記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Vagus nerve stimulation (VNS) is a well-known palliative therapy for refractory epilepsy. However, some non-responsive patients experience persistent epileptic seizures after VNS. Aiming to identify the factors affecting response to VNS, we retrospectively analyzed the temporal relationship between VNS and ictal dis-charges through electroencephalographic and electrocorticographic monitoring in a non-responsive patient.Case description: We performed VNS in an 8-year-old boy suffering from posttraumatic epilepsy after the first presurgical evaluation. However, no therapeutic effect of VNS was noted. At age 14, we conducted the second presurgical evaluation. Electroencephalographic monitoring showed that 42% of ictal events originating in the right occipital region had a temporal relationship between the onset of ictal discharges and VNS. Electro-corticographic monitoring with implanted subdural electrodes showed that 50% of the ictal events originating from the medial site of the occipital tentorial surface had a temporal relationship between onset and VNS.Conclusion: Our results suggest a possible relationship between VNS and the ictal discharges.

DOI： 10.1016/j.inat.2020.101066

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We devised a new surgical alternative to the conventional nasoseptal flap, a pedicled posterior septal-nasal floor flap that we named the Kegon flap. We evaluated the effectiveness of this flap for skull base reconstruction in patients with high-flow cerebrospinal fluid (CSF) leakage after sellar/parasellar tumor resection. METHODS: The Kegon flap with a novel rescue flap was designed to preserve blood flow and mucosa anterior to the nasal septum and to avoid flap damage during surgery. We retrospectively evaluated postoperative flap perfusion with T1-weighted contrast-enhanced magnetic resonance imaging and characterized complications and wound healing in 5 patients who experienced high-flow CSF leakage after sellar/parasellar tumor resection requiring reconstruction. RESULTS: Postoperative T1-weighted contrast-enhanced magnetic resonance imaging demonstrated good flap perfusion in all patients. The area reconstructed with the Kegon flap healed within the first month following surgery. No postoperative CSF leakage or nasal hemorrhage was observed. There was no perforation of the anterior nasal septum after surgery. The mucosal defect had completely epithelialized in all patients by 3 months after surgery. There were no instances of prolonged nasal crusting or any subjective decrease in olfactory function 3 months after surgery. CONCLUSIONS: The use of a Kegon flap with a novel rescue flap was effective and helped preserve nasal structure and function in patients undergoing skull base reconstruction after sellar/parasellar tumor resection associated with high-flow CSF leakage.

DOI： 10.1016/j.wneu.2021.02.138

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To examine the utility of FDG-PET/MRI in patients with epilepsy by comparing the diagnostic accuracy of PET/MRI and PET/CT in epileptogenic zone (EZ) detection. METHODS: This prospective study included 31 patients (17 males, 14 females) who underwent surgical resection for EZ. All patients were first scanned using FDG-PET/CT followed immediately with FDG-PET/MRI. Two series of PET plus standalone MR images were interpreted independently by five board-certified radiologists. A 4-point visual score was used to assess image quality. Sensitivities and visual scores from both PETs and standalone MRI were compared using the McNemar test with Bonferroni correction and Dunn's multiple comparisons test. RESULTS: The EZs were confirmed histopathologically via resection as hippocampal sclerosis (n = 11, 35.5%), gliosis (n = 8, 25.8%), focal cortical dysplasia (n = 6, 19.4%), and brain tumours (n = 6, 19.4%) including cavernous haemangioma (n = 3), dysembryoplastic neuroepithelial tumour (n = 1), ganglioglioma (n = 1), and polymorphous low-grade neuroepithelial tumour of the young (n = 1). The sensitivity of FDG-PET/MRI was significantly higher than that of FDG-PET/CT and standalone MRI (FDG-PET/MRI vs. FDG-PET/CT vs. standalone MRI; 77.4-90.3% vs. 58.1-64.5% vs. 45.2-80.6%, p < 0.0001, respectively). The visual scores derived from FDG-PET/MRI were significantly higher than those of FDG-PET/CT, as well as standalone MRI (2.8 ± 1.2 vs. 2.0 ± 1.1 vs. 2.1 ± 1.2, p < 0.0001, respectively). Compared to FDG-PET/CT, FDG-PET/MRI increased the visual score (51.9%, increased visual scores of 2 and 3). CONCLUSIONS: The diagnostic accuracy for the EZ detection in focal epilepsy could be higher in FDG-PET/MRI than in FDG-PET/CT. KEY POINTS: • Sensitivity of FDG-PET/MRI was significantly higher than that of FDG-PET/CT and standalone MRI (FDG-PET/MRI vs. FDG-PET/CT vs. standalone MRI; 77.4-90.3% vs. 58.1-64.5% vs. 45.2-80.6%, p < 0.0001, respectively). • Visual scores derived from FDG-PET/MRI were significantly higher than those of FDG-PET/CT and standalone MRI (2.8 ± 1.2 vs. 2.0 ± 1.1 vs. 2.1 ± 1.2, p < 0.0001, respectively). • Compared to FDG-PET/CT, FDG-PET/MRI increased the visual score (51.9%, increased visual scores of 2 and 3).

DOI： 10.1007/s00330-020-07389-1

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.25259/SNI_626_2020

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Limited dorsal myeloschisis (LDM) is characterized by a fibroneural stalk linking the skin lesion to the underlying spinal cord. LDMs originally have either saccular or nonsaccular (flat) skin lesion; we recently demonstrated the human tail-like cutaneous appendage at the lumbosacral region, which is a morphological variation. We surgically treated a 6-month-old girl with a cutaneous appendage at the upper thoracic region; the appendage was a continuation of the LDM stalk. Surgery involving cord untethering and cosmetic removal of the appendage was performed. Histopathologically, small nests of glial fibrillary acidic protein-immunopositive neuroglial tissues were observed in the appendage and in the intradural LDM stalk. Clinicians should be aware of further morphological variations of thoracic lesions associated with LDM.

DOI： 10.1016/j.inat.2020.100823

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Here, we report a juvenile (18-year-old male) case of epilepsy-associated, isocitrate dehydrogenase wild-type/histone 3 wild-type diffuse glioma with a rare BRAF mutation and a focal atypical feature resembling diffuse astrocytoma. The patient presented with refractory temporal lobe epilepsy. Subsequently, magnetic resonance imaging revealed a hyperintense lesion in the right temporal lobe on fluid attenuated inversion recovery images. The patient underwent right lateral temporal lobectomy and amygdalohippocampectomy. Histopathologically, the tumor showed isomorphic, diffuse, infiltrative proliferation of glial tumor cells and intense CD34 immunoreactivity. The tumor cells were immunonegative for isocitrate dehydrogenase 1 (IDH1) R132H and BRAF V600E. Notably, the tumor cells showed the lack of nuclear staining for α-thalassemia/mental retardation syndrome, X-linked (ATRX). In addition, the Ki-67 labeling index, using a monoclonal antibody MIB-1, was elevated focally at tumor cells with p53 immunoreactivity. Molecular analyses identified a BRAFA598T mutation, the first case reported in a glioma. BRAFA598T is predicted to result in loss of kinase action; however, inactive mutants can stimulate mitogen-activated protein kinase kinase (MEK)-extracellular signal-regulated kinase (ERK) signaling through CRAF activation. Thus, according to the recent update of the consortium to inform molecular and practical approaches to central nervous system tumor taxonomy (cIMPACT-NOW update 4), our case is also compatible with diffuse glioma with the mitogen-activated protein kinase (MAPK) pathway alteration. Thorough immunohistochemical and molecular studies are necessary for diagnosis of epilepsy-associated, diffuse gliomas. Partial resemblance in histopathological and molecular genetic features to diffuse astrocytoma also calls for attention.

