores.
Results. The results of MANOVA indicated that patients who underwent right-sided TSA showed significant improvements in Verbal Memory I (preoperatively vs 1 month postoperatively, p &lt; 0.0001; and preoperatively vs 1 year postoperatively, p = 0.0002), Nonverbal Memory 1 (preoperatively vs 1 month postoperatively, p = 0.0003; and preoperatively vs 1 year postoperatively, p = 0.006), and Delayed Recall (preoperatively vs 1 month postoperatively, p = 0.028) at both 1-month and 1-year follow-ups. In addition, Verbal Memory II (MVRT) was also significantly improved 1 year after surgery (p = 0.001). In the group of patients who underwent left-sided TSA, both Verbal Memory I and II were maintained at the same level I month after surgery, whereas the Verbal Memory I score I year after surgery increased with marginal significance (p = 0.074). In addition, Verbal Memory II showed significant improvement 1 year after surgery (p = 0.049). There were no significant changes in Nonverbal Memory I and II, Attention, or Delayed Recall at either the 1-month or 1-year follow-up.
Conclusions. Results of the present study indicated that left-sided TSA for hippocampal sclerosis tends to improve verbal memory function with the preservation of other types of memory function. Moreover, right-sided TSA for hippocampal sclerosis can lead to significant improvement in memory function, with memory improvement observed 1 month after right-sided TSA and persisting 1 year after surgery. (DOI: 10.3171/2008.9.JNS08247)

DOI： 10.3171/2008.9.JNS08247

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.2335/scs.36.415

CiNii Article

Publishing type：Research paper (scientific journal)  

We reviewed 9 cases of brainstem cavernomas and evaluated the approach for each lesion, accessibility, respectability, and pre- and post operative neurological status. The dorsal lesions were treated with posterior approaches, such as the occipital transtentorial approach or trans-4th ventricle approach. The ventral lesions were treated with anterior approaches using skull base technique, but we needed some technique to access ventral lesions. We used transposition of the cranial nerve and VA, which lay across the surface of the cavernomas in 2 cases, and we performed two-staged surgery in 1 case. In all cases, we were able to access and remove the lesions safely.<br> Dorsal lesions with traditional posterior approaches and the ventral lesions require a skull-base approach and additional technique based on consideration of local anatomy and surrounding structures.<br>

DOI： 10.2335/scs.36.415

CiNii Article

CiNii Article

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work  

脳動脈瘤手術初心者の脳動脈瘤クリッピング術の治療成績を検討した。脳神経外科認定専門医となる前の2002年9月～2004年9月に経験した無症候性未破裂脳動脈瘤13例(男4例、女9例、年齢34～76歳)、14動脈瘤(4～9mm)を対象とした。手術平均時間は335分であった。術後神経学的合併症は認めなかったが、無症候性脳損傷3例、術中破裂2例を認め、前者の内訳はHeubner artery凝固による脳梗塞、小動脈凝固での脳梗塞、側頭葉牽引による脳挫傷が各1例であった。バイポーラー使用に注意すべき点があり、合併症は経験知により回避できる可能性があった。

Publishing type：Research paper (scientific journal)  

脳動脈瘤手術初心者の脳動脈瘤クリッピング術の治療成績を検討した。脳神経外科認定専門医となる前の2002年9月～2004年9月に経験した無症候性未破裂脳動脈瘤13例(男4例、女9例、年齢34～76歳)、14動脈瘤(4～9mm)を対象とした。手術平均時間は335分であった。術後神経学的合併症は認めなかったが、無症候性脳損傷3例、術中破裂2例を認め、前者の内訳はHeubner artery凝固による脳梗塞、小動脈凝固での脳梗塞、側頭葉牽引による脳挫傷が各1例であった。バイポーラー使用に注意すべき点があり、合併症は経験知により回避できる可能性があった。

Publishing type：Research paper (scientific journal)  

