記述言語：英語   出版者・発行元：一般社団法人 日本てんかん学会  

<p><i>Background</i>: The 2021 version of the Standardized Critical Care EEG Terminology published by the American Clinical Neurophysiology Society (ACNS 2021) specifies the diagnostic criteria for non-convulsive status epilepticus (NCSE) using continuous electroencephalographic (cEEG) monitoring. Since few facilities have access to cEEG, routine EEG, which can only be performed during consultation hours, is generally used for emergencies. We examined if the diagnostic ability is enhanced by adding arterial spin labeling (ASL) perfusion imaging to 1.5-Tesla magnetic resonance imaging (MRI). <i>Patients and Methods</i>: Eighty EEGs, performed on patients with neurological emergencies for 2 years, were reviewed which included three patients diagnosed with electrographic seizures (ESz). <i>Results</i>: Based on the ACNS21, EEG could diagnose Esz, but could not diagnose NCSE, being a 30-minute recording. In contrast, ASL clearly identified focal, ictal hyperperfusion. The signal intensity was maximized at a post-labeling delay (PLD) of 1.5-1.75 s. The signal intensity gradually decreased. However, even at a PLD of 2.0 s, the intensity remained strong in areas with a close anatomical relationship to the epileptogenic lesions. Further, the same region showed high signal intensity on diffusion-weighted imaging (DWI). <i>Conclusion:</i> Although ESz can be diagnosed based on the ACNS 2021 using EEG alone, diagnosing NCSE can be challenging. Therefore, our suggestion is to initially perform MRI to capture the hemodynamics of ictal hyperperfusion using ASL with multiple PLDs, and monitor the coupling state of metabolism and blood flow with DWI. Finally, an accurate pathophysiological diagnosis of NCSE should be confirmed by EEG. </p>

DOI： 10.3805/eands.a000162

CiNii Research

記述言語：英語   出版者・発行元：(一社)日本てんかん学会  

記述言語：英語   出版者・発行元：一般社団法人 日本てんかん学会  

<p>We made a pathophysiological diagnosis of epileptic seizures in a 50-year-old male with congenital unilateral perisylvian syndrome due to right perisylvian polymicrogyria, using routine electroencephalography (EEG) and 1.5-Tesla arterial spin labeling (ASL) magnetic resonance perfusion imaging. No paroxysmal discharges were recorded on EEG performed 1 h after the generalized convulsive seizure. Pseudo-continuous and pulsed ASL images taken 1 h 30 min and 1 h 15 min after the seizure, respectively, captured subtle periictal hyperperfusion linked to seizure activity via neurovascular coupling at the perisylvian area. In particular, the fusion of ASL images with the sagittal view of a three-dimensional T1-weighted image clearly revealed periictal hyperperfusion at the area of polymicrogyria, indicating intrinsic epileptogenicity. This case report details how adding ASL to routine EEG data can be useful in the pathophysiological diagnosis of epilepsy in neurological emergencies.</p>

DOI： 10.3805/eands.a000164

CiNii Research

記述言語：英語   出版者・発行元：Pediatric Neurosurgery  

Introduction: Open-lip-type schizencephaly is characterized by trans-cerebral clefts filled with cerebrospinal fluid (CSF) between the subarachnoid space at the hemisphere surface and the lateral ventricles. Disorders related to CSF retention, including hydrocephalus and arachnoid cysts, have reportedly been associated with open-lip schizencephaly and have induced intracranial hypertension in some cases. However, detailed neuroimaging and surgical treatment findings have rarely been described. Case Presentation: We report 2 cases of open-lip schizencephaly with an expanding CSF-filled cavity overlying the ipsilateral cerebral hemisphere that manifested as signs of intracranial hypertension. Detailed three-dimensional heavily T2-weighted imaging revealed thin borders between the CSF-filled cavity and the subarachnoid space, but no separating structures between the cavity and the lateral ventricle, suggesting that the cavity was directly connected to the lateral ventricle through the schizencephalic cleft but not to the subarachnoid space. Neuroendoscopic observation in case 1 confirmed this finding. Endoscopic fenestration of the cavity to the prepontine cistern was ineffective in case 1. Shunting between the lateral ventricle (case 1) or CSF-filled cavity (case 2) and the peritoneal cavity slightly decreased the size of the CSF-filled cavity. Discussion: We speculate that the thin borders along the margin of the CSF-filled cavity are membranes that previously covered the schizencephalic cleft and are now pushed peripherally. In addition, we believe that the cavity is a ventricular diverticulum protruding through the cleft and that shunting operation is effective against such expanding cavity. Detailed magnetic resonance imaging can be useful for evaluating patients with schizencephaly associated with CSF retention disorders.