DOI： 10.1111/neup.12693

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.25259/SNI_709_2020

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/neup.12693

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Lateralized periodic discharges (LPDs), which constitute an abnormal electroencephalographic (EEG) pattern, are most often observed in critically ill patients with acute pathological conditions, and are less frequently observed in chronic conditions such as focal epilepsies, including temporal lobe epilepsy (TLE). Here we aim to explore the pathophysiological mechanism of LPD in TLE. METHODS: We retrospectively selected 3 patients with drug-resistant TLE who simultaneously underwent EEG and electrocorticography (ECoG) and demonstrated LPDs. We analyzed the correlation between the EEG and ECoG findings. RESULTS: In patients 1 and 2, LPDs were recorded in the temporal region of the scalp during the interictal periods, when repeated spikes followed by slow waves (spike-and-wave complexes; SWs) and periodic discharges (PDs) with amplitudes of >600 to 800 µV appeared in the lateral temporal lobe over a cortical area of >10 cm2. In patient 3, when the ictal discharges persisted and were confined to the medial temporal lobe, repeated SWs were provoked on the lateral temporal lobe. When repeated SWs with amplitudes of >800 µV appeared in an area of the lateral temporal lobe of >10 cm2, the corresponding EEG discharges appeared on the temporal scalp. CONCLUSIONS: LPDs in patients with TLE originate from repeated SWs and PDs of the lateral temporal lobe, which might represent a highly irritable state of the lateral temporal cortex during both interictal and ictal periods.

DOI： 10.1177/1550059420972266

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A small, incidental filar cyst associated with terminal lipoma is thought to be caused by failure of secondary neurulation; however, the precise embryologic background is not fully understood. Retained medullary cord (RMC) also originates from late arrest of secondary neurulation. The central feature of RMC histopathology is a central canal-like ependyma-lined lumen with surrounding neuroglial core. CASE DESCRIPTION: We surgically treated 2 patients with a large cyst in the rostral part of the filum and lipoma in the caudal filum. At cord untethering surgery, the filum was severed at the caudal part of the cyst. Histopathologically, the filar cyst was the cystic dilatation of the central canal-like structure at the marginal part of the lipoma. The central canal-like structure was continuous caudally in the lipoma, and its size decreased toward the caudal side. CONCLUSIONS: The present findings support the idea raised by Pang et al that entities such as filar cyst, terminal lipomas, and RMC can all be considered consequences of a continuum of regression failure occurring during late secondary neurulation.

DOI： 10.1016/j.wneu.2020.07.026

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose: Limited dorsal myeloschisis (LDM) is thought to arise from focal incomplete disjunction between the cutaneous and neural ectoderm during primary neurulation, while spinal lipoma of dorsal-type (dorsal lipoma) arises from premature disjunction. Thus, simultaneous occurrence of an LDM and dorsal lipoma are not surprising, and may represent slightly different perturbations of disjunction caused by the same insult in neighboring loci. However, the clinicopathological findings of the LDM with dorsal lipoma have not been fully determined.Methods: Of 21 patients with LDM, 3 (14.3%) had dorsal lipoma. We retrospectively analyzed the clinicopathological findings of these 3 patients, especially the histopathological distribution of the fibrocollagenous LDM tract and fibroadipose tissue of the lipoma.Results: Patients 1 and 2 had flat skin lesions, while patient 3 had a human tail-like cutaneous appendage. In the tethering stalks linking the skin lesion at the lumbosacral lesion to the low-lying conus medullaris of the three patients, fibrocollagenous tissues embedding adipose tissues at the subcutaneous site, and with abundant adipose tissues at the extradural site, were changed to fibroadipose tissue at the intradural site. While glial fibrillary acidic protein-immunopositive neuroglial tissues were observed in 2 (patients 1 and 2), peripheral nerve fibers were observed in every stalk. Smooth muscle fibers were noted in patient 1, while a large amount of striated muscle fibers were seen in patients 2 and 3.Conclusion: These cases showed various tissues with different origins in the stalk. There may also be a seamless continuation between fibrocollagenous LDM tissue at the distal site and lipomatous tissue at the proximal site. Peripheral nerve fibers and smooth muscle fibers of neural crest origin may be dragged into the stalk during incomplete disjunction, while the striated muscle fibers of mesodermal origin may enter the stalk along with the lipomatous tissues during premature disjunction.

DOI： 10.1016/j.inat.2020.100781

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Magnetic resonance imaging (MRI), including perfusion MRI with three-dimensional pseudocontinuous arterial spin labeling (ASL) and diffusion-weighted imaging (DWI), are applied in the periictal (including ictal and postictal) detection of circulatory and metabolic consequences associated with epilepsy. Our previous report revealed that periictal hyperperfusion can firstly be detected on ASL, and cortical hyperintensity of cytotoxic edema secondarily obtained on DWI from an epileptically activated cortex. Although magnetic resonance angiography (MRA) using three-dimensional time-of-flight is widely used to evaluate arterial circulation, few MRA studies have investigated the detection of periictal hyperperfusion. Methods: To compare the ability of ASL and MRA to detect the periictal hyperperfusion on visual inspection, we retrospectively selected 23 patients who underwent ASL and MRA examination on both periictal and interictal periods. Patients were divided into the following three groups according to periictal ASL/DWI findings: positive ASL and DWI findings (n = 13, ASL+/DWI+ group), positive ASL and negative DWI findings (n = 5, ASL+/DWI- group), and negative ASL and DWI findings (n = 5, ASL-/DWI- group). Results: Periictal hyperperfusion on MRA was detected in 6 out of 13 patients (46.2%) in the ASL+/DWI+ group, but not in all patients in the ASL+/DWI- and ASL-/DWI- groups. Furthermore, in 5 out of these 6 patients, the diagnosis of periictal MRA hyperperfusion could not be made without referring to interictal MRA and/or periictal ASL findings, because the periictal MRA findings were so minute. Conclusion: The minimum requirement for the development of periictal MRA hyperperfusion is that its epileptic event is intense enough to induce the uncoupling between metabolism and circulation, with the induction of glutamate excitotoxity, and severe cytotoxic edema on DWI. ASL is vastly superior to MRA in the detection of periictal hyperperfusion.