70歳男。2日前からの構音障害を主訴とした。MRI拡散強調像で右大脳半球深部白質に散在する高信号域を認め、血管撮影で内頸動脈外頸動脈分岐部より近位へ6cmにわたり、一部に深い潰瘍形成を伴う狭窄病変を認めた。頸動脈超音波検査では石灰化のないsoft plaqueを示唆する所見が得られた。症候性の頸動脈狭窄症と診断し、頸動脈ステント留置術を施行した。術中、安定した親カテーテルの保持が困難であったため、上腕動脈経由のgoose neck snareを使用した。その結果、良好な位置に親カテーテルを保持することができ、手術を遂行することができた。術後経過は順調で、血管撮影で良好な狭窄部の拡張を認めた。

PubMed

Publishing type：Research paper (scientific journal)  

A goose neck snare is a useful device not only for the retrieval of intravascular foreign bodies, such as detachable coils and catheter fragments, but also for holding a guiding catheter. In carotid artery stenting, the guiding catheter should be kept stable in the proximal of the stenotic lesion, but it is sometimes difficult because of the tortuousity of the proximal common carotid artery. We present a case of carotid artery stenting for proximal part common carotid artery stenosis and discuss the usefulness of the goose neck snare from the brachial artery for holding the guiding catheter.

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work  

2005年10月より．急性期脳梗塞に対する、遺伝子組み換え組織型プラスミノゲン・アクティベータであるアルテプラーゼの静脈内投与が本邦でもようやく認可された。NINDS studyに基づく本邦での臨床試験J-ACTの結果報告では、適応基準を満たし、発症三時間以内に治療を開始した症例では、3ヶ月後の予後良好群は37%であったとされている。一方、重大な副作用としての症候性頭蓋内出血の発症頻度はNINDS studyにおいて6.4%、J-ACTにおいて5.8%と報告されており、投与中は厳重な経過観察が必要である。なおrt-PAの投与は早期に投与するほど、予後は良好となると報告されており医療現場では慎重かつ迅速な対応が必要である。我々がの施設で行っている少しでも早く投与を始めるための工夫と投与中、投与後の集中管理について述べる。

Publishing type：Research paper (scientific journal)  

CiNii Article

Other URL： http://search.jamas.or.jp/link/ui/2007242154

Publishing type：Research paper (scientific journal)  

症例は88歳女性、86歳男性、84歳男性の3例で、視力障害で発症し、非機能性下垂体腺腫の診断で腫瘍摘出術を行った。術後、視力障害は全例改善した。また、American Society of Anesthesiologist physical status(ASA-PS)3の1例に気胸を認めたが、他に重篤な合併症はなかった。ホルモン補充療法は、術前、術後とも、全例に行った。超高齢者の非機能性下垂体腺腫に対する安全な治療は、ASA-PS 3以上の症例は手術適応の慎重な考慮、ASA-PS 2以下の症例は経蝶形骨到達法によるpalliativeな腫瘍部分摘出と共に、ホルモン補充療法を含めた周術期管理であると思われた。

PubMed

Publishing type：Research paper (scientific journal)  

There are no reports of surgical treatment for non-functioning pituitary adenomas in the 9th decade of life, and it is thought that these patients often select conservative treatment and observation, because of their worry about deterioration of their general condition due to invasive surgery and because hypopituitarism and other medical problems are often present. However, it is also true that there is necessity for considering surgical treatment for the pituitary adenomas even in the 9th decade when there is a complaint of visual disturbance. We carried out the palliative surgical removal of three non-functioning pituitary adenomas with visual disturbance in the 9th decade and report these surgical treatments and outcomes. The improvement of visual disturbance was obtained in all three cases. The only perioperative complication was pneumothorax caused by barotrauma. The palliative transsphenoidal surgical removal of non-functioning pituitary adenomas for the purpose of improvement of visual disturbance is a safe procedure in the 9th decade of life.