DOI： 10.1159/000536188

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：(一社)日本てんかん学会  

神経救急での脳内出血後てんかん(PICHE)の病態生理学診断において、通常行われる脳波検査(EEG)の弱点を補う目的でMRIの1.5-Tesla動脈スピン標識(ASL)灌流画像を追加することの有用性と限界について検討した。2023年8月～2024年1月に、脳内出血後にてんかん発作が出現し、直ちに当院を受診したPICHE患者5例(女性3例、男性2例、年齢56～85歳)を対象に、MRI所見と脳波所見を後ろ向きに分析した。MRIは、全例で来院後1時間以内に行われていた。一方で脳波検査は、平日昼間に搬送された2例(症例1、2)は来院から1時間以内に施行されていたが、診療時間外に搬送された3例(症例3、4、5)は1～2日後に施行されていた。症例1～3のperiictal ASLでは、脳内出血による皮質病変部位および手術に行われた皮質切開部位に関連して局所的に過灌流が認められた。脳波所見では、発作時放電がperiictal ASLで認められた過灌流部位とほぼ一致して出現していた。症例4と5では、periictal ASLで局所的な過灌流は認められなかった。periictal ASL画像上の過灌流域を調べることでPICHEの診断精度が向上する可能性があるが、脳内出血の出現から時間が経過したPICHE症例の場合、中大脳動脈(MCA)の損傷に加えてMCAの変性や退縮が起こる場合があることから、MR血管造影や脳波検査などの他の検査手法を併用した評価が必要であると考えられた。

記述言語：日本語   出版者・発行元：一般社団法人 日本機械学会  

<p>Robotic rehabilitation is attracting attention as a solution to improve the quality of life for post-stroke patients. Biological signals are often used as a trigger for actuating these robots to faciliate neurorehabilitation. In this study, we developed and evaluated an augmentation method for motion intention extraction using machine learning based on EMG signal for hand rehabilitation robots, aiming at improving the accuracy of motion intention extraction when applied to patients with cerebrovascular diseases.</p>

DOI： 10.1299/jsmermd.2024.2p1-f04

CiNii Research

記述言語：日本語   出版者・発行元：公益社団法人 日本生体医工学会  

<p>著者らは、脳血管疾患による手指運動機能低下に対するリハビリテーションに用いるためのリハビリテーションロボットSMOVEの開発を行っている。当該装置の特徴は、ばねを層状に配置した特殊な機構により、小型・軽量に手指運動支援を行うことにある。また、高精度な筋電位測定機能を実装しており、患者の微弱な筋電位信号を読み取り、ロボットの運動支援のトリガに用いることができる。</p><p>当該研究開発において、当初の最も大きな課題は小型・軽量な手指運動支援機構の開発であった。この技術課題は機構開発により達成したかに考えていたが、その後に脳血管疾患患者に単回の装着試験、および限られた患者数での臨床研究の実施により様々な課題が探索され、研究開発を継続してきた。現在、より規模の大きな臨床研究を５施設にて実施しており、本発表ではその概況についても報告する。</p><p>先端医療デバイスの開発には、当初から具体的な医療応用のイメージを明確化し、それに向けた仕様策定、試作機開発、評価（非臨床・臨床）の実施が好ましい。しかしながら、先端技術であればあるほど、研究進捗に沿って新たな課題の探索されることもしばしばある。本発表が、そのような先端医療デバイス開発の一事例として、同分野の研究者間の理解を深めるための議論の題材となれば幸いである。</p><p></p><p>謝辞：本研究は、AMEDの課題番号JP23ym0126092の支援を受けた。</p>

