Publishing type：Research paper (scientific journal)  

DOI： 10.3171/2020.8.JNS202060

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.3389/fneur.2021.617291

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.3390/curroncol28010071

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.21873/anticanres.14766

PubMed

Publishing type：Research paper (scientific journal)  

<p>  Craniopharyngiomas are regarded as particularly challenging tumors for safe and complete removal due to their anatomical location and proximity to vital neurovascular structures. Therefore, in several articles, partial tumor removal followed by radiotherapy is recommended to avoid perioperative complications. These reports present sufficient tumor control with acceptable complications. However, tumor recurrence after long follow-up periods or the effects of radiation on the hypothalamus and visual pathway should be considered when determining the appropriate treatment for these tumors. Contrastingly, several clinical articles on the endoscopic endonasal approach (EEA) report satisfactory outcomes in patients with craniopharyngiomas. However, these clinical series do not have adequate follow-up periods. This article presents several treatment options for craniopharyngiomas.</p>

DOI： 10.7887/jcns.30.41

CiNii Article

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

Publishing type：Research paper (scientific journal)  

症例は40歳代男性で、約6ヵ月前より頭痛が出現しており、脳MRI検査で頭蓋内に腫瘤性病変を指摘されたため当院紹介となった。左小脳テントに沿って腫瘤を認め、単純CTで石灰化はみられず高濃度を呈し、MRIのT2強調像で低信号、T1強調像で等信号、拡散強調像で低信号、造影T1強調像で比較的均一に強い造影増強効果を認めた。診断目的に側頭筋生検が施行された。側顔筋膜は一見正常であったが小さな結節状の硬結を触れ、筋膜下の側頭筋内にも多数の小さな結節状の硬結を触れた。病理所見では筋肉内やその周囲の軟部組織にLanghans型の巨細胞を伴う類上皮肉芽腫が数珠状に形成されていた。病理診断はサルコイドーシスであった。FDG-PET/CTが行われ、両側肺門リンパ節の腫大、Th10レベルの脊柱管内の結節を認め、いずれの病変にもFDG集積がみられ、サルコイドーシス病変であると診断した。

Publishing type：Research paper (scientific journal)  

頭蓋咽頭腫は手術的に全摘出することが理想である。しかし、病変が血管穿通枝、視神経視交叉や視床下部と近接しているため、安全に摘出することは容易ではない。小児頭蓋咽頭腫への経鼻内視鏡手術の適応が広がっており、当院では2014年4月以降経鼻内視鏡下での病変摘出を基本方針としてきた。近年、視交叉後方型や第三脳室型の小児頭蓋咽頭腫に対しても経鼻内視鏡手術を積極的に選択し、比較的良好な結果が得られている。我々の手術手技の工夫およびその治療成績について報告する。(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.wneu.2019.10.081

PubMed

Publishing type：Research paper (scientific journal)  

<p>  Most skull base tumors are basically classified as pathologically benign tumors. However, their clinical courses are not usually benign due to anatomical proximity to critical neurovascular structures. It is thought that the extent of tumor removal is a significant factor for long tumor control, but at the same time, surgical radicality entails some risk that can lead to deterioration of the quality of life of the patient. Surgical outcomes depend largely on each institute and each neurosurgeon. Therefore, clinical evidence in the field of skull base tumor treatments is lacking. In this article, we briefly summarize recent clinical articles on skull base tumors and explain our strategy regarding treatment of skull base tumors.</p>

DOI： 10.7887/jcns.29.17

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.inat.2019.100529

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.wneu.2019.06.053

PubMed

Publishing type：Research paper (scientific journal)  

頭蓋咽頭腫は血管穿通枝と複雑に癒着し視神経視交叉や視床下部と近接しているため、安全に病変を全摘出することは容易でない。当院では小児頭蓋咽頭腫に対して積極的な切除を基本的な治療方針とし、2006年以降前医での治療歴がある再発7症例を含む22症例に対して摘出術を行った。術後下垂体機能の温存は困難であったが、記銘力や視機能は改善もしくは維持が得られた。腫瘍の局所制御については亜全摘出となった8例中4例に定位放射線照射を追加し、平均4.6年のフォロー期間で22例中8例に再発を認めたが、全摘出後の再発は14例中2例であり、亜全摘出後の再発は8例中6例であった。小児頭蓋咽頭腫に対しては長期の腫瘍制御が必要であるため、種々の手術到達法を駆使し、患者の機能を保ちつつ腫瘍の徹底切除を行うことが重要と考える。(著者抄録)

Publishing type：Research paper (scientific journal)  

当科では頭蓋咽頭腫に対し、可能な限り全摘出を目指した治療を行っている。今回、2014年1月以降に経鼻内視鏡手術を行った51例の成績を報告した。小児15例、成人36例で、腫瘍と視交叉との位置関係に基づいて腫瘍を分類すると鞍内型が4例、視交叉前方型7例、視交叉後方型25例、第三脳室内型14例、海綿静脈洞内再発1例であった。51例中50例(98%)で全摘出が可能であった。腫瘍切除のために両側後床突起切除を要したものが視交叉後方型で22例(88%)、第三脳室内型で14例(100%)あった。両側後床突起を削除することで術野の左右方向が大きく拡大するため、直線型手術器具が動眼神経や視索下面へ容易に到達できるようになり、安全な腫瘍剥離が可能であった。代表例1例を提示した。

Publishing type：Research paper (scientific journal)  

当施設では3次元融合画像によるシミュレーションを2014年3月に導入した。今回、2014年3月〜2018年1月に頭蓋底病変の摘出術を行った症例のうち、術前に摘出困難と予想された99例のシミュレーション成績を報告した。シミュレーションの方法は、まずMRIとCTの画像をもとに画像解析ソフト(Zed-ViewおよびSynapse-Vincent)を用いて3次元融合画像を作成する。次に3次元融合画像をstandard triangulated language形式で出力し、3次元マウスと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う。成績は、全例で実際の術野と同様の3次元融合画像が得られ、病巣を中心とした微小解剖を容易に把握することができ、適切な手術到達法の選択や安全・確実な摘出が可能であった。代表例2例を提示した。

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.radcr.2019.05.023

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1158/1538-7445.AM2019-4901

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.wneu.2019.03.293

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.3171/2019.2.JNS183278

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.wneu.2019.02.123

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.radcr.2018.11.017

PubMed

Publishing type：Research paper (scientific journal)  