Publishing type：Research paper (scientific journal)  

2001年1月～2006年1月に外減圧術後頭蓋形成術を施行した連続13例を対象に、癒着防止なし4例(N群)、テフロンシート使用5例(G群)、セプラフィルム使用4例(S群)に分け比較検討した。どの群も術後出血や創部感染など合併症はみられなかった。平均手術時間はS群102分、G群121分、N群167分であった。時間短縮の主な要因は皮膚の剥離操作が短時間で行えたことが考えられた。出血量はS群135ml、G群217ml、N群320mlでセプラフィルム使用で少量に抑えられる傾向であった。癒着防止を行わなかった群では頭蓋形成術までの期間が100日を超えたものが2例あったが、手術時間、出血量については癒着防止を施さなかった他の症例と比べ大きな差はなかった。

Publishing type：Research paper (scientific journal)  

Surgical procedures for cerebral hemispherotomy may be broadly divided into those using a lateral and those using a vertical approach. However, careful study of surgical procedures using the lateral approach described in the literature shows differences in the approach to the ventricles. We discuss the application of transventricular hemispherotomy as a technique which provides relatively easy ventricular access for cerebral hemispherotomy. Transventricular hemispherotomy was successfully performed in a 36-year-old woman who was diagnosed with intractable epilepsy due to Sturge-Weber disease, and in a 25-year-old man who had developed intractable post-traumatic seizures after suffering cerebral contusion in a traffic accident as a child. These patients had no seizures or complications after surgery, and both patients have been weaned from antiepileptic drugs. The transventricular approach, as compared with other lateral approaches described in the literature, provides easy access to the ventricular cavity. Transventricular hemispherotomy proved to be a useful approach that allowed the following four common steps in cerebral hemispherotomy to be performed safely: (i) interruption of the internal capsule and corona radiata; (ii) resection of the medial temporal structures; (iii) transventricular corpus callosotomy; and (iv) disruption of the frontal horizontal fibers.

DOI： 10.1016/j.jocn.2005.11.051

PubMed

Publishing type：Research paper (scientific journal)  

Surgical procedures for cerebral hemispherotomy may be broadly divided into those using a lateral and those using a vertical approach. However, careful study of surgical procedures using the lateral approach described in the literature shows differences in the approach to the ventricles. We discuss the application of transventricular hemispherotomy as a technique which provides relatively easy ventricular access for cerebral hemispherotomy. Transventricular hemispherotomy was successfully performed in a 36-year-old woman who was diagnosed with intractable epilepsy due to Sturge-Weber disease, and in a 25-year-old man who had developed intractable post-traumatic seizures after suffering cerebral contusion in a traffic accident as a child. These patients had no seizures or complications after surgery, and both patients have been weaned from antiepileptic drugs. The transventricular approach, as compared with other lateral approaches described in the literature, provides easy access to the ventricular cavity. Transventricular hemispherotomy proved to be a useful approach that allowed the following four common steps in cerebral hemispherotomy to be performed safely: (i) interruption of the internal capsule and corona radiata; (ii) resection of the medial temporal structures; (iii) transventricular corpus callosotomy; and (iv) disruption of the frontal horizontal fibers. (c) 2006 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jocn.2005.11.051

PubMed

Publishing type：Research paper (scientific journal)  

Cranioplasty performed after external decompression for brain swelling due to cerebral infarction, injury and hemorrhage may be difficult because of the development of adhesions between the dura and the temporal muscle, subcutaneous layer. Preventing such adhesions, we have used Seprafilm instead of Gore-Tex membranes which had been used in neurosurgery. Seprafilm were placed between the temporal muscle and the dura with dural plasty using periostium or temporal fascia. Insertion of Seprafilm makes it easy for subsequent cranioplasty, to decrease operating time and blood loss, and avoids injury to the temporal muscle and dura. In addition, the price of Seprafilm is lower than Gore-Tex.
Seprafilm is a safe and inexpensive material for preventing the adhesions after external decompression.

Publishing type：Research paper (scientific journal)  

A 48-year-old woman presented with subarachnoid hemorrhage originating from a dissecting aneurysm of the left vertebral artery (VA). Internal trapping with proximal flow arrest was planned. The origin of the left VA was too tortuous to allow positioning of an occlusion balloon catheter and a microcatheter in the left VA via the femoral artery. Therefore, the temporary subclavian steal technique was used for proximal flow arrest, by placing an occlusion balloon catheter in the subclavian artery proximal to the VA origin via the femoral artery. Thereafter, coil embolization was achieved through the left axillary artery. The patient recovered well after the procedure.

