国際・国内誌：国際誌  

DOI： 10.1186/s40478-024-01863-3

PubMed

国際・国内誌：国際誌  

DOI： 10.3390/brainsci14100958

PubMed

国際・国内誌：国際誌  

DOI： 10.1016/j.wneu.2024.05.128

PubMed

国際・国内誌：国際誌  

DOI： 10.1016/j.wneu.2024.05.016

PubMed

国際・国内誌：国際誌  

DOI： 10.1002/epd2.20240

PubMed

国際・国内誌：国際誌  

DOI： 10.1007/s00381-024-06435-3

PubMed

国際・国内誌：国際誌  

DOI： 10.1186/s40478-024-01808-w

PubMed

国際・国内誌：国際誌  

DOI： 10.3171/2024.4.FOCVID2414

PubMed

国際・国内誌：国際誌  

DOI： 10.7759/cureus.58424

PubMed

国際・国内誌：国際誌  

DOI： 10.1016/j.jocn.2024.03.024

PubMed

国際・国内誌：国際誌  

DOI： 10.1093/noajnl/vdae016

PubMed

国際・国内誌：国際誌  

DOI： 10.1016/j.ebr.2024.100670

PubMed

国際・国内誌：国際誌  

DOI： 10.3390/brainsci13121701

PubMed

国際・国内誌：国際誌  

DOI： 10.1227/ons.0000000000000867

PubMed

国際・国内誌：国際誌  

DOI： 10.1148/radiol.223016

PubMed

国際・国内誌：国際誌  

DOI： 10.1016/j.wneu.2023.04.099

PubMed

国際・国内誌：国際誌  

DOI： 10.1002/epi4.12698

PubMed

国際・国内誌：国内誌  

DOI： 10.11441/shinshumedj.71.115

国際・国内誌：国際誌  

DOI： 10.3390/brainsci13030440

PubMed

国際・国内誌：国際誌  

DOI： 10.1007/s00701-023-05517-6

PubMed

国際・国内誌：国内誌  

<p>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カ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。</p>

DOI： 10.3805/jjes.40.548

国際・国内誌：国際誌  

DOI： 10.3390/brainsci13010115

PubMed

国際・国内誌：国内誌  

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)

国際・国内誌：国内誌  

DOI： 10.11477/mf.1436204721

PubMed

国際・国内誌：国際誌  

DOI： 10.2176/jns-nmc.2022-0010

PubMed

国際・国内誌：国際誌  

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。

国際・国内誌：国際誌  

DOI： 10.3390/brainsci12070875

PubMed

国際・国内誌：国際誌  

DOI： 10.3171/2022.2.PEDS21522

PubMed

国際・国内誌：国際誌  

国際・国内誌：国際誌  

DOI： 10.1016/j.braindev.2022.02.003

PubMed

国際・国内誌：国際誌  

DOI： 10.1016/j.radcr.2022.01.014

PubMed

国際・国内誌：国際誌  

DOI： 10.1016/j.eplepsyres.2022.106870

PubMed

国際・国内誌：国際誌  

DOI： 10.1038/s41598-021-04216-5

PubMed

国際・国内誌：国際誌  

DOI： 10.1007/s00381-021-05399-y

PubMed

国際・国内誌：国際誌  

DOI： 10.3390/brainsci11121608

PubMed

国際・国内誌：国際誌  

DOI： 10.1684/epd.2021.1347

PubMed

国際・国内誌：国際誌  

DOI： 10.1093/ons/opab265

PubMed

国際・国内誌：国際誌  

DOI： 10.1007/s00401-021-02337-9

PubMed

国際・国内誌：国際誌  

DOI： 10.1016/j.inat.2021.101099

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1016/j.wneu.2021.01.012

PubMed

国際・国内誌：国際誌  

DOI： 10.1016/j.wneu.2021.01.012

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.3390/cancers13061415

PubMed

国際・国内誌：国際誌  

DOI： 10.3390/cancers13061415

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.3171/2020.9.PEDS20520

PubMed

国際・国内誌：国際誌  

DOI： 10.3171/2020.9.PEDS20520

PubMed

国際・国内誌：国内誌  

DOI： 10.18888/rp.0000001517

CiNii Article

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.3389/fneur.2021.617291

PubMed

国際・国内誌：国内誌  

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。

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.3389/fonc.2020.596448

PubMed

国際・国内誌：国際誌  

DOI： 10.21873/anticanres.14766

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1016/j.ebr.2021.100429

PubMed

国際・国内誌：国内誌  

<p> 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.</p>

DOI： 10.7887/jcns.30.496

CiNii Article

国際・国内誌：国際誌  

DOI： 10.3389/fneur.2021.617291

PubMed

国際・国内誌：国際誌  

DOI： 10.1016/j.ebr.2021.100429

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1186/s40478-020-01078-2

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1371/journal.pone.0243272

PubMed

国際・国内誌：国際誌  

DOI： 10.1186/s40478-020-01078-2

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1016/j.jocn.2020.10.019

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

国際・国内誌：国際誌  

DOI： 10.1016/j.jocn.2020.10.019

PubMed

国際・国内誌：国際誌  

DOI： 10.1016/j.jocn.2020.07.026

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

国際・国内誌：国際誌  

DOI： 10.1007/s10014-020-00363-1

PubMed

国際・国内誌：国際誌  

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。

国際・国内誌：国内誌  

国際・国内誌：国際誌  

DOI： 10.3389/fonc.2020.596448

PubMed

国際・国内誌：国際誌  

DOI： 10.1371/journal.pone.0243272

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   共著区分：共著   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1038/s41598-019-50849-y

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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)

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1186/s40478-019-0749-8

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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)

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

【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)

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1007/s11060-018-2957-7

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1016/j.clinph.2017.11.026

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

<p> 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 gradeⅠ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 gradeⅡ, 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.</p>

DOI： 10.7887/jcns.27.441

CiNii Article

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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.