DOI： 10.1016/j.ensci.2020.100233

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/neup.12408

記述言語：英語  

Background: Several authors have reported the various patterns of coexistence of spinal dermoid cysts and lipoma; however, the association of intramedullary dermoid cysts with lipoma is extremely rare. In addition to the embryological and pathological aspects of this rare condition, we discuss the feasibility of combined microscopic and endoscopic procedures for the management of intramedullary dermoid cysts.Case description: An 18-year-old woman presented with right buttock pain. Magnetic resonance (MR) imaging revealed a large, well-defined mass extending from L2 to L4. The conus medullaris terminated in the mass and was tethered by a fatty filum. According to the signal intensities on MR images, the mass could be divided into two components. The upper component existed intramedullary and was iso- to hypo-intense relative to the spinal cord on T1-weighted images. The lower component exhibited homogeneous hyper-intensity signals on both T1and T2-weighted images. Partial removal of the cyst wall and evacuation of the cyst contents followed by untethering of the spinal cord were performed by the combined microscopic and endoscopic procedures. The patient's symptoms were relieved postoperatively and pathological studies confirmed the diagnosis of dermoid cysts associated with lipoma.Conclusions: We present a rare case of an embryological "collision" of an intramedullary dermoid cyst associated with filar lipoma underlining the spectrum of intradural pathologies in spinal dysraphism. Surgical management is creative in these circumstances and multimodal. Our surgical management shows that the use of endoscopes can be effective in the surgical removal of long sectional spinal dermoid cysts.

DOI： 10.1016/j.inat.2019.100546

記述言語：日本語  

症例1は日齢1の女児で、胎児MRIでアーノルドキアリ奇形(II型)と診断され、妊娠38週に帝王切開術で出生した。出生体重は2776gで開放性二分脊椎を認めた。脊髄形成術と髄膜瘤還納術および硬膜再建術後、腰仙部に3.5×3cmの皮膚欠損が生じ、術前のカラードプラエコーで確認した上臀動脈穿通枝皮弁を挙上し欠損部へ被覆した。症例2は日齢2の女児で、症例1と同様に妊娠36週に帝王切開で出生し、出生体重は2328gで開放性二分脊椎を認めた。症例1と同様に手術を施行したが術後7×5cmの皮膚欠損が生じ、術前のカラードプラエコーで確認した背側肋間動脈穿通枝皮弁を挙上し皮膚欠損を被覆した。術後皮弁採取部の一部に創離開を認めたが、生後16日に再縫合した。両症例とも皮弁は全生着し、術後6ヵ月で創部の状態は良好である。

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Recently, brain-computer interfaces, combined with feedback systems and goal-oriented training, have been investigated for their capacity to promote functional recovery after stroke. Accordingly, we developed a brain-computer interface-triggered robotic hand orthosis that assists hand-closing and hand-opening for post-stroke patients without sufficient motor output. In this system, near-infrared spectroscopy is used to monitor the affected motor cortex, and a linear discriminant analysis-based binary classifier estimates hand posture. The estimated posture then wirelessly triggers the robotic hand orthosis. For better performance of the brain-computer interface, we tested feature windows of different lengths and varying feature vector compositions with motor execution data from seven neurologically intact participants. The interaction between a feature window and a delay in the hemodynamic response significantly affected both classification accuracy (Matthew Correlation Coefficient) and detection latency. The 'preserving channels' feature vector was able to increase accuracy by 13.14% and decrease latency by 29.48%, relative to averaging. Oxyhemoglobin combined with deoxyhemoglobin improved accuracy by 3.71% and decreased latency by 6.01% relative to oxyhemoglobin alone. Thus, the best classification performance resulted in an accuracy of 0.7154 and a latency of 2.8515 s. The hand rehabilitation system was successfully implemented using this feature vector composition, which yielded better classification performance.

DOI： 10.3390/app9183845

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Limited dorsal myeloschisis (LDM) is characterized by a fibroneural stalk linking the skin lesion to the underlying spinal cord. On account of the external skin lesion, all LDMs are either flat (nonsaccular) or saccular, and a human tail-like cutaneous appendage has not been reported. METHODS: In our 14 LDM patients, 2 had tail-like appendages. We retrospectively analyzed the relationship between the appendage and the LDM tract from the clinicopathological findings of these 2 patients. RESULTS: Preoperative magnetic resonance imaging including three-dimensional heavily T2-weighted images demonstrated an intradural tethering tract, but failed to reveal the precise communication with the appendage. However, surgery revealed the extradural and intradural slender stalk, starting at the base of appendage and running through the myofascial defect. Histological examination demonstrated that there was a tight anatomical relationship between the fibroadipose tissue of the appendage and the fibrocollagenous LDM stalk. CONCLUSION: When there is potential for an LDM stalk in patients with an appendage, a meticulous exploration of the stalk leading from an appendage is required. Clinicians should be aware of possible morphological variations of skin lesions associated with LDM.

DOI： 10.1007/s00381-019-04071-w

記述言語：英語  

The article was recently published, contained error. Author name "Nobutaka Mukai" should be "Nobutaka Mukae". Given in this article is the correct name.

DOI： 10.1007/s00381-019-04111-5

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Limited dorsal myeloschisis (LDM) is characterized by two invariable features: a focal closed neural tube defect and a fibroneural stalk linking the skin lesion to the underlying spinal cord. Although detailed histopathological findings of the LDM stalk were originally described by Pang et al., the precise relationship between the histopathological findings and clinical manifestations including intraoperative findings has not been fully determined. METHODS: We retrospectively analyzed the histopathological findings of the almost entire stalk and their relevance to the clinical manifestations in six Japanese LDM patients with flat skin lesions. RESULTS: Glial fibrillary acidic protein (GFAP)-immunopositive neuroglial tissues were observed in three of the six patients. Unlike neuroglial tissues, peripheral nerve fibers were observed in every stalk. In four patients, dermal melanocytosis, "Mongolian spot," was seen surrounding the cigarette-burn lesion. In three of these four patients, numerous melanocytes were distributed linearly along the long axis of the LDM stalk, which might represent migration of melanocytes from trunk neural crest cells during formation of the LDM stalk. CONCLUSION: Immunopositivity for GFAP in the LDM stalk was observed in as few as 50% of our patients, despite the relatively extensive histopathological examination. We confirm that the clinical diagnosis of LDM should be made based on comprehensive histopathological examination as well as clinical manifestations. The profuse network of peripheral nerve fibers in every stalk and the high incidence of melanocyte accumulation associated with dermal melanocytosis might assist the histopathological diagnosis of LDM.