PubMed

Publishing type：Research paper (scientific journal)  

A 48-year-old woman presented with subarachnoid hemorrhage originating from a dissecting aneurysm of the left vertebral artery (VA). Internal trapping with proximal How arrest was planned. The origin of the left VA was too tortuous to allow positioning of an occlusion balloon catheter and a microcatheter in the left VA via the femoral artery. Therefore, the temporary subclavian steal technique was used for proximal flow arrest, by placing an occlusion balloon catheter in the subclavian artery proximal to the VA origin via the femoral artery. Thereafter, coil embolization was achieved through the left axillary artery. The patient recovered well after the procedure.

Publishing type：Research paper (scientific journal)  

1997年4月から2005年2月迄に破裂椎骨解離性動脈瘤に対する血管内治療を施行した7例のうち、5例に対してproximal flow arrestを用いたinternal trappingを行い、その有用性を検討した。男性3例、女性4例で平均54歳で、術前のWorld Federation of Neurosurgical Societies ScaleによるグレードはGrade III、IV、Yが各2例、右側が3例であった。後下小脳動脈(PICA)よりも末梢の解離は3例、解離部からPICA分枝を認めたものが1例、前小脳動脈からPICAが灌流されるものが3例あった。PICAの分岐を認めた例はproximal occlusionとし、他の6例はinternal trappingを行った。最終的な転帰は、Glasgow Outcome Scaleでgood recovery 3例、moderate disability 1例、vegetative state 1例、death 2例であった。代表的な症例として3例を提示したが、1例は重症クモ膜下出血により死亡し、1例は術後に延髄右側に小梗塞を認め右上肢の軽度の痺れを残し独歩退院し、1例は水頭症を残して独歩退院となった。Internal trappingに対するProximal flow arrestの有用性の証明は困難であるが、安全性を高めるための有効なoptionであると考える。

PubMed

Publishing type：Research paper (scientific journal)  

Ruptured vertebral artery (VA) dissecting aneurysms are associated with a higher incidence of rebleeding than saccular aneurysms, so, it is encouraged that diagnosis be followed by early treatment. The standard treatment for VA dissecting aneurysms is internal trapping using an endovascular technique. In this procedure, a proximal flow arrest is sometimes used to ensure safety. In this report, we demonstrated the usefulness of proximal flow arrest.
The subjects consisted of seven patients treated with endovascular treatment for ruptured VA dissecting aneurysms from 1997 to 2005. Two of the seven patients were treated without proximal flow arrest and one of the two encountered rerupture of the aneurysm at coil embolization. Five patients were treated with proximal flow arrest. Internal trapping was safely completed in these patients. Overall outcomes measurment by Glasgow Outcome Scale were good recovery in three, moderate disability in one, vegetative state in one and dead in two.
Proximal flow arrest is considered to be useful for the following four reasons: 1) for the prevention of distal embolism; 2) for the prevention of distal coil migration; and 3) to block blood flow upon rerupture; 4) for the balloon occlusion test, but the necessity of this technique is now controversial. However it is difficult to prove the necessity, we believe it is an effective optional technique for safety embolization.

Publishing type：Research paper (scientific journal)  

We present a rare case of skull base chordoma of extraosseous intradural type that presented as acute intratumoral hemorrhage. Surgical removal of the tumor was accomplished using a skull base approach.

Publishing type：Research paper (scientific journal)  

We present a rare case of skull base chordoma of extraosseous intradural type that presented as acute intratumoral hemorrhage. Surgical removal of the tumor was accomplished using a skull base approach.

DOI： 10.4103/0028-3886.27162

PubMed

Publishing type：Research paper (scientific journal)  

CiNii Article

CiNii Article

Publishing type：Research paper (scientific journal)  

1歳1ヵ月男児。発育、発達に異常は見られなかったが、生後11ヵ月に頭囲拡大を指摘され経過観察されていたところ、発熱を契機にCTにて異常を指摘されたが、頭部外傷の明らかな既往はなかった。白血球とCRPの上昇を認めたが、尿、血液培養において細菌は陰性であった。CTでは脳の右方への偏位を認め、硬膜下の貯留液を疑わせる低吸収域を認めた。MRIでもその病変の鑑別は困難であった。穿刺によりドレナージを施行し、穿刺液から大腸菌が検出され、第3世代セフェム系抗生剤の投与により全身状態の改善と白血球数及びCRPの改善を認め、術後1週間でのMET-PETでは病変の残存部に集積を認め、病巣の炎症反応が示唆された。術後6週でのMET-PETでは明らかな集積の低下を認め、抗生剤を中止した。患児はその後、元気に退院し、術後4ヵ月でのMRIでも被膜の造影効果は残存していた。METは炎症部位に有意に集積し、その程度は炎症の活動性に相関すると考えられることから、MET-PETは感染治癒の有用な検査と考えられた。