<p>  Although stereotactic radiosurgery is a basic treatment for cavernous sinus tumors, surgical excision is required in patients with symptomatic tumors or recurrent tumors after radiotheraphy. Here, we present detailed anatomical knowledge of the cavernous sinus and surgical techniques for preservation of the third, fourth and sixth cranial nerves. Our surgical procedure for cavernous sinus tumor is an option for the treatment of cavernous sinus tumors.</p>

DOI： 10.7887/jcns.28.398

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.wneu.2018.06.244

PubMed

Publishing type：Research paper (scientific journal)  

頭蓋咽頭腫は外科的全摘出が最良の治療であるが同時に視床下部障害、視機能障害、下垂体機能障害の危険を伴う。このため部分切除に放射線治療を組み合わせた治療が行われることも多い。近年は経鼻内視鏡手術が選択される傾向にあるが、やはり合併症回避のため部分摘出に終わることがある。我々は以前から頭蓋咽頭腫に対しては、下垂体機能は犠牲にしても、視床下部障害や視機能障害を来さず病変の全摘出を目指してきた。2014年より小児例にも積極的に経鼻内視鏡下での腫瘍徹底切除を行っているので治療成績を報告する。(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.3171/2017.11.JNS172670

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.3171/2018.1.FOCUS17703

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1055/s-0037-1620248

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)  

2008年〜2015年に外科的摘出を行った橋海綿状血管腫10例中、経錐体到達法を選択した8例(男性5例、女性3例、27〜64歳、平均46.9歳)を対象に、自験例を示し、同到達法の有用性について検討した。8例全例で出血による神経症状が術前にみられた。画像所見では病変または血腫による皮質脊髄路偏位を認め、軽度から重度の片麻痺が7例にみられた。その他、構音障害4例、失調3例、意識障害2例、眼球運動障害1例が認められた。手術によって全例で肉眼的全摘出ができた。術後、眼球運動が悪化した症例はなく、顔面神経麻痺や片麻痺の悪化もみられなかった。経錐体到達法は橋外側および腹側を広く観察でき、様々な方向から血管腫境界を観察でき、最小限の皮質切開で大きな血腫を切除できた。脳幹部橋海綿状血管腫に対する方法として有用な到達法と思われた。

Publishing type：Research paper (scientific journal)  

DOI： 10.3171/2017.3.FOCUS17180

Publishing type：Research paper (scientific journal)  

症例1は26歳男性で、軽度の交通事故後に撮像された全身スクリーニングスキャンにより、頭蓋内腫瘍が偶発的に発見された。入院時の神経学的検査では、右側嗅覚障害が認められた以外は正常であったが、入院時MRIで、最大直径21.4×17.6mm大の前頭蓋窩右側に塊病変が認められ、右側直回に隣接し嚢胞成分を伴っていた。Frontobasalアプローチによる腫瘍摘出術を施行した。腫瘍塊の固形部分のみを全摘出し、術後MRIで全切除が確認された。退院後は、右側嗅覚障害以外の神経学的症状はなく経過は良好である。症例2は24歳女性で、失神エピソードの検査時に頭蓋内腫瘍が認められた。入院時の神経学的検査では、右側嗅覚障害以外に異常はみられなかったが、入院時MRIにより、右側前頭下部領域に位置する最大直径17.9×10.4mmの固形塊病変が認められた。前方開頭術による腫瘍摘出術を行い、術後MRIで全切除が確認された。術後経過は順調で、右側嗅覚覚障害が認められるのみで退院となった。なお、両例とも組織病理学的所見により、形態学的特徴から変性した神経鞘腫と考えられたが、免疫組織学的検討では共に、S-100、ネスチン、Schwann/2Eに陽性で、Leu7とEMAに陰性を示し、症例1では少数の散在細胞のみがKi-67陽性で、症例2では1〜7%がKi-67陽性であった。

Publishing type：Research paper (scientific journal)  

DOI： 10.1111/neup.12357

PubMed

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

DOI： 10.11477/mf.1436203472

PubMed

Publishing type：Research paper (scientific journal)  

Surgical resection of pontine cavernomas remains a particularly formidable challenge in the neurosurgical field because of their deep-seated and eloquent locations. We report and discuss our experience and surgical approaches in the treatment of pontine cavernomas via a transpetrosal approach. We investigated eight cases of pontine cavernomas who underwent resection via an anterior or combined transpetrosal approach at our hospital between 2008 and 2015. These eight patients comprised six men and two women with a mean age of 46.9 years. All cases presented with neurological deficits caused by hemorrhage before surgery. We used an anterior transpetrosal approach in six cases and a combined transpetrosal approach in two. Gross total resection of the tumor was achieved in all cases. No postoperative complications, viz., worsening of facial nerve palsy, ocular movement disorder, or hemiplegia were noted in any patient. It is possible to obtain a wide surgical corridor from the ventral and lateral side via an anterior or combined tranpetrosal approach for treatment of pontine cavernomas. A small cortical incision with multi-directional dissection is the best approach to avoid additional neurological deficits. We conclude that resection of pontine cavernomas via a transpetrosal approach might be superior to other approaches to minimize postoperative neurological deficits.

DOI： 10.2335/scs.45.260

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.3171/2016.9.FOCUS16211

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10143-016-0735-6

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.3171/2015.3.JNS141618

PubMed

Publishing type：Research paper (scientific journal)  

With recent advances in surgical technology such as preoperative imaging, neuro-monitoring, and surgical instruments, the surgical resectability of intracranial meningiomas has increased over the last two decades. This study reviewed clinical articles regarding the surgical treatment of meningiomas to clarify the role of surgical excision, with a focus on skull base meningiomas. We sub-classified clinical articles about skull base meningiomas into two categories (anterior and middle fossa meningiomas; and posterior fossa meningiomas) and reviewed papers in each category. In cases with anterior and middle fossa meningiomas, surgical resectability has reached a sufficient level to maximize functional preservation. In cases of posterior fossa meningioma, however, surgical respectability remains insufficient even with full use of recent surgical modalities. Continuous refining of operative procedures is required to obtain more satisfactory outcomes, especially for posterior fossa meningioma. In addition, recent long-term outcomes of stereotactic radiosurgery (SRS) were acceptable for controlling the skull base meningiomas. Therefore, combination with surgical excision and SRS should be considered in complicated skull base meningiomas.