DOI： 10.1007/s00381-018-3870-2

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: An ependyma-lined canal with surrounding neuroglial tissues can be present in lumbosacral lipomatous malformations; however, the precise embryological significance is still unclear. Method: Six out of 50 patients with lipomatous malformations had ependymal structures. We retrospectively analyzed the clinical, neuroradiological, and histological findings of these patients to demonstrate the relationship with the embryological background of the retained medullary cord (RMC), which normally regresses, but was retained here because of late arrest of secondary neurulation. Results: Five (13.9%) of 36 patients with filar and caudal types and 1 of 3 lipomyelomeningoceles had ependymal structures, while none with dorsal and transitional types had these tissues. Histologically, the ependymal structures surrounded by neuroglial tissue and containing various amounts of adipose tissue bear a striking resemblance to the ependymal structures in RMC. Conclusion: The 13.9% incidence of association between the ependymal structures and filar and caudal types is thought to be because of second ary neurulation failure with the same embryological background as that of RMC. Dorsal and transitional types, resulting from primary neurulation failure, therefore, did not have ependymal structures.

DOI： 10.1159/000494029

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

Robotic neurorehabilitation that provides the support movement for the affected limb triggered by brain signal has a great potential to improve the recovery for post-stroke patients. We are studying a hand rehabilitation robotic system that a robotic hand orthosis is moved triggered by Near-Infrared Spectroscopy. In this paper, we propose a new method to classify the motion intention out of the NIRS signal. The classification accuracy that is an essential factor to extract the users' motion intension, was significantly improved by parameterizing the individual hemodynamic response.

DOI： 10.1109/CBS.2018.8612169

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose: It is well known that bony and cartilaginous tissues can be present in lumbosacral lipomas; however, the relationship between their presence and clinical features has not been demonstrated. Methods: Five (10.4%) out of 48 patients had osteochondral tissues in lipomas. We retrospectively analyzed the clinical, neuroradiological, and histological findings of these patients. Results: Five (45.5%) of 11 patients with dorsal and transitional type lipomas had osteochondral tissues, while none with caudal and filar type lipomas had these tissues. Presurgical imaging demonstrated that the osteochondral tissue was located in a large subcutaneous lipoma dorsal to the bifid vertebral column. Histologically, mature bone with hematopoietic marrow and hyaline cartilage were observed in 3 and 2 patients, respectively. Conclusions: The high incidence of association of osteochondral tissues with dorsal and transitional type lipomas is thought to be the result of primary neurulation failure with invasion of mesenchymal tissues. Caudal and filar type lipomas, resulting from secondary neurulation failure, thus did not have osteochondral tissue.

DOI： 10.1159/000490391

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Magnetic resonance imaging (MRI), including perfusion MRI with arterial spin labeling (ASL) and diffusion-weighted imaging (DWI), are applied in the periictal detection of circulatory and metabolic consequences associated with epilepsy. Although previous report revealed that prolonged ictal hyperperfusion on ASL can be firstly detected and cortical hyperintensity of cytotoxic edema on DWI secondarily obtained from an epileptically activated cortex, the hemodynamic state of the periictal hyperperfusion has not been fully demonstrated. Methods study-1: We retrospectively analyzed the relationship between seizure manifestations and the development of periictal MRI findings, in Case 1 with symptomatic partial epilepsy, who underwent repeated periictal ASL/DWI examination for three epileptic ictuses (one examination for each ictus). Study-2: We evaluated the hemodynamic state of periictal hyperperfusion with the ASL technique using a dual postlabeling delay (PLD) of 1.5 and 2.5 s in nine patients, according to the presence or absence of the localized epileptogenic lesion (EL) on conventional 3 T-MRI, who were divided into Group EL+ (six patients) and Group EL- (three patients). Results: Study-1 confirmed that the stratified representation of the periictal MRI findings depends on the time interval between the ictal cessation and MRI examination in addition to the magnitude and duration of the epileptic activity. In Study-2, two types of periictal hyperperfusion were noted. In all six Group EL+ patients, periictal ASL findings showed "fast flow type". Markedly increased ASL signals were noted at the epileptically activated cortex, having a tight topographical relationship with EL, on ASL with a PLD of 1.5 s, which is decreased on ASL with a PLD of 2.5 s. In all three Group EL- patients, periictal ASL findings showed "gradual flow type", which is characterized by gradual signal increase of the epileptically activated cortex on ASL with a PLD of 1.5 and 2.5 s. Conclusion: We confirmed that ASL hyperperfusion is superior to DWI in the periictal detection of epileptic events. ASL with dual PLD offers the ability to document two types of hemodynamics of periictal hyperperfusion.

DOI： 10.1016/j.ensci.2018.06.001

記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To investigate the radiological features on computed tomography (CT) of brain metastasis (BM) from epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: Thirty-four patients with NSCLC with BMs who underwent surgical resection of the BMs at the Department of Neurosurgery, Kyushu University from 2005 to 2016 were enrolled in the study. The EGFR statuses of the 34 BMs were investigated. Radiological features, including the number, size, and location of the tumor, were delineated by CT. RESULTS: Patients with EGFR-mutated BMs had significantly higher frequencies of multiple metastases than those with the non-EGFR-mutated type (p=0.042). BMs harboring mutations in EGFR were more frequently observed in the central area of the brain compared to those without mutations in EGFR (p=0.037). CONCLUSION: Careful follow-up of patients with EGFR-mutated NSCLC may be necessary given the high frequencies of multiple BMs and their location in the central area of the brain.

DOI： 10.21873/anticanres.12653

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: This cross-sectional survey explored the characteristics and outcomes of direct oral anticoagulant (DOAC)-associated nontraumatic intracerebral hemorrhages (ICHs) by analyzing a large nationwide Japanese discharge database. METHODS: We analyzed data from 2,245 patients who experienced ICHs while taking anticoagulants (DOAC: 227; warfarin: 2,018) and were urgently hospitalized at 621 institutions in Japan between April 2010 and March 2015. We compared the DOAC- and warfarin-treated patients based on their backgrounds, ICH severities, antiplatelet therapies at admission, hematoma removal surgeries, reversal agents, mortality rates, and modified Rankin Scale scores at discharge. RESULTS: DOAC-associated ICHs were less likely to cause moderately or severely impaired consciousness (DOAC-associated ICHs: 31.3%; warfarin-associated ICHs: 39.4%; p = 0.002) or require surgical removal (DOAC-associated ICHs: 5.3%; warfarin-associated ICHs: 9.9%; p = 0.024) in the univariate analysis. Propensity score analysis revealed that patients with DOAC-associated ICHs also exhibited lower mortality rates within 1 day (odds ratio [OR] 4.96, p = 0.005), within 7 days (OR 2.29, p = 0.037), and during hospitalization (OR 1.96, p = 0.039). CONCLUSIONS: This nationwide study revealed that DOAC-treated patients had less severe ICHs and lower mortality rates than did warfarin-treated patients, probably due to milder hemorrhages at admission and lower hematoma expansion frequencies.