Publishing type：Research paper (scientific journal)  

Transsylvian selective amygdalohippocampectomy (TSA) is an operative technique designed to spare unaffected brain tissue during surgical treatment for mesial temporal lobe epilepsy. In contrast to standard anterior temporal lobectomy (ATL), the advantages of TSA with respect to postoperative cognitive outcome are equivocal. We compared cognitive function before and after surgery in 49 patients with unilateral mesial temporal lobe seizures who underwent either ATL (n=17) or TSA (n=32). All patients received neuropsychological testing before and 1 year after surgery. The intelligence quotient (IQ) increased postoperatively in both surgical groups. Memory evaluation in the ATL group revealed a postoperative decline in nonverbal memory after right-sided resection and a postoperative decline in verbal memory after left-sided resection. In the TSA group, there was a slight postoperative decline only in verbal memory after left-sided resection, but other memory function was well preserved. In particular, there was significant postoperative improvement in verbal memory after right-sided resection. Overall, memory function was better preserved in the TSA group than in the ATL group.

DOI： 10.1016/j.yebeh.2006.04.017

PubMed

Publishing type：Research paper (scientific journal)  

Transsylvian selective amygdalohippocampectomy (TSA) is an operative technique designed to spare unaffected brain tissue during surgical treatment for mesial temporal lobe epilepsy. In contrast to standard anterior temporal lobectomy (ATL), the advantages of TSA with respect to postoperative cognitive outcome are equivocal. We compared cognitive function before and after surgery in 49 patients with unilateral mesial temporal lobe seizures who underwent either ATL (n = 17) or TSA (n = 32). All patients received neuropsychological testing before and 1 year after surgery. The intelligence quotient (IQ) increased postoperatively in both surgical groups. Memory evaluation in the ATL group revealed a postoperative decline in nonverbal memory after right-sided resection and a postoperative decline in verbal memory after left-sided resection. In the TSA group, there was a slight postoperative decline only in verbal memory after left-sided resection, but other memory function was well preserved. In particular, there was significant postoperative improvement in verbal memory after right-sided resection. Overall, memory function was better preserved in the TSA group than in the ATL group. (C) 2006 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.yebeh.2006.04.017

PubMed

DOI： 10.11477/mf.1436100041

Publishing type：Research paper (scientific journal)  

内側側頭葉てんかんに対して経シルビウス裂到達法による選択的海馬扁桃体摘出術(TSA)を施行し,術後1年以上経過観察が可能であった32例(左側切除18例,右側切除14例)を対象に,発作予後と術前後の脳高次機能について検討した.術後,Engel class Iは25例,class IIは5例,class IIIは2例で,抗てんかん薬の断薬は1例で可能であった.WAISRで測定したIQは,右側切除群の運動性IQ以外,いずれも術前に比べ有意に上昇した.記銘力は,左側切除群では術後に低下がみられたが,右切除では有意な改善が見られた.合併症は左片麻痺と左同名半盲を1例に認めた

Publishing type：Research paper (scientific journal)  

内側側頭葉てんかんに対して経シルビウス裂到達法による選択的海馬扁桃体摘出術(TSA)を施行し,術後1年以上経過観察が可能であった32例(左側切除18例,右側切除14例)を対象に,発作予後と術前後の脳高次機能について検討した.術後,Engel class Iは25例,class IIは5例,class IIIは2例で,抗てんかん薬の断薬は1例で可能であった.WAISRで測定したIQは,右側切除群の運動性IQ以外,いずれも術前に比べ有意に上昇した.記銘力は,左側切除群では術後に低下がみられたが,右切除では有意な改善が見られた.合併症は左片麻痺と左同名半盲を1例に認めた