DOI： 10.11239/jsmbe.annual62.151_1

CiNii Research

記述言語：英語   出版者・発行元：(一社)日本てんかん学会  

症例は27歳女性で、3歳時に自動車事故で右大脳半球に広範な外傷が生じ、保存的治療を受けたが、左片麻痺が残った。6歳時に全身にけいれん発作が出現し、外傷後てんかんと診断され、抗てんかん薬(ASM)投与が開始された。その後、カルバマゼピンとレベチラセタムで発作は良好にコントロールされており、25歳で当院へ転院となった。MRIでは、右中大脳動脈(MCA)の灌流領域と一致して前頭側頭・頭頂葉の脳実質に脳軟化が認められた。FLAIR画像ではこの領域に高信号が認められ、グリオーシスの存在が示唆された。27歳の月経時の夜21時頃に頭部不快感を訴え、その後焦点起始両側強直間代発作(FBTCS)が認められため当院へ救急搬送された。発作1時間後に撮像したtriple postlabeling delaysを用いた動脈スピンラベリングでは傍発作時過灌流は認められなかった。右内頸動脈とMCAが未発達であったため、右大脳半球への血液供給が十分でなく、発作時の代謝亢進を示すことができなかった可能性があった。ホスフェニトインを静注し、その翌日に退院した。患者と話し合った。その結果、ASMは変更しなかったが、過去6ヵ月間にFBTCSを経験していない。

記述言語：英語   出版者・発行元：(一社)日本てんかん学会  

焦点性～両側性の強直間代発作を発症し神経救急部を受診した認知症患者で、発作の病態生理学的診断を、脳波検査に加え動脈スピン標識(ASL)灌流MRIも利用して行った症例を後ろ向きに調べ、ASL還流画像法の有用性を検討した。2022年6月～2023年5月に全般痙攣性発作を初回発症し、その直後に当院へ搬送された上記の認知症患者8名を対象とした。1名を除き、MRIは脳波検査よりも前に行われていた。ASL画像では全員で局所的な過灌流の存在が実証されていた。器質的な焦点性てんかんの1名と急性症候性発作の1名では、発作の病態生理を示す、器質性病変の付近での過灌流が発作周辺期に観察された。残りの6名では発作周辺期に過灌流が、器質性病変とは無関係に、片方の大脳半球または両側の前頭側頭葉の尖端部に認められ、この所見から認知症関連てんかんの疑いと診断した。一方、脳波では3名のみで突発性放電が示された。それらの放電位置は、ASLで過灌流が示された位置と一致していた。脳波で焦点性徐波がみられ、それがASL所見の位置と合致した1名を除き、脳波所見のみで病態生理学的診断を確定することができた症例はなかった。発作周辺期にまずASL画像で過灌流の存在をいち早く把握することで、認知症に関連した焦点性～両側性の強直間代発作の病態生理学的診断を素早く下せると考えられた。