DOI： 10.2176/nmc.ra.2015-0354

PubMed

CiNii Article

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)  

DOI： 10.3171/2014.8.JNS132406

PubMed

Publishing type：Research paper (scientific journal)  

&emsp;&emsp;The orbitozygomatic approach is a well-known and well established basic surgical procedure that has been performed in most neurosurgical institutes. But there remain several misunderstandings about the procedure itself and the indications for using the approach. In this article we present surgical tips for the procedure step by step along with the actual surgical steps.<br>&emsp;&emsp;Obtaining wide exposure of the anterior clinoid process in the epidural field is a key surgical step for safe and easy clinoidectomy and opening the optic canal. An appropriately designed dural incision can provide safe mobilization of the sylvian vein which can offer wide and shallow epidural surgical field around the parasellar area.<br>&emsp;&emsp;In our experience of skull base tumor surgeries, we have found that retrochiasmatic craniopharyngiomas of small or medium size and large paraclinoid meningiomas will be suitable candidate for the approach

DOI： 10.7887/jcns.24.738

CiNii Article

Publishing type：Research paper (scientific journal)  

当院で手術を行った大型石灰化を伴う頭蓋咽頭腫8例について検討した。腫瘍体積の10%以上の石灰化を31例で認め、50%以上の石灰化を8例に認めた。基本的な手術戦略は、術前の画像評価に従い4つのタイプに細分類化し、病変に応じて最適な手術到達法を選択、外科的全摘出を優先して必要に応じ多段階手術を行うこととした。また、石灰化部位は縦割して漸次摘出した。対象は細分類で視交叉後方型6例、トルコ鞍内型1例、視交叉前方型1例であった。5例で2期的な手術を施行し、手術到達法(重複あり)は6例で経錐体到達法、4例で経眼窩頬骨到達法、2例で経大脳半球間裂経終板到達法、1例で経蝶形骨洞到達法を選択した。腫瘍摘出度は3例で肉眼的全摘出が可能で、その他の5例は亜全摘出であった。視機能の異常は5例で改善、3例で不変であった。術後経過観察期間は0.6〜17.0年で、2例で腫瘍の再発を認め、うち1例は術後2.6年で腫瘍死した。

Publishing type：Research paper (scientific journal)  

脳幹部海綿状血管腫は頭蓋内海綿状血管腫の9〜35%を占め、特に脳幹部では橋に好発する。また出血率、再出血率ともに他部位に比して高く、症候性のものは摘出術が考慮される。摘出に関してはさまざまな到達法が報告されているが、経錐体到達法を用いた橋海綿状血管腫の手術に関する報告は多くない。われわれは、術後の神経症状の悪化や新たな症状発現を防ぐためには正常脳組織への侵襲を最小限にする到達法を選択することが重要であると考えており、その点で、小さな皮質切開でかつ多方向性に病変を直視下に観察することを可能にする経錐体到達法は、橋海綿状血管腫の手術において有用な到達法になる可能性があると思われる。(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00701-014-2028-6

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.3171/2013.10.JNS13673

PubMed

Publishing type：Research paper (scientific journal)  

&emsp;&emsp;Even with the wealth of recent advances in surgical equipment and techniques, the surgical excision of craniopharyngiomas remains challenging due to their anatomical location and proximity to critical neurovascular structures. Although various surgical approaches to remove craniopharyngiomas have been described, including the pterional, orbitopterional, orbitozygomatic, transbasal subfrontal, frontobasal interhemispheric, and transnasal transsphenoidal, designating the optimal surgical approach remains controversial. In this article, we presented our sub-classification of craniopharynigiomas based on the anatomical location of the tumor. In addition, the most appropriate surgical approach to the lesion is discussed for these anatomical sub-classifications.

DOI： 10.7887/jcns.23.12

CiNii Article

Publishing type：Research paper (scientific journal)  

&emsp;&emsp;Brainstem cavernous malformations account for 9-35% of all intracranial cavernous malformations and most brainstem cavernous malformations arise from the pons. Pontine cavernous malformations remain surgically challenging because of their deep-seated and eloquent locations. Although several approaches have been reported to remove pontine cavernous malformations, there are only a few reports available regarding the transpetrosal approach in pontine cavernous malformation surgery. Here, we report our experience in treating patients with pontine cavernous malformations by the transpetrosal approach. Furthermore, alternate surgical approaches to pontine cavernous malformations will be discussed.<br>&emsp;&emsp;A total of six cases were included in this study. There were four men and two women with an average age of 46.2 years. All cases presented neurological deficits caused by hemorrhage before surgery. The anterior transpetrosal approach was used in four and a combined transpetrosal approach was used in two cases. Gross total removal was achieved in all cases with an acceptable surgical outcome.<br>&emsp;&emsp;We consider that a small cortical incision which allows multi-direction dissection is the most important factor to avoid additional neurological deficits in cavernous malformation surgeries. Therefore, the transpetrosal approach can be used to minimize neurological deficits after removal of pontine lesions.

DOI： 10.7887/jcns.23.341

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.wneu.2014.02.029

PubMed

Publishing type：Research paper (scientific journal)  

11C-メチオニン(MET)PETを対象に、髄膜腫の進行と再発に関連する危険因子をレトロスペクティブに評価した。1995〜2010年に大阪市立大学病院で頭蓋内髄膜腫と診断された患者73名から得た37症例(男性14名、女性23名、平均54.5±12.9歳)を対象とした。33名は外科術を施され、4名は観察下にあり、いずれも外科術や観察前にMET PET検査を受診した。腫瘍切除の程度、腫瘍部位、WHO等級、Ki-67標識指標、MET取込の病変-正常組織比率(LN比)と髄膜腫の進行や再発との関連性を調べた。追跡期間中に外科術患者6名で再発が認められ、観察下患者2名で進行が認められた。単変量解析からMET取込の高LN比が有意な危険因子であることが示された。MET取込のLN比のROC曲線解析からAUCは0.754で、カットオフ値を3.18に設定すると再発や進行の予測性能が最大(感度63%、特異性79%)となることが示された。