DOI： 10.1212/WNL.0000000000005207

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A retained medullary cord (RMC) is a rare closed spinal dysraphism with a robust elongated neural structure continuous from the conus and extending to the dural cul-de-sac. One case extending down to the base of a subcutaneous meningocele at the sacral level has been reported. CLINICAL PRESENTATION: We report on three cases of closed spinal dysraphism, in which a spinal cord-like tethering structure extended out from the dural cul-de-sac and terminated at a skin-covered meningocele sac in the sacrococcygeal region, which was well delineated in curvilinear coronal reconstructed images of 3D-heavily T2-weighted images (3D-hT2WI). Intraoperative neurophysiology revealed the spinal cord-like tethering structure was nonfunctional, and histopathology showed that it consisted of central nervous system tissue, consistent with RMC. The tethering structure histologically contained a glioneuronal core with an ependymal-like lumen and smooth muscle, which may indicate developmental failure during secondary neurulation. CONCLUSIONS: When the RMC extending to a meningocele is demonstrated with the detailed magnet resonance imaging including 3D-hT2WI, decision to cut the cord-like structure for untethering of the nervous tissue should be made under careful intraoperative neurophysiological monitoring.

DOI： 10.1007/s00381-017-3644-2

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Craniopharyngioma consists of adamantinomatous and papillary subtypes. Recent genetic analysis has demonstrated that the two subtypes are different, not only in clinicopathological features, but also in molecular oncogenesis. Papillary craniopharyngioma (pCP) is characterized by a BRAF mutation, the V600E (Val 600 Glu) mutation. Adamantinomatous craniopharyngioma (aCP) can be distinguished by frequent β-catenin gene (CTNNB1) mutations. Although these genetic alterations can be a diagnostic molecular marker, the precise frequency of these mutations in clinical specimens remains unknown. In this study, we first evaluated BRAF V600E and CTNNB1 mutations in four and 14 cases of pCP and aCP, respectively, using high-resolution melting analysis followed by Sanger sequencing. The results showed that 100% (4/4) of pCP cases had BRAF V600E mutations, while 78% (11/14) of the aCP cases had CTNNB1 mutations, with these genetic alterations being subtype-specific and mutually exclusive. Second, we evaluated BRAF V600E and CTNNB1 mutations by immunohistochemical analysis (IHC). All pCP cases showed positive cytoplasmic staining with the BRAF V600E-mutant antibody (VE-1), whereas 86% (12/14) of aCP cases showed positive cytoplasmic and nuclear staining for CTNNB1, suggesting a CTNNB1 mutation. Only one case of wild-type CTNNB1 on the DNA analysis showed immunopositivity on IHC. We did not detect a coexistence of BRAF V600E and CTNNB1 mutations in any single tumor, which indicated that these genetic alterations were mutually exclusive. We also report our modified IHC protocol for VE-1 staining, and present the possibility that BRAF V600E mutations can be used as a diagnostic marker of pCP in the differentiation of Rathke cleft cyst with squamous metaplasia.

DOI： 10.1111/neup.12408

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The term limited dorsal myeloschisis (LDM) was used by Pang et al. (2010) to describe a distinct clinicopathological entity. LDMs are characterized by two invariable features: a focal-closed neural tube defect and a fibroneural stalk that links the skin lesion to the underlying spinal cord. METHODS: We retrospectively analyzed the neurosurgical pathologic findings of four LDM patients. RESULTS: Case 1 had a saccular skin lesion with nonterminal abortive myelocystocele at T11-12. Cases 2, 3, and 4 had a non-saccular (flat) skin lesion in the lumbosacral region. The morphologic features of the lesion in case 2 were those of meningocele manque. Cases 3 and 4 had accompanying non-LDM anomalies, caudal-type lipoma and type II split-cord malformation with neurenteric cyst, respectively. At preoperative diagnosis of the LDM stalk, magnetic resonance imaging, including 3D heavily T2-weighted image was useful; however, minute findings were often missed in the complicated cases 3 and 4. All patients had a favorable outcome following untethering of the stalk from the cord. The central histopathological feature of the LDM stalk is neuroglial tissue in the fibrocollagenous band; however, the stalk in cases 2 and 4 did not have glial fibrillary acidic protein-immunopositive neuroglial tissues. CONCLUSIONS: Therefore, the diagnosis of LDM should be made based on comprehensive evaluation of histologic and clinical findings.

DOI： 10.1007/s00381-017-3625-5

記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To investigate the association between positivity for programmed cell death-ligand 1 (PD-L1) in brain metastases (BM) and the prognosis or clinical factors in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Thirty-two patients with surgically resected brain-metastatic NSCLC were enrolled. The PD-L1 expression in BM was analyzed using the antibody against human PD-L1 (clone SP142). The PD-L1 positivity was defined as PD-L1 expression on brain-metastatic tumor cells of ≥5%. RESULTS: Seven (21.9%) out of 32 patients showed PD-L1 positivity in BM. The PD-L1-positive BM group had a significantly shorter brain-specific disease-free survival than the PD-L1-negative BM group (p<0.05). PD-L1 positivity in BM was significantly associated with a heavy smoking history and the administration of radiotherapy for BM before surgery (p<0.05 and p<0.05, respectively). CONCLUSION: The PD-L1 expression in BM from NSCLC may be associated with local recurrence following surgery, and the smoking- or radiotherapy-derived effects.

DOI： 10.21873/anticanres.12258

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Lumbosacral lipomas are the most common form of occult spinal dysraphism. The development of lumbosacral lipomas is from the premature disjunction of the neural tube from the surrounding ectoderm, leaving the neural plate open posteriorly and allowing for the infiltration of mesodermal tissue, including fatty tissue. Since lumbosacral lipomas are a common cause of spinal cord tethering that can lead to progressive neurological deficits, prophylactic neurosurgery for lumbosacral lipomas, including untethering of the spinal cord, is recommended. We briefly review the embryology, classification, clinical presentation, imaging evaluation, surgical indication, neurosurgical management and pathological examination that are involved in recognizing these complicated malformative pathologies.

DOI： 10.1111/neup.12382

記述言語：英語   掲載種別：研究論文（その他学術会議資料等）  

There is a demand for a new neurorehabilitation modality with a brain-computer interface for stroke patients with insufficient or no remaining hand motor function. We previously developed a robotic hand rehabilitation system triggered by multichannel near-infrared spectroscopy (NIRS) to address this demand. In a preliminary prototype system, a robotic hand orthosis, providing one degree-of-freedom motion for a hand's closing and opening, is triggered by a wireless command from a NIRS system, capturing a subject's motor cortex activation. To examine the feasibility of the prototype, we conducted a preliminary test involving six neurologically intact participants. The test comprised a series of evaluations for two aspects of neurorehabilitation training in a real-time manner: classification accuracy and execution time. The effects of classification-related factors, namely the algorithm, signal type, and number of NIRS channels, were investigated. In the comparison of algorithms, linear discrimination analysis performed better than the support vector machine in terms of both accuracy and training time. The oxyhemoglobin versus deoxyhemoglobin comparison revealed that the two concentrations almost equally contribute to the hand motion estimation. The relationship between the number of NIRS channels and accuracy indicated that a certain number of channels are needed and suggested a need for a method of selecting informative channels. The computation time of 5.84 ms was acceptable for our purpose. Overall, the preliminary prototype showed sufficient feasibility for further development and clinical testing with stroke patients.