記述言語：英語   出版者・発行元：一般社団法人 日本てんかん学会  

<p><i>Background</i>: We investigated the usefulness and limitations of adding arterial spin labeling (ASL) perfusion imaging to 1.5-Tesla magnetic resonance imaging (MRI) to compensate for the weakness of routine electroen-cephalography (EEG) in the pathophysiological diagnosis of post-intracerebral hemorrhage (ICH) epilepsy (PICHE) at neuroemergency.</p><p><i>Patients & Methods</i>: Five patients who developed PICHE and were immediately admitted to our hospital between August 2023 and January 2024 were studied. Patients 1-3 developed PICHE within 2 years after ICH onset, whereas patients 4 and 5 developed PICHE after more than 12 years. We retrospectively analyzed the performance status and MRI and EEG findings of each patient during the periictal and interictal states.</p><p><i>Results</i>: MRI was performed within 1 h of arrival in all patients. On the other hand, EEG was performed within 1 h in patients 1 and 2, who were transported during weekday hours, but 1-2 days later in patients 3-5, who were transported outside the consultation hours. In patients 1-3, periictal ASL showed focal hyperperfusion related to the site of cortical involvement due to the ICH and corticotomy performed during surgery. EEG revealed paroxysmal discharges almost corresponding to the site of periictal ASL hyperperfusion. However, ASL demonstrated the pathophysiological mechanism of structural focal epilepsy more clearly. In patients 4 and 5, on the contrary, the periictal ASL showed no focal hyperperfusion. MR angiography (MRA) showed markedly poor visualization of the ipsilateral peripheral middle cerebral artery (MCA), and the ipsilateral hemisphere showed a marked decrease in blood flow on the interictal ASL.</p><p><i>Conclusion</i>: Capturing periictal ASL hyperperfusion can improve the diagnosis of PICHE. However, in cases of PICHE occurring long after ICH onset, degeneration and regression of the affected MCA may occur in addition to primary damage to the MCA that supplies periictal hyperperfusion, making the visualization of periictal hyperperfusion difficult. Therefore, evaluations in conjunction with other modalities such as MRA and EEG are necessary.</p>

DOI： 10.3805/eands.16.78

CiNii Research

記述言語：英語   出版者・発行元：Surgical Neurology International  

Background: Omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex is a rare, life-threatening congenital malformation primarily treated with abdominogenital repair. The optimal indication and timing of neurosurgical interventions for the associated spinal cord lesions remains insufficiently studied. We reviewed spinal dysraphism in OEIS to evaluate the best timing for neurosurgical intervention. Methods: We retrospectively reviewed 10 patients with OEIS, analyzing their clinical and imaging data, as well as surgical and pathological findings. Results: Terminal myelocystocele (TMCC) and spinal lipomas were observed in 5 patients each. Of the spinal lipomas, one had a single filar lipoma, while four had double lipomas (3 caudal and dorsal; 1 filar and dorsal). TMCC manifested with severe lower limb motor dysfunction in addition to abdominogenital disorder at birth, with the cyst-induced lumbosacral mass increasing over time. Spinal lipomas were less symptomatic except for abdominogenital issues and demonstrated minimal growth of the intraspinal lipoma over time. Untethering surgery was performed in 8 patients (5 TMCC; 3 spinal lipomas) at a median age of 3 (range, 2-10) months for TMCC and 6 (range, 2-14) months for spinal lipomas. One TMCC patient (surgery at 10 months) experienced postoperative cerebrospinal fluid leakage, necessitating three reoperations. Conclusion: Magnetic resonance imaging is essential to diagnose spinal cord malformations accurately. The necessity and timing of surgical intervention differ between TMCC and spinal lipomas. Since TMCC lesions tend to enlarge, surgery should be performed as soon as the patient's abdominogenital condition stabilizes. For spinal lipomas, surgery should be considered carefully based on the patient's neurological condition.

DOI： 10.25259/SNI_820_2024

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PubMed

記述言語：英語   出版者・発行元：Surgical Neurology International  

Background: Retained medullary cord (RMC) and filar lipomas are believed to originate from secondary neurulation failure; filar lipomas are reported to histopathologically contain a central canal-like ependyma-lined lumen with surrounding neuroglial tissue with ependyma-lined central canal (NGT w/E-LC) as a remnant of the medullary cord, which is a characteristic histopathology of RMC. With the addition of glial fibrillary acidic protein (GFAP) immunostaining, we reported the presence of GFAP-positive NGT without E-LCs (NGT w/o E-LCs) in RMC and filar lipomas, and we believe that both have the same embryopathological significance. Methods: We examined the frequency of GFAP-positive NGT, with or without E-LC, in 91 patients with filar lipoma. Results: Eight patients (8.8%) had NGT w/E-LC, 25 patients (27.5%) had NGT w/o E-LC, and 18 patients (19.8%) had tiny NGT w/o E-LC that could only be identified by GFAP immunostaining. Combining these subgroups, 56% of the patients (n = 51) with filar lipoma had GFAP immunopositive NGT. Conclusion: The fact that more than half of filar lipomas have NGT provides further evidence that filar lipoma and RMC can be considered consequences of a continuum of regression failure that occurs during late secondary neurulation.