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s12149-013-0747-z

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

側頭骨錐体斜台部髄膜腫14例の術前に、造影(CE)principles of echo-shifting with a train of observations(PRESTO) MRIを用いて腫瘍と錐体静脈との関係について調べ、CT、3D-CT血管造影、従来のCE-MRI血管造影及びconstructive interference in steady-state(CISS) MRIの感度と比較した。その結果、11例において、術中に錐体静脈が同定できた。術前に腫瘍と錐体静脈との解剖学的関連が同定できたのは、CE PRESTO-MRI 10例、3D-CT血管造影5例、CE-MRI血管造影5例、CISS-MRI4例であった。全例で外科的血管合併症は認めなかった。

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10143-013-0451-4

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s11604-012-0150-z

PubMed

Publishing type：Research paper (scientific journal)  

症例1は小児期の外傷後右側難聴を有する52歳男性で、右顔面の知覚異常歴があった。症例2は右三叉神経痛の悪化を主訴とする44歳男性で、神経学的検査により右顔面の感覚減少と右耳難聴が示された。頭部コンピューター断層撮影(CT)により、錐体尖において、脂肪が殆どまたは全く認められない明確な低減衰病変が示され、症例1では骨浸食と硬化性乳様突起炎と関連し、症例2は錐体尖の骨浸食と関連していた。各磁気共鳴(MR)画像において、見かけの拡散係数(ADC)の減少を伴わず、脂肪抑制されない高信号領域であることが示され、症例1では錐体尖のコレステリン腫および類表皮嚢腫、症例2は硬膜間の類表皮嚢腫であると予測診断された。2症例とも切除術が行われ、病理組織学的に症例1は脂質を含まない類皮嚢腫であり、症例2は脂肪分泌腺と脂肪を有する類皮嚢腫であると診断された。本症例は非常に稀であり、硬膜間の類表皮嚢腫と誤診断されやすいことに留意すべきである。

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.wneu.2011.05.022

PubMed

Publishing type：Research paper (scientific journal)  

The present detailed radiological study investigated the relationship between petroclival meningiomas and petrosal veins with contrast-enhanced (CE) principles of echo-shifting with a train of observations (PRESTO) imaging to assess the potential contribution of the findings to the surgical strategy. Fourteen patients (13 women and 1 man) with unilateral petroclival meningiomas underwent microsurgical resection at Osaka City University Hospital between April 2009 and February 2011. Preoperatively, patients were examined using computed tomography (CT) and magnetic resonance (MR) imaging, including CE PRESTO imaging, focusing on the relationship between the tumor and the petrosal vein, and compared to the sensitivity of three-dimensional CT (3D-CT) venography or conventional MR imaging, including CE MR venography and constructive interference in steady-state (CISS) MR imaging. In 11 of 14 cases, we could identify the petrosal veins with intraoperative findings. In 10 of these 14 cases, the anatomical relationship between the tumor and the petrosal vein was detected preoperatively with CE PRESTO imaging, compared to 5 of 14 cases with 3D-CT venography, 5 of 14 cases with CE MR venography, and only 4 of 14 cases using CISS MR imaging. CE PRESTO imaging compares favorably to other approaches. There was no venous complication related to the surgery in any of the cases. CE PRESTO imaging is a non-invasive and useful method to assess the status of the petrosal vein in patients with petroclival meningiomas.<br>

DOI： 10.2176/nmc.53.490

PubMed

CiNii Article

Publishing type：Research paper (scientific journal)  

頭蓋咽頭腫において、手術単独で再発した13例(A群)と手術と放射線を施行後に再発した12例(B群)を対象に、摘出度、合併症、手術後の再発率、視機能(Visual Impairment Scale)、下垂体機能(Pituitary Craniorharyngioma Clinical Status Scale)、高次脳機能(WAIS-III)を初発群38例と比較した。その結果、A群は初発例に比べて腫瘍摘出度と再発率が低かったが有意差はなかった。また、合併症率、視機能および高次脳機能は初発例と変わらず良好な結果が得られた。一方、B群は初発群に比べて合併症率に差はなかったが、全摘出度と視機能が有意に低かった。また、高次脳機能は経過観察期間中に徐々に増悪する傾向にあった。以上より、再発頭蓋咽頭腫であっても、頭蓋底アプローチを用いることで安全な全摘出が可能と思われた。手術で全摘出を目指す治療は長期的なQOLを維持するために重要な治療と考えられた。

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/1752-1947-6-181

PubMed

Publishing type：Research paper (scientific journal)  

Skull base meningiomas can occasionally obstruct the basal venous sinuses as the tumor growth. We therefore analyzed the venous draining pattern from sylvian veins in clinoidal meningiomas. Between 1995 and 2007, twenty patients with clinoidal meningioma underwent surgical intervention at our institute. Venous drainage from sylvian veins was categorized into three patterns, including cortical type, sphenobasal type and sphenoparietal type, according to the main draining vein. Preoperative angiographic evaluation showed 14 patients (70%) as cortical type, 5 patients (25%) as sphenobasal type and 1 patient (5%) as sphenoparietal type. Postoperative clinical courses revealed that dominant sphenobasal sinuses were successfully preserved by skull base techniques in all of the sphe-nobasal type patients. One sphenoparietal type patient developed a brain contusion conceivably, by the obstruction of the dominant sphenoparietal sinus during tumor resection. Drainers from sylvian veins to the skull base should be carefully evaluated preoperatively and must be preserved, if dominant, in the surgery of clinoidal meningioma.

CiNii Article

Publishing type：Research paper (scientific journal)  

A combined trans-petrosal approach which includes some degree of anterior petrosectomy and presigmoid posterior petrosectomy is quite an effective procedure for petroclival lesions, offering a wide and shallow surgical field. Several petrosal approach variations have been reported by master skull base surgeons and a detailed anatomy of the temporal bone has been obtained by cadaveric studies. These achievements enhanced the surgical safety and standardization of the procedure. But there still remain some critical risks in the procedure such as CSF leakage, sigmoid sinus injury and damaging the facial and cochlea nerves at petrosectomy. In this report, tips for the procedure including the way to harvest the fascia-pericranial flap to prevent CSF leakage, to expose sigmoid sinus safely, to perform safe petrosectomy and to resect the petroclival tumors caring critical vascular and nerve structures, will be minutely presented. A fascia-pericranial flap with a pedicle of sternocleid mastoid muscle has completely prevented CSF leakage and the following infections. Dissecting the sinus wall at an antegrade direction has enabled the safe and quick exposure of the sigmoid sinus. Both the mastoid antrum and endlymphatic sac are crucial landmarks for detecting the semi-circular canals. Opening Meckel's cave encourages large transposition of the trigeminal nerve which enlarges the exposure of the tumor at the area between the trigeminal and facial-acoustic nerve band. Surgical results of the combined transpetrosal approach have been satisfactorily improved by the accumulated modifications of the procedure.