DOI： 10.1109/ICORR.2017.8009239

記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To investigate the discordance in the programmed cell death-ligand 1 (PD-L1) expression between primary and metastatic tumors and analyze the association between the discordance and the clinical factors in non-small cell lung cancer (NSCLC) patients. PATIENTS AND METHODS: Twenty-one NSCLC patients who underwent surgery or biopsy for paired primary and metastatic lesions at our Institution from 2005 to 2016 were analyzed. Lesions with the PD-L1 expression being ≥5% were considered PD-L1-positive. RESULTS: The metastatic sites included the brain (n=16), adrenal gland (n=3), spleen (n=1) and jejunum (n=1). Negative conversion of the primary PD-L1-positive NSCLC and positive conversion of the primary PD-L1-negative NSCLC were observed in 3 (14%) and 2 (10%) cases, respectively. Radiotherapy for the metastatic brain lesion before its resection showed a significant relationship with the positive conversion of the primary PD-L1-negative NSCLC (p=0.048). CONCLUSION: Radiotherapy-derived effects may contribute to the positive conversion of the primary PD-L1-negative NSCLC.

DOI： 10.21873/anticanres.11813

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The utility of corticospinal tract (CST)-tractography-integrated navigation was reported for brain tumors near pyramidal tracts. However, the efficacy of arcuate fasciculus (AF)-tractography-integrated navigation is unclear. Awake craniotomy is recommended to preserve language function for glioma located near the language area, although the patients' condition can limit its application. In such cases, AF-tractography-integrated navigation may help protect neurological function.Methods: We performed a retrospective analysis of AF-tractography-integrated navigation. We evaluated 11 patients who underwent glioma surgery near the language area using AF-tractography-integrated navigation. Six patients received intraoperative awake language functional mapping, whereas five did not due to adverse preoperative or intraoperative conditions. Language function was evaluated using the Western Aphasia Battery or Standard Language Test of Aphasia both preoperatively and postoperatively (2-4 weeks and 2-3 months after surgery).Results: Extent of resection (EOR) ranged from 59.5% to 100% (mean 82.1%). Language function at 2-3 months after surgery was improved in one patient, intact in nine, and moderately disturbed in one compared with preoperative function. Among the non-awake craniotomy group, EOR ranged from 78.7% to 100% (mean 89.82%). Language function at 2-3 months after surgery was improved in one patient, intact in three, and moderately disturbed in one, in whom tumor removal very close to the AF tract was performed following preoperative patient's intent.Conclusions: AF-tractography-integrated navigation is useful for glioma surgery near the language area, especially for patients with unsuitable conditions for awake craniotomy. (C) 2016 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license.

DOI： 10.1016/j.inat.2016.11.003

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Parietal atretic cephalocele (AC) and its associated intracranial venous anomalies, such as vertical embryonic positioning of the straight sinus (VEP of SS), have, in previous reports, been exclusively restricted to the midline. CLINICAL PRESENTATION: We report a patient with lateralized parietal AC on the right side. The AC was in the shape of a tadpole, with a large head and a long tail, extending to the proximity of the right external canthus, where a lacrimal gland fistula was observed. The superior sagittal sinus and VEP of SS were also displaced to the right side, although the sagittal suture was located at the midline. Schizencephalic clefts in the right posterior cortex were also observed. CONCLUSION: The parietal AC, which was initially located in the midline, could conceivably have been displaced to the right side by other developmental processes. However, the relationship between lateralized AC and associated multiple anomalies on the ipsilateral side is difficult to explain monogenetically. Our case study indicates that AC might have a broader spectrum of clinical symptoms than was once thought to be the case.

DOI： 10.1007/s00381-016-3254-4

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Three-dimensional (3D) high-definition endoscopy is an innovative technical advancement that helps surgeons gain precise depth perception and spatial recognition during endoscopic surgery. Here, we describe a new dual optical channel 3D neuroendoscopic technique and its clinical application. We performed endoscopic endonasal surgery on 88 patients using 3D and two-dimensional (2D) endoscopes in conjunction. We evaluated the usefulness of stereoscopic images acquired by dual optical channel 3D endoscopy during endoscopic surgery and compared the image resolution between dual optical channel 3D endoscopy and 2D endoscopy. Additionally, we compared the stereoscopic images acquired by dual optical channel and Visionsense 3D endoscopy in three cases. Combination surgery using 3D and 2D endoscopy was found to be safe. Stereoscopic images were useful in several surgical steps, especially in recognition of complex bony structures, bone drilling, and suprasellar manipulation. The magnitude of binocular disparity was greater in dual optical channel 3D endoscopy than in Visionsense 3D endoscopy. Stereoscopic images acquired by dual optical channel 3D neuroendoscopy were of adequate quality and were useful for endoscopic endonasal surgery. In consideration of its lower image resolution compared to that of 2D high-definition endoscopy, dual optical channel 3D neuroendoscopy can be applied as an assistive technique in endoscopic endonasal surgery. The magnitude of binocular disparity is one of the key factors to be considered for evaluation of the clinical significance of 3D endoscopy. (C) 2016 The Authors. Published by Elsevier B.V.

DOI： 10.1016/j.inat.2016.08.001

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The use of antithrombotic agents such as anticoagulants and antiplatelet agents is widespread, and the opportunities to treat patients with chronic subdural hematoma (CSDH) under antithrombotic therapy are growing. However, whether antithrombotic therapy contributes to postoperative complications and recurrences of CSDH and how these agents should be managed in the surgical treatment of CSDH remains unclear. METHODS: We retrospectively analyzed 150 consecutive patients with CSDH who underwent neurosurgical interventions at Kyushu Rosai Hospital from 2011 to 2015 and followed them for more than 3 months. RESULTS: Of the 150 study patients, 44 received antithrombotic therapy. All anticoagulants and 76% of the antiplatelet agents were discontinued before surgical treatment of CSDH and resumed within 1 week except in 4 patients whose treatment was terminated and 7 patients who developed postoperative complications or underwent reoperations before resumption of these agents. Postoperative hemorrhagic complications associated with surgical treatment of CSDH occurred in 8 patients (5.3%), and there was no significant difference in the incidence of these complications between patients with and without antithrombotic therapy (6.8% vs. 4.7%, respectively; p=0.90). Postoperative thromboembolic complications occurred in 5 patients (5.4%), including 4 patients with antithrombotic therapy; these complications developed before resumption of antithrombotic agents in 2 patients. There was a significant difference in the incidence of postoperative thromboembolic complications between patients with and without antithrombotic therapy (9.1% vs. 0.9%, respectively; p=0.04). There were no significant differences in the incidence of radiographic deterioration or reoperation of ipsilateral or contralateral hematomas between patients with and without antithrombotic therapy after surgical treatment of unilateral CSDH. CONCLUSION: A history of antithrombotic therapy was significantly correlated with the incidence of postoperative thromboembolic complications in patients with CSDH. Antithrombotic agents should be resumed as soon as possible when no hemorrhagic complication is confirmed after neurosurgical intervention for CSDH.