DOI： 10.25259/SNI_458_2024

Scopus

PubMed

記述言語：英語   出版者・発行元：一般社団法人 日本てんかん学会  

<p><i>Background</i>: We investigated the usefulness of the addition of arterial spin labeling (ASL) perfusion imaging to 1.5-Tesla magnetic resonance imaging (MRI) during the periictal period for the pathophysiological diagnosis of focal to bilateral tonic-clonic seizures (FBTCS) in dementia patients presenting at neurological emergency, to compensate for the weaknesses of electroencephalography (EEG).</p><p><i>Patients & Methods</i>: We retrospectively examined the performance status and findings of EEG and MRI in eight dementia patients who were transported to our hospital immediately after first-onset generalized convulsive seizures.</p><p><i>Results</i>: Five of the eight patients were transported outside of consultation hours, while three were transported within consultation hours. MRI was performed 1 to 7 h (mean, 2.8 h) after arrival, while EEG 2 h to 2 days (mean, 15.1 h). In addition, MRI was performed first in seven patients, and EEG was done first in only one patient. ASL demonstrated focal hyperperfusion in all patients. In Patients 1 and 2, periictal hyperperfusion was observed around the organic lesions, indicating the pathophysiology of structural focal epilepsy and acute symptomatic seizure, respectively. In Patients 3–8, periictal hyperperfusion was noted in one cerebral hemisphere or the apex of bilateral frontotemporal lobes unrelated to the organic lesions, which led to a suspicion of dementia-related epilepsy. In contrast, paroxysmal discharges were observed on EEG in only three patients, and their locations were consistent with the hyperperfusion identified on ASL. Focal slow waves, the location of which matched the ASL findings, were observed in one patient. However, a pathophysiological diagnosis could not be made from the EEG findings alone in the other patients.</p><p><i>Conclusion</i>: At our hospital, ASL was almost always performed prior to EEG. Capturing periictal ASL hyperperfusion first may improve the ability to make a prompt pathophysiological diagnosis of FBTCS associated with dementia.</p>

DOI： 10.3805/eands.16.29

CiNii Research

記述言語：英語   出版者・発行元：一般社団法人 日本てんかん学会  

<p>Arterial spin labeling (ASL) perfusion images allow noninvasive visualization of periictal hyperperfusion in epileptically activated areas occurring secondary to seizures in structural focal epilepsy, and demonstrate a close anatomical relationship between epileptogenic lesions and the activated area. A 27-year-old female patient with epilepsy presented with focal to bilateral tonic-clonic seizures. She had an extensive traumatic lesion in the perfusion area of the right middle cerebral artery (MCA), which occurred at 3 years of age. ASL with triple postlabeling delays (PLDs) imaged 1 hour after the seizure failed to reveal periictal hyperperfusion around the lesion. It was possible that because of the underdevelopment of the right internal carotid artery and MCA, the blood supply to the right hemisphere was not adequate to demonstrate ictal hypermetabolism. ASL results should be interpreted comprehensively by combining the clinical manifestations, electroencephalographic findings, and magnetic resonance (MR) imaging findings of various modalities including MR angiography.</p>

DOI： 10.3805/eands.16.1

CiNii Research

記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本神経学会  

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記述言語：英語   出版者・発行元：International Journal of Computer Assisted Radiology and Surgery  

Purpose: To meet the urgent and massive training needs of healthcare professionals, the use of digital technologies is proving increasingly relevant, and the rise of digital training platforms shows their usefulness and possibilities. However, despite the impact of these platforms on the medical skills learning, cultural differences are rarely factored in the implementation of these training environments. Methods: By using the Scrub Nurse Non-Technical Skills Training System (SunSet), we developed a methodology enabling the adaptation of a virtual reality-based environment and scenarios from French to Japanese cultural and medical practices. We then conducted a technical feasibility study between France and Japan to assess virtual reality simulations acceptance among scrub nurses. Results: Results in term of acceptance do not reveal major disparity between both populations, and the only emerging significant difference between both groups is on the Behavioral Intention, which is significantly higher for the French scrub nurses. In both cases, participants had a positive outlook. Conclusion: The findings suggest that the methodology we have implemented can be further used in the context of cultural adaptation of non-technical skills learning scenarios in virtual environments for the training and assessment of health care personnel.