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：Domestic journal  

brain fiber dissection法を円滑に行うために必要な脳白質内の神経線維束の解剖とその剥離法を,特に大脳半球の外側面を中心に示した.更に,本法を用いた脳機能解剖の研究が非常に有用であった難治性てんかん例に対する大脳半球離断術について報告した.本法を用いた神経線維束の機能解剖を研究することにより,この手術法でどの神経線維をどのように切断すれば良いかを視覚的に捉えることが可能となる

Responsible for pages：1319-1322  

(1)意識障害は脳腫瘍による頭蓋内圧亢進が原因となることがあるため、初期対応の際に単純CTを行い、頭蓋内病変を認めれば脳神経外科と連携して治療する。(2)けいれんは頭蓋内圧亢進を助長するため、ただちにけいれんを完全に止める。(3)頭蓋内圧亢進を伴わない大脳半球腫瘍によって発生するけいれんは、腫瘍の全摘出で予後良好である。

Total pages：261   Responsible for pages：88-99  

Eloquent areaにおける神経膠腫の治療では腫瘍の局所制御と、患者の日常生活レベルの向上を両立させる必要がある。我々は、MRIと11C-methionine PETの両所見から腫瘍の進展範囲を把握し、functional MRI、脳磁図、diffusion tractographyにて運動及び言語関連部位を把握している。術中はneuronavigationを使用し、motor evoked potential、sensory evoked potential及び、必要症例にはawake surgeryを行い、皮質と白質のmonitoringを行っている。2004年から2009年までの5年間に22例のeloquent areaの神経膠腫の外科的治療を行った。本報告ではeloquent areaのglioma治療に対する我々の治療戦略を示し、症例の結果および、代表症例を提示する。

Responsible for pages：437-446   Book type：Scholarly book

放射線壊死と腫瘍再発の鑑別については多くの報告があり、JainやAlexiouらが様々な検査方法についての解説をしているが、まだ確立された診断法がないのが現状である。本稿でも最近の報告を中心にレヴューを行い、それらを理解する上での注意点について記載する。

Responsible for pages：437-446  

放射線壊死と腫瘍再発の鑑別については多くの報告があり、JainやAlexiouらが様々な検査方法についての解説をしているが、まだ確立された診断法がないのが現状である。本稿でも最近の報告を中心にレヴューを行い、それらを理解する上での注意点について記載する。

Total pages：261   Responsible for pages：88-99  

Eloquent areaにおける神経膠腫の治療では腫瘍の局所制御と、患者の日常生活レベルの向上を両立させる必要がある。我々は、MRIと11C-methionine PETの両所見から腫瘍の進展範囲を把握し、functional MRI、脳磁図、diffusion tractographyにて運動及び言語関連部位を把握している。術中はneuronavigationを使用し、motor evoked potential、sensory evoked potential及び、必要症例にはawake surgeryを行い、皮質と白質のmonitoringを行っている。2004年から2009年までの5年間に22例のeloquent areaの神経膠腫の外科的治療を行った。本報告ではeloquent areaのglioma治療に対する我々の治療戦略を示し、症例の結果および、代表症例を提示する。

難治性てんかんに対する外科手術は有用な治療手段である。非侵襲的検査において焦点の局在同定が困難な場合、頭蓋内電極を用いた精査が行われる。従来は硬膜下電極を用いることが一般的であったが、近年では定位的手法で挿入した頭蓋内電極で焦点診断を行うことが諸外国で増加している。てんかん焦点が局在している場合、より低侵襲な手術が望ましい。一方で、広範囲のてんかんネットワークが発作に関与している場合、脳梁や脳葉の離断を概念とした手術を考慮する必要がある。本邦未導入であるが、近年では局所の凝固術や、視床前核への深部脳刺激、反応性発作起始領域刺激などの新規治療も行われるようになってきている。(著者抄録)