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.3171/2011.5.JNS101812

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1227/NEU.0b013e318211490f

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

顕微手術の三次元(3D)ビデオ録画は従来の二次元ビデオシステムよりもプレゼンテーションおよび教育にとってより有望なツールであるが、以前の3Dビデオシステムは3D画像の処理が複雑で、光学装置がなければ可視化できないため広く採用されていない。顕微手術の3Dビデオプレゼンテーションに対する新技術開発について述べた。高精細(HD)ビデオカメラを搭載した顕微鏡で顕微手術を録画し、3Dカメラアダプターを用いて右眼および左眼視野を単一HDデータとして同時に記録する。顕微鏡の右眼と左眼の視野は右側と左側に別々に表示される。次いで、手術ビデオは右眼視野を左側、左眼視野を右側に表示するよう、ビデオ編集ソフトウェアで編集する。編集したビデオを交差視表示法により表示することにより、光学器械なしに顕微手術の3Dビデオを作成できる。3D顕微手術ビデオは特に深度に関してより正確な視野と顕微手術解剖のよりよい理解を提供する。

Publishing type：Research paper (scientific journal)  

A 58-year-old woman presented with a rare tentorial schwannoma manifesting as a chief complaint of headache. Magnetic resonance imaging showed an infratentorial extra-axial mass lesion with both cystic and solid components and dural tail sign. The tumor was easily separated from the surrounding structures, and the origin was apparently the tentorial branch of the trigeminal nerve. Tentorial schwannoma should be considered in the differential diagnosis of mixed cystic and solid mass lesions associated with the tentorium around the ambient cistern.<br>

DOI： 10.2176/nmc.51.382

CiNii Article

Publishing type：Research paper (scientific journal)  

58歳女。頭痛を主訴に受診した。30年前に副甲状腺機能亢進症で手術した既往があった。頭部MRIで左小脳橋角部に約20mm大の嚢胞および固形成分を含む腫瘤を認め、T1強調画像で低信号、T2強調画像で不均質な信号を呈し、造影剤で不均質に増強され、dural tail signを呈した。腫瘍境界は明瞭で内耳道への浸潤はなかった。外側後頭下retrosigmoid開頭術を施行した。腫瘍はテントから発生し、主にテント下くも膜外スペースに存在し、側頭葉錐体骨端、錐体静脈に接していることが分かった。腫瘍亜全摘を施行し、テントの一部も切除した。組織学的診断は典型的な神経鞘腫で、発生源は三叉神経テント枝であった。術後2年経過し、腫瘍の再発は認めなかった。

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

A 50-year-old man presented with pituitary apoplexy resulting in internal carotid artery occlusion manifesting as sudden onset of severe headache, right ptosis, and left hemiparesis, associated with visual impairment. Computed tomography showed a nodular mass, located in the sellar and suprasellar regions with early signs of acute cerebral ischemia. Magnetic resonance (MR) imaging indicated that the mass compressed the bilateral cavernous sinuses, resulting in obliteration of the cavernous portion of the right internal carotid artery. Right middle cerebral artery territory infarction was also found. Conservative therapy with steroids was given in the acute stage and repeated MR imaging showed recanalization of the internal carotid artery with reduction of the tumor size. The tumor was removed through the transsphenoidal approach to obtain a definitive diagnosis in the chronic stage. The histological diagnosis was consistent with non-functioning pituitary adenoma. Eye movement of this patient showed full recovery after the operation. Pituitary apoplexy resulting in internal carotid artery occlusion is rare. Surgical decompression through the transsphenoidal approach is appropriate, but the optimal timing should consider severe disturbance of visual acuity and visual field in the acute stage.<br>

DOI： 10.2176/nmc.51.48

CiNii Article

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

50歳男。突然の頭痛、右眼瞼下垂、左片麻痺、視力障害が出現した。CTでトルコ鞍及び鞍上部に結節性腫瘤と急性脳虚血の早期徴候を認め、MRIで腫瘤が両側海綿静脈を圧迫し、右内頸動脈の海綿静脈洞部を閉塞している所見と、右中大脳動脈領域の梗塞も認めた。急性期にはステロイドを用いた保存的治療を行い、反復MRI検査で腫瘍サイズの減少に伴い内頸動脈が再開通する所見を認めた。腫瘍は経蝶骨アプローチで除去し、慢性期において非分泌性下垂体腺腫と確定診断した。手術により眼球運動は完全に回復した。

Publishing type：Research paper (scientific journal)  

PubMed

Publishing type：Research paper (scientific journal)  

Three-dimensional (3-D) video recording of microsurgery is a more promising tool for presentation and education of microsurgery than conventional two-dimensional video systems, but has not been widely adopted partly because 3-D image processing of previous 3-D video systems is complicated and observers without optical devices cannot visualize the 3-D image. A new technical development for 3-D video presentation of microsurgery is described. Microsurgery is recorded with a microscope equipped with a single high-definition (HD) video camera. This 3-D video system records the right- and left-eye views of the microscope simultaneously as single HD data with the use of a 3-D camera adapter: the right- and left-eye views of the microscope are displayed separately on the right and left sides, respectively. The operation video is then edited with video editing software so that the right-eye view is displayed on the left side and left-eye view is displayed on the right side. Consequently, a 3-D video of microsurgery can be created by viewing the edited video by the cross-eyed stereogram viewing method without optical devices. The 3-D microsurgical video provides a more accurate view, especially with regard to depth, and a better understanding of microsurgical anatomy. Although several issues are yet to be addressed, this 3-D video system is a useful method of recording and presenting microsurgery for 3-D viewing with currently available equipment, without optical devices.<br>

DOI： 10.2176/nmc.51.467

PubMed

CiNii Article

Publishing type：Research paper (scientific journal)  

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.3171/2010.9.PEDS10280

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.3171/2010.2.JNS091118

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.wneu.2010.06.049

PubMed

Publishing type：Research paper (scientific journal)  

CiNii Article

Publishing type：Research paper (scientific journal)  