国際・国内誌：国際誌  

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。

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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.

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1111/pan.13111

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1016/j.braindev.2016.08.002

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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)

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1371/journal.pone.0168588

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1016/j.jocn.2015.03.063

PubMed

国際・国内誌：国内誌  

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。

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.4103/0974-8237.161593

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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.

国際・国内誌：国際誌  

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。

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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。

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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。

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1097/BRS.0b013e31826f25a3

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   共著区分：共著   国際・国内誌：国内誌  

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。

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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。

掲載種別：研究論文（学術雑誌）   共著区分：共著   国際・国内誌：国際誌  

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.

掲載種別：研究論文（学術雑誌）   共著区分：共著   国際・国内誌：国内誌  

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。

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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。

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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.

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1016/j.jocn.2011.11.043

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

PETやPerfusion CTのような様々な脳検査法で脳の循環代謝を測定することは, 虚血巣をふくむ領域の脳機能の評価に有用である。しかし, 脳の循環動態は直接的に脳の神経活動を反映しているものではない。容積伝導した神経活動を表す頭皮脳波において, 急性期の脳虚血巣での徐波の出現が知られているが, 空間分解能, 定量性において脳機能の客観的指標とするには問題があった。脳磁図はこの脳波の短所をカバーできるものと期待され, 虚血性脳疾患への臨床応用がなされつつある。しかし, 脳磁図は, てんかん以外の疾患においては科学的エビデンスは明らかでない。本研究では文献検索に基づき虚血性脳疾患の脳磁図臨床研究の動向を調べMEDLINE にて (stroke OR cerebral ischemia) AND (MEG OR magnetoencephalography) を検索2010年7月までで58論文が検索された。この中から原著論文をえらび, エビデンスレベル, 抄録内容に基づいて25論文に絞りこみ現在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はグレード2以上の12編について検討してまとめた。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・治療方針の決定に関してはエビデンスレベルの高い論文もあるもののごく少数の報告に限られており, 今後の研究に期待しなければならない。しかし, 虚血に伴う脳の障害程度を脳循環代謝以外の方法で明らかにできることは意義深いと考えられる。

DOI： 10.11422/jscn.40.195

CiNii Article

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1016/j.clinph.2011.12.008

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

PETやPerfusion CTのような様々な脳検査法で脳の循環代謝を測定することは, 虚血巣をふくむ領域の脳機能の評価に有用である。しかし, 脳の循環動態は直接的に脳の神経活動を反映しているものではない。容積伝導した神経活動を表す頭皮脳波において, 急性期の脳虚血巣での徐波の出現が知られているが, 空間分解能, 定量性において脳機能の客観的指標とするには問題があった。脳磁図はこの脳波の短所をカバーできるものと期待され, 虚血性脳疾患への臨床応用がなされつつある。しかし, 脳磁図は, てんかん以外の疾患においては科学的エビデンスは明らかでない。本研究では文献検索に基づき虚血性脳疾患の脳磁図臨床研究の動向を調べMEDLINE にて (stroke OR cerebral ischemia) AND (MEG OR magnetoencephalography) を検索2010年7月までで58論文が検索された。この中から原著論文をえらび, エビデンスレベル, 抄録内容に基づいて25論文に絞りこみ現在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はグレード2以上の12編について検討してまとめた。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・治療方針の決定に関してはエビデンスレベルの高い論文もあるもののごく少数の報告に限られており, 今後の研究に期待しなければならない。しかし, 虚血に伴う脳の障害程度を脳循環代謝以外の方法で明らかにできることは意義深いと考えられる。

DOI： 10.11422/jscn.40.195

CiNii Article

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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。

CiNii Article

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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

国際・国内誌：国際誌  

CiNii Article

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.4103/0974-8237.100054

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.4103/0974-8237.100060

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.4103/0028-3886.82714

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.2967/jnumed.110.082875

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   共著区分：共著   国際・国内誌：国際誌  

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.

掲載種別：研究論文（学術雑誌）   共著区分：共著   国際・国内誌：国際誌  

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

国際・国内誌：国内誌  

DOI： 10.2531/spinalsurg.25.295

CiNii Article

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.2967/jnumed.109.068783

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.2176/nmc.50.1091

PubMed

CiNii Article

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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。

国際・国内誌：国内誌  

DOI： 10.11477/mf.1436101056

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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.

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.3171/2008.9.JNS08247

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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

国際・国内誌：国内誌  

CiNii Article

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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。

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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.

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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。

CiNii Article

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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。

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1016/j.jocn.2005.11.051

PubMed

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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.

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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

掲載種別：研究論文（学術雑誌）   国際・国内誌：国内誌  

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.

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

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.

国際・国内誌：国内誌  

CiNii Article

掲載種別：研究論文（学術雑誌）   国際・国内誌：国際誌  

DOI： 10.1016/j.yebeh.2006.04.017

PubMed

国際・国内誌：国内誌  

DOI： 10.11477/mf.1436100041

国際・国内誌：国内誌  

PubMed

掲載種別：研究論文（学術雑誌）   共著区分：共著   国際・国内誌：国内誌  

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

担当ページ：440-446   著書種別：学術書   参加形態：ファーストオーサー

担当ページ：412-416   著書種別：学術書   参加形態：ファーストオーサー

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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