DOI： 10.1007/s11548-023-02834-0

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

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記述言語：日本語   出版者・発行元：耳鼻と臨床会  

<p>症例は 18 歳、男性。3 年前に意識消失を伴うてんかん発作を発症、その後薬物治療を行うもてんかん発作を繰り返す状態であった。画像検査で中頭蓋窩から蝶形骨洞側窩に陥入する側頭葉の髄膜脳瘤を指摘され、側頭葉てんかんの焦点と考えられたため髄膜脳瘤切除目的に当院入院となった。経鼻内視鏡下に蝶形骨側窩の髄膜脳瘤を切除し、その後、有茎中鼻甲介粘膜弁を用いて多層での頭蓋底再建を行った。術後、てんかん発作は消失、髄液漏や創部の合併症なく経過している。蝶形骨洞側窩のように蝶口蓋孔近傍で限局した箇所であれば鼻中隔粘膜弁でなくても中鼻甲介粘膜弁での代用が可能で、minimal transpterygoid approach を用い、さらに蝶口蓋動脈とその分枝である中鼻甲介動脈を温存することで頭蓋底再建時に中鼻甲介粘膜弁の利用が可能となった。</p>

DOI： 10.11334/jibi.69.2_116

CiNii Research

記述言語：日本語   出版者・発行元：耳鼻と臨床会  

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記述言語：日本語   出版者・発行元：耳鼻と臨床会  

症例は18歳、男性。3年前に意識消失を伴うてんかん発作を発症、その後薬物治療を行うもてんかん発作を繰り返す状態であった。画像検査で中頭蓋窩から蝶形骨洞側窩に陥入する側頭葉の髄膜脳瘤を指摘され、側頭葉てんかんの焦点と考えられたため髄膜脳瘤切除目的に当院入院となった。経鼻内視鏡下に蝶形骨側窩の髄膜脳瘤を切除し、その後、有茎中鼻甲介粘膜弁を用いて多層での頭蓋底再建を行った。術後、てんかん発作は消失、髄液漏や創部の合併症なく経過している。蝶形骨洞側窩のように蝶口蓋孔近傍で限局した箇所であれば鼻中隔粘膜弁でなくても中鼻甲介粘膜弁での代用が可能で、minimal transpterygoid approachを用い、さらに蝶口蓋動脈とその分枝である中鼻甲介動脈を温存することで頭蓋底再建時に中鼻甲介粘膜弁の利用が可能となった。(著者抄録)

記述言語：英語   出版者・発行元：Clinical EEG and Neuroscience  

Objective: Previous reports on the simultaneous recording of electroencephalography (EEG) and electrocorticography (ECoG) have demonstrated that, in patients with temporal lobe epilepsy (TLE), ictal ECoG discharges with an amplitude as high as 1000 μV originating from the medial temporal lobe could not be recorded on EEG. In contrast, ictal EEG discharges were recorded after ictal ECoG discharges propagated to the lateral temporal lobe. Here, we report a case of TLE in which the ictal EEG discharges, corresponding to ictal ECoG discharges confined to the medial temporal lobe, were recorded. Case report: In the present case, ictal EEG discharges were hardly recognized when the amplitude of the ECoG discharges was less than 1500 μV. During the evolution and burst suppression phase, corresponding to highly synchronized ECoG discharges with amplitudes greater than 1500 to 2000 μV, rhythmic negative waves with the same frequency were clearly recorded both on the lateral temporal lobe and scalp. The amplitude of the lateral temporal ECoG was approximately one-tenth of that of the medial temporal ECoG. The amplitude of the scalp EEG was approximately one-tenth of that of the lateral temporal ECoG. Conclusions: Highly synchronized ictal ECoG discharges with high amplitude of greater than 1500 to 2000 μV in the medial temporal lobe could be recorded on the scalp as ictal EEG discharges via volume conduction.