A combined trans-petrosal approach which includes some degree of anterior petrosectomy and presigmoid posterior petrosectomy is quite an effective procedure for petroclival lesions, offering a wide and shallow surgical field. Several petrosal approach variations have been reported by master skull base surgeons and a detailed anatomy of the temporal bone has been obtained by cadaveric studies. These achievements enhanced the surgical safety and standardization of the procedure. But there still remain some critical risks in the procedure such as CSF leakage, sigmoid sinus injury and damaging the facial and cochlea nerves at petrosectomy. In this report, tips for the procedure including the way to harvest the fascia-pericranial flap to prevent CSF leakage, to expose sigmoid sinus safely, to perform safe petrosectomy and to resect the petroclival tumors caring critical vascular and nerve structures, will be minutely presented. A fascia-pericranial flap with a pedicle of sternocleid mastoid muscle has completely prevented CSF leakage and the following infections. Dissecting the sinus wall at an antegrade direction has enabled the safe and quick exposure of the sigmoid sinus. Both the mastoid antrum and endlymphatic sac are crucial landmarks for detecting the semi-circular canals. Opening Meckel's cave encourages large transposition of the trigeminal nerve which enlarges the exposure of the tumor at the area between the trigeminal and facial-acoustic nerve band. Surgical results of the combined transpetrosal approach have been satisfactorily improved by the accumulated modifications of the procedure.

DOI： 10.7887/jcns.19.802

CiNii Article

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

A 66-year-old man presented with an extremely rare primary frontal sinus squamous cell carcinoma who was successfully treated by the extreme radical extended frontobasal approach. The tumor was resected en bloc with a clear margin and the large defect of the frontal region was reconstructed using a rectus abdominis myocutaneous flap. The tumor was well controlled without adjuvant therapy, and no recurrence or metastasis had occurred 2 years after the operation. Frontal sinus malignancy can be resected by the extreme radical extended frontobasal approach. The rectus abdominis myocutaneous flap is useful for the large defect of the skin and frontal base.<br>

DOI： 10.2176/nmc.49.481

PubMed

CiNii Article

Publishing type：Research paper (scientific journal)  

CiNii Article

Publishing type：Research paper (scientific journal)  

Two patients presented with primary intramedullary spinal cord germinoma (PISCG). Neither diagnosis was correct at initial evaluation, and both underwent surgical verification of the tumor. Based on the histological diagnosis, both patients were treated successfully by combination of chemotherapy and radiotherapy. These cases illustrate the unexpected occurrence of PISCG and treatment strategy.<br>

DOI： 10.2176/nmc.49.128

CiNii Article

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

<b>Objective</b>: To evaluate the effectiveness of preoperative embolization for skull base meningiomas.<br><b>Method</b>: Forty-one patients with skull base meningiomas, three posterior clinoid meningiomas, three cavernous meningiomas, and thirty five petroclival meningiomas were evaluated. They were divided into two groups: Group A had 17 patients who had undergone successful predominant feeder embolization and group B had 24 patients for whom predominant feeder embolization had failed or had intentionally not been attempted. Change of C-reactive protein (CRP) level, MRI enhancement, and operative tumor characters were compared between two groups.<br><b>Result</b>: 13 cases in group A showed an increase of CRP level, while there were no CRP level changes in group B. Eleven cases in group A demonstrated a diminished MRI enhancement, whereas two of the five cases in group B with supplement feeder embolization showed the same finding. Intraoperative tumor softening and/or whitening was recognized in 10 cases in group A and in 4 cases in group B. These differences were statistically significant (p<0.05).<br><b>Conclusion</b>: Dominant feeder embolization for skull base meningiomas, even if they are branches of internal carotid arteries, is useful to diminish operative bleeding and facilitate dissection.

DOI： 10.5797/jnet.3.165

CiNii Article

Publishing type：Research paper (scientific journal)  

<p>  <b>Objective</b> : Once atlantoaxial joint instability has been detected, the goal of surgery is to reduce pathological subluxation, decompress neural elements and maintain vertebral column alignment. Herain, the surgical technique for internal fixation and fusion at the atlantoaxial joint is presented with an emphasis on complication avoidance.</p><p>  <b>Patients and methods</b> : The patient record included a total of 12 patients with the atlantoaxial instability (11 male and 1 female), who underwent surgery over the past four years. The age of the patients ranged from 16 to 75 years old. Patients were classified into 7 in trauma group, and 5 in rheumatoid arthritis or degeneration group based on their etiology. Goel-Harms method with a cancellous screw and rod system was preferably used. In the cases of retroodontoid pseudotumor with chronic atlantoaxial instability, the posterior C1 arch was resected and combined with posterior fusion.</p><p>  <b>Results and conclusion</b> : None of the patients demonstrated neurological deterioration after surgery. All of the patients with retroodontoid pseudotumor demonstrated neurological recovery with gradually diminishing pseudotumor. In one case treated by Megerl method, revision surgery was accomplished to achieve complete bone fusion. To avoid the surgical complications, selection and safe placement of C2 anchor screws, sufficient exposure of the lateral atlantoaxial joint, and fusion technique are key elements for successful surgery.</p>

DOI： 10.2531/spinalsurg.23.121

CiNii Article

Publishing type：Research paper (scientific journal)  

CiNii Article

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

Occipitocervical fusion with the head in a functionally neutral position is critically important. Various methods have been proposed for measuring the angle of the craniovertebral junction based on lateral radiography. We describe a simple and reliable measurement of fixation angle during occipitocervical fusion using the line parallel to the bony palate and the posterior longitudinal line of the C2 vertebra. The normal range of the angle of the craniovertebral junction was measured in 30 normal healthy volunteers, 15 males and 15 females aged from 17 to 77 years (mean 45.1 years), without symptoms of neck pain or limitations of neck movement. The angle ranged from 85 to 118 degrees. The mean angle was 97.1 degrees in males and 102.6 degrees in females, with overall mean &plusmn; standard deviation of 99.9 &plusmn; 8.1 degrees. Careful adjustment of the angle of the craniovertebral junction can help to avoid postoperative complications such as dysphagia, dyspnea, and subaxial subluxation.<br>

DOI： 10.2176/nmc.48.279

PubMed

CiNii Article

Publishing type：Research paper (scientific journal)  

CiNii Article

Publishing type：Research paper (scientific journal)  

Skull base meningiomas can occasionally obstruct the basal venous sinuses as the tumor growth. We therefore analyzed the venous draining pattern from sylvian veins in clinoidal meningiomas. Between 1995 and 2007, twenty patients with clinoidal meningioma underwent surgical intervention at our institute. Venous drainage from sylvian veins was categorized into three patterns, including cortical type, sphenobasal type and sphenoparietal type, according to the main draining vein. Preoperative angiographic evaluation showed 14 patients (70%) as cortical type, 5 patients (25%) as sphenobasal type and 1 patient (5%) as sphenoparietal type. Postoperative clinical courses revealed that dominant sphenobasal sinuses were successfully preserved by skull base techniques in all of the sphenobasal type patients. One sphenoparietal type patient developed a brain contusion conceivably, by the obstruction of the dominant sphenoparietal sinus during tumor resection. Drainers from sylvian veins to the skull base should be carefully evaluated preoperatively and must be preserved, if dominant, in the surgery of clinoidal meningioma.