髄膜腫は頭蓋内腫瘍の中でも頻度が高く、脳神経外科医にとって遭遇する機会が多い腫瘍である。初期治療として手術切除が選択されることに異論はないと思われるが、残存、再発腫瘍についてどのように治療を行うかは意見の一致をみていない。最近の論文でも手術切除度が腫瘍無再発期間や生存率に関連していることは明らかであるが、一方過度な切除は患者に重篤な合併症をきたし、かえって生存期間を短縮させるなどの問題もある。放射線照射はWHO grade I髄膜腫に対して腫瘍無再発期間を有意に延長させる効果があることが多くの論文で示されている。しかし生存期間を延長させることは示されていない。WHO grade II、III髄膜腫ではさらに放射線の効果そのものに否定的な論文もある。本論文では最近の論文および自験例をもとに残存、再発腫瘍をどのように治療すべきかについて考察した。(著者抄録)

＜Key Points＞(1)意識障害は脳腫瘍による頭蓋内圧亢進が原因となることがあるため、初期対応の際に単純CTを行い、頭蓋内病変を認めれば脳神経外科と連携して治療する。(2)けいれんは頭蓋内圧亢進を助長するため、ただちにけいれんを完全に止める。(3)頭蓋内圧亢進を伴わない大脳半球腫瘍によって発生するけいれんは、腫瘍の全摘出で予後良好である。(著者抄録)

CiNii Article

Other URL： http://search.jamas.or.jp/link/ui/2011063253

CiNii Article

平成17年10月、急性期脳梗塞に対する治療薬としてrt-PA（プラスミノゲン・アクティベータ）が認可された。rt-PAは10年以上前に米国で認可されていた脳梗塞の治療薬だが、日本では平成14年から平成15年にかけて22施設で臨床試験が行われ、適応基準を満たせば良好な結果が見込めると確認された。rt-PAは発症3時間以内のできる限り早い時期に投与する治療薬である。一方、時間が経てば経つほど副作用である頭蓋内出血のリスクが高まるとされており、rt-PA静注療法の適切な運用のためには、医療施設や地域の救急体制の充実が重要なポイントとなってくる。ここではrt-PA静注療法の導入に伴って、いち早く迅速な対応と治療中の集中管理を行うための体制を整えた市立島田市民病院を紹介しよう。市立島田市民病院は病床数550床を持ち、静岡県島田市を中心に志太・榛原医療圏における急性期医療を担っている。中でも脳卒中患者は多く、平成15年には脳神経外科と並んで脳卒中科も開設された。平成17年2月には日本脳卒中学会専門医認定制度による研修教育病院の認定を受けている。そして平成17年10月から12月にかけてrt-PA静注療法の導入を行うための体制づくりと院内スタッフの教育・啓蒙を行った。脳梗塞の特効薬といわれ、期待が高まるrt-PAを適切に、より効果的に投与するためには何が重要なのか。市立島田市民病院脳神経外科・脳卒中科の宇田武弘先生に取材した中から、同院のシステムと今後の脳卒中治療への提言を伝えたい。

平成17年10月、急性期脳梗塞に対する治療薬としてrt-PA（プラスミノゲン・アクティベータ）が認可された。rt-PAは10年以上前に米国で認可されていた脳梗塞の治療薬だが、日本では平成14年から平成15年にかけて22施設で臨床試験が行われ、適応基準を満たせば良好な結果が見込めると確認された。rt-PAは発症3時間以内のできる限り早い時期に投与する治療薬である。一方、時間が経てば経つほど副作用である頭蓋内出血のリスクが高まるとされており、rt-PA静注療法の適切な運用のためには、医療施設や地域の救急体制の充実が重要なポイントとなってくる。ここではrt-PA静注療法の導入に伴って、いち早く迅速な対応と治療中の集中管理を行うための体制を整えた市立島田市民病院を紹介しよう。市立島田市民病院は病床数550床を持ち、静岡県島田市を中心に志太・榛原医療圏における急性期医療を担っている。中でも脳卒中患者は多く、平成15年には脳神経外科と並んで脳卒中科も開設された。平成17年2月には日本脳卒中学会専門医認定制度による研修教育病院の認定を受けている。そして平成17年10月から12月にかけてrt-PA静注療法の導入を行うための体制づくりと院内スタッフの教育・啓蒙を行った。脳梗塞の特効薬といわれ、期待が高まるrt-PAを適切に、より効果的に投与するためには何が重要なのか。市立島田市民病院脳神経外科・脳卒中科の宇田武弘先生に取材した中から、同院のシステムと今後の脳卒中治療への提言を伝えたい。

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