DOI： 10.1177/15500594211062702

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PubMed

記述言語：日本語   出版者・発行元：一般社団法人 日本臨床神経生理学会  

<p>当検査室は大学病院検査部の1部署であり脳波専従のスタッフがいるわけではない。しかしながら, 医師と技師が診療科の垣根を越え密なコミュニケーションを図ることにより信頼関係を築き, 質の高いてんかん診療を可能としている。技師は医師に対し脳波所見だけでなく検査のタイミングや追加検査など積極的に情報発信, 提案することで, 早期診断, 治療戦略決定に貢献することができる。医師は技師に対し脳波記録や判読について助言, 指導し, てんかん診療に必要な教育を充実させている。医師–技師間連鎖のいずれかが切れると理想的なてんかん診療は実現しない。患者の利益向上のため技師は日々技術を磨き知識を深め自らを高める努力をしている。ここでは当院の運用の工夫を紹介するが, 病院の規模や関わる診療科など自施設の特性を考慮し参考にしていただきたい。</p>

DOI： 10.11422/jscn.51.7

CiNii Research

記述言語：英語   出版者・発行元：(一社)日本てんかん学会  

症例は45歳男性。結節性硬化症複合体および重度の精神遅滞を有していた。乳児期に結節性硬化症複合体に伴う発達障害およびてんかん性脳症と診断され、別の精神科病院により抗てんかん薬が処方されていた。ここ数年、全般性強直間代発作を呈していなかったが、約1日間持続する全般性強直間代発作を発症し、当院に救急搬送された。発作から約4時間後に、動脈スピンラベル灌流画像を含むMRIを施行した。動脈スピンラベル画像およびFLAIRシーケンスの融合画像から、過灌流部位は左前頭葉の結節周囲皮質にあることが明らかになった。2日目に鎮静状態となったが、中等度の全身けいれんが持続した。4日目に覚醒し、7日目に施設に戻った。抗てんかん薬にラコサミド100mgを1日1回追加投与した。7ヵ月間の経過観察中に全般性強直間代発作はみられなかった。

記述言語：英語   出版者・発行元：(一社)日本てんかん学会  

症例1は43歳男性。3ヵ月前の食事中に全身性強直間代発作が突然出現していた。今回、飲酒後の夜10時頃に5分ほど続く2回目の全身性発作が出現し、当院を受診した。発作から約1時間後に行ったMRIでの動脈スピン標識(ASL)灌流画像では、左側の海馬から側頭葉にかけて信号強度がわずかに上昇していた。発作から約12時間後の脳波検査では突発性放電は観察されず、左側頭領域に焦点性徐波が稀に出現していた。2週後の脳波では突発性放電も焦点性徐波も観察されなかった。当初疑った通り側頭葉てんかんと診断してラコサミドを開始し、6ヵ月間の経過観察で発作は発生しなかった。症例2は63歳男性。1ヵ月前に僧帽弁置換術を受けていた。てんかんの既往と家族歴はなく、焦点意識減損発作(FIAS)が年に数回出現し、他院で脳波検査とMRIを受けたが異常は発見されていなかった。今回、約10分間続くFIASが出現したため当院へ搬送された。MRIのASL画像では両側の海馬、右側の側頭葉、両側の前頭葉基底部にわずかな信号増強を認めた。第3病日の早朝に得た脳波では右側頭領域に突発性活動が頻繁に観察された。以降に得られた画像所見も併せ、当初の疑い通り、右側頭葉てんかんと診断しラコサミドを開始した。6ヵ月間の経過観察中、FIASは発生しなかった。