DOI： 10.7887/jcns.17.673

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

Publishing type：Research paper (scientific journal)  

Posterior C1-2 fixation with individual screw placement in C-1 and C-2 was performed in three patients presenting with progressive myelopathy caused by retro-odontoid pseudotumor associated with chronic atlantoaxial subluxation. Postoperatively, all patients demonstrated neurological recovery with gradually diminishing pseudotumor. Posterior C1-2 fixation with the cancellous screw and rod system is a safe and reliable method, and can be used to treat retro-odontoid pseudotumor associated with chronic atlantoaxial subluxation.<br>

DOI： 10.2176/nmc.47.189

CiNii Article

Publishing type：Research paper (scientific journal)  

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

DOI： 10.7887/jcns.16.323_3

CiNii Article

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

DOI： 10.4103/0028-3886.28125

PubMed

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Publishing type：Research paper (scientific journal)  

PubMed

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DOI： 10.1016/j.yebeh.2006.04.017

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1227/01.NEU.0000219930.65161.AD

PubMed

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CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.1055/s-2006-934109

PubMed

Publishing type：Research paper (scientific journal)  

We report the case of a fusiform middle cerebral artery aneurysm at the M1 segment, which was successfully treated with proximal occlusion after a bypass surgery. A 48-year-old-male was admitted with a chief complaint of repeated left hemiparesis. Cerebral angiography showed a fusiform aneurysm at the M1 segment on the right side, corresponding to the ischemic symptom. We performed the occlusion of M1 at its most proximal segment after the high flow bypass from external carotid artery to M2 with a radial artery graft. <br> The post-operative course was uneventful, and the patient was discharged 10 days after operation. Follow-up imaging studies showed the prominent thrombus formation inside the aneurysm keeping the blood flow from the aneurysmal wall to the M1 perforators intact. <br> This surgical result supports the hypothesis that the spontaneous fusiform MCA aneurysm might be caused by dissection and the reversing of blood flow inside the dissected artery might make the dissection subside.<br>

DOI： 10.2335/scs.34.59

CiNii Article

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

DOI： 10.3171/jns.2006.104.1.47

PubMed

Publishing type：Research paper (scientific journal)  

We evaluate the morphology of the carotid plaque using echogram, CT scan and MRI and compare those neuroradiological findings with histological findings of the plaque. <br> We evaluated 14 cases operated with carotid endoarterectomy for carotid stenosis. We estimated the findings of the echogram, enhanced CT scan and black blood MRI (BB MRI), in comparison with the histological findings of the carotid plaque. <br> Echogram, enhanced CT scan and MRI clearly demonstrated the plaque in cervical carotid stenosis. In most cases, echograms could show the plaque, but in some cases could not due to the back shadow caused by plaque calcification. Enhanced CT scan clearly demonstrated the calcification and the neovasculization in plaque. BB MRI clearly showed the carotid plaque. Low-intensity lesions in T1 and T2 weighted images showed hard and fibrous plaque. High-intensity lesions in T1 and T2 weighted images showed soft plaque with lipoprotein and/or hemorrhage. <br> This study demonstrates the potential of a systemic approach to atherosclerotic plaque with enhanced CT scan and BB MRI compared with histological findings of the carotid plaque. These estimations elucidate the growth mechanism of carotid plaque.<br>

DOI： 10.2335/scs.34.199

CiNii Article

Publishing type：Research paper (scientific journal)  

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jocn.2005.02.003

PubMed

Publishing type：Research paper (scientific journal)  

We report our experience of using a navigation system in spinal surgery, and assess its usefulness. Forty cases were operated upon using a navigational system, and 33 were operated upon using conventional methods, without a navigational system. There were significantly fewer complications when the navigation system was used than when it was not. We mostly used the navigation system for cases having anomalies and/or severe deformation of the spine requiring instrumentation (transarticular screw, pedicle screw) and bony resection. The system increased the accuracy of spinal instrumentation and decreased the risk of neurovascular injury. Navigation-assisted surgery improves the accuracy of spinal instrumentation and bony resection because it provides a multidimentional view of anatomnical relationships during surgery.

CiNii Article

Publishing type：Research paper (scientific journal)  

We report the results of surgical treatment of lesions in the cranio-vertebral junction and qualify the decision to use a surgical approach. 40 cases were treated. In consideration of the location of the lesion, relationship to lower cranial nerves and vertebral artery, some cases were added large suboccipital craniotomy, condylar resection and/or resection for transverse process of atlas and axis. We could remove the lesion totally in 88% of the cases. All of the cases had improvement in neurological symptoms. Subtotal removal was performed in three cases, because the tumor had adhesion to the brain stem or lower cranial nerves. For the lesions in the craniovertebral junction, the basic approach was dorsolateral approach, for the lesion extending to the spinal canal was performed hemilaminectomy of the atlas and axis. In consideration of the location of the lesion, the relationship to lower cranial nerves and the vertebral artery, suboccipital craniotomy, condylar resection and/or resection of transverse process of the atlas and axis should be added. For the intramedullary lesion, we should make the approach more laterally to get to the lesion directly.

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.7887/jcns.14.280_2

CiNii Article

Publishing type：Research paper (scientific journal)  

We report our experience of using a navigation system in spinal surgery, and assess its usefulness. Forty cases were operated upon using a navigational system, and 33 were operated upon using conventional methods, without a navigational system. There were significantly fewer complications when the navigation system was used than when it was not. We mostly used the navigation system for cases having anomalies and/or severe deformation of the spine requiring instrumentation (transarticular screw, pedicle screw) and bony resection.<br>The system increased the accuracy of spinal instrumentation and decreased the risk of neurovascular injury. Navigation-assisted surgery improves the accuracy of spinal instrumentation and bony resection because it provides a multidimentional view of anatomnical relationships during surgery.