DOI： 10.1016/j.clineuro.2016.10.002

記述言語：日本語  

記述言語：日本語  

症例1:35歳男。転落し、全身多発骨折と重度肺挫傷の診断で人工呼吸器下に管理された。治療後、四肢の重度痙縮をきたした。リハビリテーションを継続したが改善は得られず、発症6ヵ月後に当科紹介となった。mean Ashworth scale(mean AS)は4.5で、麻痺は軽度であった。日常生活動作はKenny self-care score(KSS)34点で、痙縮のため指先で物を握ることが出来ず、肘をついた状態で車輪付き歩行器を使用し、やっと歩行ができる状態であった。頭部MRIでは、両側内包後脚に限局した淡いFluid attenuated inversion recovery高信号域を対称性に認め、バクロフェン髄腔内投与(ITB療法)のカテーテル先端は第4脊椎レベルに留置した。バクロフェン用量を50μgで開始したところ、治療開始1ヵ月目には指先で物を掴むことが可能となり、手で固定型歩行器を握って歩行可能となった。6年経過した現在は、バクロフェン用量は154μg/日で、mean ASは3.5、KSSは62点に改善し、自立した生活を送っていた。症例2:33歳男。交通事故により腹腔内大量出血をきたし、ショック状態となり、治療後に四肢の重度痙縮をきたした。症例1と同様、リハビリテーションにて改善が得られず、発症10年後に当科紹介となった。mean ASは4.5で、麻痺はごく軽度であった。日常生活動作では、KSSは66点で、指先を使う細かい作業が出来ず、手すりにつかまってゆっくり歩行できる程度であった。頭部MRIでは、両側内包後脚に限局した淡いT2高信号域を対称性に認め、カテーテル先端は第3脊椎レベルに留置した。バクロフェン用量は50μgで開始したところ、術後1ヵ月目には手すりにつかまらずにゆっくりではあるが、歩行可能となった。術後4年経過現在は、バクロフェン用量は59μg/日で、mean ASは2.0、KSSは68点と改善し、素早く安定した歩行が可能となった。

記述言語：日本語  

当院で行った18例の側頭葉てんかん(temporal lobe epilepsy;TLE)手術と35例の迷走神経刺激療法(vagal nerve stimulation;VNS)における、術後の就労・就学(就労)の改善について検討した。TLE術後の発作転帰は全例良好で、術前正規雇用8例の就労転帰はきわめて良好であった。一方、術前臨時雇用7例のうち2例が正規雇用に改善された。また、無職の3例は良好な発作転帰にもかかわらず改善はなかった。術前IQが90程度であれば術後正規雇用を期待できるが、60以下であれば無職の改善は望めなかった。すなわち、術後就労状況の改善はIQを含んだ術前の状況に左右された。一方、VNSは根治手術ではなく、著効例は3例のみであった。また、今回VNSの対象となった症例の多く、特に15歳以下の小児例26例は種々の程度の精神発達遅滞を伴っており、発作転帰にかかわらず術後の就労状況は改善されなかった。(著者抄録)

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Visionary Approach to Neurosurgery

DOI： 10.15017/1515852

記述言語：英語   掲載種別：研究論文（学術雑誌）  

"Solitary" meningioangiomatosis (MA) is a rare, benign, hamartomatous lesion of the cerebral cortex and frequently leads to epilepsy. However, the source of the epileptogenicity in meningioangiomatosis remains controversial. We report two surgically-treated meningioangiomatosis cases with medically intractable epilepsy. In both cases, chronic subdural electrocorticogram (ECoG) recordings identified the ictal onset zone on apparently normal cortex, adjacent to and/or above the meningioangiomatosis lesion, not on the meningioangiomatosis lesion itself. The ictal onset zone was resected, along with the MA lesion, and good seizure outcome was achieved. Histological examination of the ictal onset zone revealed the presence of ILAE focal cortical dysplasia (FCD) type IIIc. Our case studies suggest that in the surgical management of epilepsy with meningioangiomatosis, it is important to identify undetected, but epileptogenic, ILAE FCD Type IIIc, using preoperative multimodal examinations, including chronic ECoG recordings.

DOI： 10.1684/epd.2014.0695

記述言語：日本語  

脳神経外科領域において、ZIOSTATION2やAmiraで作成した高精密融合三次元(3D)画像を有効に術中応用する方法を考案した。CTからは主に骨や血管の情報を、MRIからは脳腫瘍、脳神経、血管、脳表の情報を、DSAからは特に血管障害症例でより詳細な血管構築の情報を得て、融合3D画像を作成した。そして術前に融合3D画像から術中のビューを予想した動画や静止画を作成しておき、術中にこれらを再生して顕微鏡/内視鏡モニター上へ提示、あるいは顕微鏡視野内表示装置を用いて顕微鏡に表示することで、術中支援を行った。本法を脳神経外科手術168名に適用し、代表例3例を提示した。いずれも術中の解剖把握には非常に有用であった。

記述言語：日本語  

手術加療を行ったmedulloblastoma13例(男7例、女5例、0.5～39歳)のMRI所見について検討した。内訳はclassic medulloblastoma(CMB)10例、desmoplastic/nodular medulloblastoma(DMB)3例であった。腫瘍発生部位はDMBの1例(小脳半球)以外は正中で、CMBでは全例第4脳室(上/下髄帆)に達し、DMBは上/下髄帆は保たれていた。MRIのT1WIではCMBの8例、DMB全例が低信号、T2WIはCMBの9例が高信号、DMBの2例が等信号であった。apparent diffusion coefficient(ADC)値はCMBの半数が高値、DMBは同等または低値で、ガドリニウム増強効果は全例に認めた。proton MR spectrographyでは、CMBの1例を除きcholine-containing compounds/creatine and phosphocreatine(Cr)の上昇、N-acetyl aspartate/Crの低下がみられた。定量的比較ではT2WIで腫瘍内の最も低いintensityを呈する部位において、DMBが有意に低値であった。

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Vagus nerve stimulation (VNS) is a palliative treatment for medically intractable epilepsy and has been covered by public health insurance in Japan since July 1, 2010. The frequency of the use of VNS during the first year of insurance coverage was determined by assessing the number of cases for which VNS was performed in Kyushu Rosai Hospital, the number of registered cases, and the questionnaire survey filled by 68 surgeons who are board certified as both epileptologists and neurosurgeons. VNS devices were placed in 98 patients from July 2010 to June 2011. These devices were placed in an average of 4.4 patients per month from July 2010 to November 2010 and in an average of 10.9 patients from December 2010 to June 2011. However, we did not observe an increasing trend. Almost all of the surgeries were performed in the Kanto (56 patients in 8 institutes) and Tokai (24 patients in 2 institutes) areas. VNS was not performed in many institutes primarily because VNS was not indicated for any of the patients. The questionnaire survey indicated that the use of VNS was likely to increase with an increase in the number of neurologists who decide on performing VNS preoperatively and regulate the conditions of the vagus nerve stimulator postoperatively. In conclusion, VNS is currently being applied in a limited number of institutes in the Kanto and Tokai areas, and a close association between the epileptologists and neurologists during preoperative and postoperative periods will increase the use of VNS.