DOI： 10.2531/spinalsurg.19.127

CiNii Article

Publishing type：Research paper (scientific journal)  

We report the results of surgical treatment of lesions in the cranio-vertebral junction and qualify the decision to use a surgical approach.<br>40 cases were treated. In consideration of the location of the lesion, relationship to lower cranial nerves and vertebral artery, some cases were added large suboccipital craniotomy, condylar resection and/or resection for transverse process of atlas and axis. We could remove the lesion totally in 88% of the cases. All of the cases had improvement in neurological symptoms. Subtotal removal was performed in three cases, because the tumor had adhesion to the brain stem or lower cranial nerves.<br>For the lesions in the craniovertebral junction, the basic approach was dorsolateral approach, for the lesion extending to the spinal canal was performed hemilaminectomy of the atlas and axis. In consideration of the location of the lesion, the relationship to lower cranial nerves and the vertebral artery, suboccipital craniotomy, condylar resection and/or resection of transverse process of the atlas and axis should be added. For the intramedullary lesion, we should make the approach more laterally to get to the lesion directly.

DOI： 10.2531/spinalsurg.19.29

CiNii Article

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

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)

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Kind of work：Single Work  

＜POINT 1＞深部静脈損傷を回避するためには、大きな深部静脈が手術到達経路を遮ることのない到達法を選択する必要がある。＜POINT 2＞脳神経機能を温存するためには腫瘍から脳神経を剥離するのではなく、脳神経から腫瘍を剥離する操作が重要となる。＜POINT 3＞腫瘍に巻き込まれた脳神経を同定するためには、正常解剖を指標にした早期の脳神経同定が重要である。(著者抄録)

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Kind of work：Single Work  

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Kind of work：Single Work  

Transpetrosal approachesは、脳幹腹側、錐体斜台部、視交叉後方病変に対して、比較的広く浅い術野を得ることができる有用な到達法である。Anterior petrosal approach、posterior petrosal approachのいずれの場合も、硬膜剥離を十分行い錐体骨を広く露出することが、安全、迅速な錐体骨削除に不可欠である。また血液のない術野を心がけ、解剖学的指標の視認性を向上させることも重要である。これらを心がけると、比較的安全に行い得る手術手技である。(著者抄録)

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Orbitozygomatic approachは広く普及した頭蓋底到達法であるが、広く普及したがゆえに、手術の細かなコツあるいは適応について語られる機会が減少している。今回は手術解剖の知識を中心に同到違法を行う手順を解説した。(著者抄録)

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

頭蓋咽頭腫(craniopharyngioma)は胎生期の頭蓋咽頭管の遺残から発生する良性腫瘍で,全脳腫瘍の2〜4%,小児では5〜10%を占める.頭蓋咽頭腫に対する治療は,種々の顕微鏡下経頭蓋到達法的手術や内視鏡下経鼻的手術による外科的切除,分割照射や定位放射線照射などの放射線治療,嚢胞内薬物療法などオプションが増えており議論が多い.病理学的特徴を考慮すると手術によって全摘出することが理想である.しかし,腫瘍は重要血管穿通枝と複雑に癒着し,視神経視交叉や視床下部と近接しており,安全に摘出することは容易ではない.このため基本的な治療方針は,種々の到達法を駆使し,患者の機能を保ちつつ腫瘍の徹底切除を行う.亜全摘出例や再発例に対しては,分割照射や定位放射線照射などの放射線治療を行う.内分泌補充に関しては内分泌内科専門医との連係および長期的経過観察が重要である.(著者抄録)

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

＜POINT1＞三叉神経内側に付着部がある狭義の錐体斜台部髄膜腫に対しては、脳幹との剥離、顔面神経、聴神経機能温存、いずれの観点からも経錐体法が有用である。＜POINT2＞手術法が複雑に見える錐体斜台部髄膜腫であっても、大まかな腫瘍摘出の手順は一定である。(著者抄録)

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

術前画像診断や、手術手技、手術機器が進歩した現在も頭蓋咽頭腫に対する治療は非常に難しく、議論が分かれるところである。また手術法についても、経蝶形骨洞到達法、経眼窩頬骨弓到達法、経大脳間裂経終板到達法、経側脳室到達法、さらに経錐体到達法などさまざまな報告がなされている。われわれは頭蓋咽頭腫を発生部位に基づいて、4つに細分類し、病変に応じた手術法を選択している。本論文では、われわれの細分類および手術法選択基準を紹介した。(著者抄録)

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

＜POINT1＞S状静脈洞は、乳様骨を削除する前に乳様骨内板から静脈洞を剥離すると安全かつ迅速に露出できる。＜POINT2＞狭い術野で錐体骨を削除すると、迷路損傷、蝸牛損傷などを起こしやすい。中頭蓋底側、後頭蓋窩側の両方で硬膜を十分剥離して、錐体骨を露出させた後に、骨削除を行うと安全に骨削除が可能になる。(著者抄録)

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

鞍結節部髄膜腫(tuberculum sellae meningioma)は両側視神経管の間に存在する小さな骨隆起である鞍結節を中心に発育する腫瘍である。このため両側視神経を内側から外側に圧排し視力視野障害を来す疾患である。また時に発育とともに前交通動脈とその穿通枝を巻き込みながら発育する。筆者らは以前からこの腫瘍に対し、腫瘍発育部に到達しやすく、また両側視神経・視交叉・前交通動脈との離が最も確実な両側前頭開頭による腫瘍切除を行っている。基本的にこの「両側前頭下到達法」で腫瘍を切除し、腫瘍が前交通動脈を巻き込んでいる場合には「経大脳間裂到達法」を併用している。(著者抄録)

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Kind of work：Single Work  

＜看護のポイント＞■脳腫瘍は脳実質内腫瘍と脳実質外腫瘍の2つに大別されます。■脳実質内腫瘍では手術の役割は限定的で、多くの場合その後に放射線療法、化学療法を考慮する必要があります。■脳実質外腫瘍は、手術治療により治癒が可能な疾患です。しかし、手術が患者に大きな合併症を強いることのないように、十分な治療計画を立てなければいけない疾患です。(著者抄録)

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)