記述言語：日本語  

難治てんかんに対する迷走神経刺激療法(VNS)導入1年後の状況について報告した。手術はすべて手術用顕微鏡下に行った。日本てんかん学会専門医ならびに日本脳神経外科学会専門医の両資格を有するてんかん外科専門医68例のうち、既に51例がVNS講習会を受講していた。アンケート調査では、外科系VNS認定医で回答した45例中VNS手術を行った者は20例で、行っている者のほうがわずかに少なかった。各人の症例数はほかの外科系VNS認定医と重複した症例も含めて、1～5例の少数例が13例、9～27例の多数例が7例と2つに分かれた。登録症例を地域別にみると関東(8施設)が56例、東海(2施設)が24例と、この2つの地域で81.6%の手術が行われていた。現在の内科系VNS認定医数は56例で、外科系VNS認定医の数47例をわずかに上回った。

掲載種別：研究論文（学術雑誌）  

記述言語：日本語  

内側側頭葉てんかん(MTLE)に対する外科手術の術前検査で、発作時頭皮上脳波だけてんかん原性域の側方性が診断できなかった例を経験した。術中頭蓋内脳波記録はMTLEに典型的な所見で、前側頭葉・海馬切除により良好な発作転帰が得られた。発作間欠時脳波、MRI、脳機能画像の側方性が一致すれば、慢性頭蓋内脳波記録を経由せずに手術を行うことができる症例があると考えられた。(著者抄録)

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語  

症例は46歳女性で、1週間前から体調不良を訴えていたが、買い物中に倒れ不穏状態となり救急搬送された。初診時、自発語なく意思疎通不能で、突発的に興奮状態となった。検査所見では甲状腺機能低下があり、C型肝炎ウイルス抗体陽性で、髄液中の単純ヘルペスウイルスDNA PCRは陰性であった。頭部MRIでは異常所見を認めず、エコーでは甲状腺はび漫性に腫大し内部は不均一で橋本病(HE)に合致する所見であった。入院後、辺縁系脳炎を疑いacyclovir 1500mg/日を投与したが、2日後には意識清明となったため脳炎は否定的と考えられacyclovirは中止し、甲状腺機能低下に対してlevothyroxine 25μg/日の投与により9日目に独歩退院となった。退院2日後に自宅にて下着姿で布団上を歩き回るところを家人に発見され再度救急搬送となった。入院時、初回入院時と同様に意思疎通不能で、突発的興奮状態となったことからHEの再燃と診断、ステロイドパルス療法(メチルプレドニゾロン1000mg/日×3日間)の施行により翌日には意識障害は改善し、プレドニゾロン40mg/日内服から開始し漸減したところ、1週間後の髄液検査では甲状腺機能も改善し、以後神経症状の悪化はみられない。以上より、本症例では2週間の間に意識障害・不穏を生じたが、初回症状は自然緩解してステロイド治療導入後は再発を認めておらず、ステロイド治療導入のタイミングが重要と考えられた。

開催年月日： 2021年2月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：Web開催   国名：日本国  

開催年月日： 2020年11月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：Web開催   国名：日本国  

開催年月日： 2020年10月

記述言語：日本語  

開催地：ハイブリッド開催（岡山・Web開催）   国名：日本国  

開催年月日： 2020年8月 - 2022年8月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：WEB開催   国名：日本国  

開催年月日： 2020年2月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：福岡   国名：日本国  

開催年月日： 2020年1月

記述言語：日本語  

開催地：浜松   国名：日本国  

開催年月日： 2019年10月 - 2019年11月

記述言語：日本語  

開催地：神戸   国名：日本国  

開催年月日： 2019年5月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：福岡   国名：日本国  

開催年月日： 2019年3月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：福岡   国名：日本国  

開催年月日： 2019年3月

記述言語：日本語  

開催地：福岡   国名：日本国  

開催年月日： 2019年2月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：福岡   国名：日本国  

開催年月日： 2019年1月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：東京   国名：日本国  

開催年月日： 2018年10月

記述言語：日本語  

開催地：仙台   国名：日本国  

開催年月日： 2016年11月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：福岡   国名：日本国  

開催年月日： 2016年10月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：静岡   国名：日本国  

開催年月日： 2016年7月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：福岡   国名：日本国  

開催年月日： 2016年3月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：福岡   国名：日本国  

開催年月日： 2016年1月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：仙台   国名：日本国  

開催年月日： 2015年10月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

国名：日本国  

開催年月日： 2015年1月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

国名：日本国  

開催年月日： 2011年6月

会議種別：口頭発表（一般）  

国名：日本国  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

Objective : With advent of an endovascular suite in the operating room (hybrid OR), it has been reported recently that combination therapy with surgical and endovascular procedures in hybrid OR for complex cerebrovascular diseases is feasible. / Materials and methods : We analyzed the 15 consecutive cases who underwent combination therapy with hybrid OR in our hospital from October 2014 to September 2017 (8 Aneurysms, 3 carotid artery stenosis, and 4 dural arteriovenous fistulas (DAVF)). / Results : All procedures were performed successfully. We performed bypass surgery and endovascular trapping with endovascular procedure for all aneurysm cases. In 3 cases of carotid artery stenosis, we performed carotid artery stenting (CAS) with direct puncture of common carotid artery for 2 cases and rescue stenting with carotid endarterectomy for 1 case. Perioperative antiplatelet therapy was performed in all cases of unruptured aneurysms and carotid artery stenosis. In the cases of DAVF, we performed transarterial or transvenous embolization combined with craniotomy, or shunt ligation with selective indocyanine green videoangiography using microcatheter. Systemic full heparinization was performed during all endovascular procedures. There was no symptomatic hemorrhagic and ischemic complication. There was no neurological deterioration of modified Rankin scale at discharge except for the case of symptomatic hyperperfusion after CAS. / Conclusion : Combination therapy with hybrid OR for complex cerebrovascular disease is safe and feasible.

DOI： 10.15017/2545089

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

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記述言語：日本語  

A study of the intraoperative imageanalysis method using Hyperspectral Camera(HSC) in the neurosurgery

記述言語：日本語  

記述言語：英語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語