記述言語：英語   出版者・発行元：(一社)日本てんかん学会  

症例は94歳女性。一人暮らしで、自立した日常生活活動はほとんどできていなかった。朝6時半頃に室内を徘徊しているところを発見され当院受診となった。到着時には意思疎通ができなかったが麻痺は観察されなかった。CTでは急性病変は発見されず、脳波検査では三相性の形態を示す全般性周期性放電が認められた。血液検査では肝機能と腎機能に異常はみられず、代謝性脳症と非痙攣性てんかん重積状態を鑑別するのは困難であった。脳波検査の約30分後にMRIを行ったところ、拡散強調画像では異常な高信号は示されなかったが、FLAIR画像では左側脳室下角の拡大と、両側深部白質の慢性虚血性変化が描出された。さらに動脈スピン標識(ASL)画像では、脳実質がびまん性に低灌流となっており、てんかん発作であれば同画像で高灌流が示されるはずであった。さらに同画像では、主要な動脈に、おそらく血流停滞によると思われるarterial transit artifactが著明に認められた。第2病日の血中アンモニア濃度は128mg/dL(基準値30～86mg/dL)と高く、上記のASL画像所見と併せ、便秘によって生じた高アンモニア血症性脳症と診断した。強力な下剤の投与を続けたところアンモニア濃度は正常化し、精神状態とASL画像所見も改善した。

記述言語：英語   出版者・発行元：(一社)日本てんかん学会  

症例は62歳男性で、意識不明の状態で発見され搬送された。非痙攣性てんかん重積状態であった。アルコール依存症の既往があったが、てんかんの既往はなかった。1.5-Tesla装置を用いて、24時間の間隔をおいて取得したpulsed arterial spin labeling(PASL)とpseudocontinuous ASL(pCASL)画像を比較した。その結果、PASLは動脈一過性アーチファクトの影響が大きいため、てんかん発作前後の過灌流の検出においてpCASLよりやや劣ることが確認された。その後、神経学的障害を伴うことなく退院した。しかし、医療コンプライアンス不良および飲酒により、同様のてんかん発作により交通事故を起こした。他院に入院となり、脳挫傷を含む多発外傷と診断された。

記述言語：英語   出版者・発行元：Surgical Neurology International  

Background: Severe type of segmental spinal dysgenesis (SSD) is a rare and complex anomaly in which the spinal cord completely disconnects at the portion of the spinal dysgenesis. Although closed spinal dysraphisms have been associated with SSD, to the best of our knowledge, the association between open neural tube defect (ONTD) and SSD is significantly rare, with only one case being reported to date. Case Description: We report a case of an infant with severe SSD and a disconnected spinal cord and spinal column at the thoracolumbar junction associated with myelomeningocele (MMC) in the lumbosacral region. The patient presented severe neurological deficits in the legs and impaired bowel function. The spinal column of L1–L3 was absent. The lower spinal segment consisted of neural placode at the L5–S1 level and no connecting structure between the upper and lower spinal cords. A repair surgery for MMC, including cord untethering and dura plasty, was performed. Histopathological findings revealed a neural placode consisting of a neuroglial tissue and leptomeninges. Conclusion: The management of severe SSD during the perinatal period is more challenging when it is associated with ONTD. We report detailed neuroradiological, intraoperative, and histological findings of such a case and discuss the embryopathogenesis of the associated ONTD and the treatment strategies.

DOI： 10.25259/SNI_156_2023

Scopus

PubMed

記述言語：英語   出版者・発行元：Surgical Neurology International  

Background: The retained medullary cord (RMC), caudal lipoma, and terminal myelocystocele (TMCC) are thought to originate from the failed regression spectrum during the secondary neurulation, and the central histopathological feature is the predominant presence of a central canal-like ependyma-lined lumen (CC-LELL) with surrounding neuroglial tissues (NGT), as a remnant of the medullary cord. However, reports on cases in which RMC, caudal lipoma, and TMCC coexist are very rare. Case Description: We present two patients with cystic RMC with caudal lipoma and caudal lipoma with an RMC component, respectively, based on their clinical, neuroradiological, intraoperative, and histopathological findings. Although no typical morphological features of TMCC were noted on neuroimaging, histopathological examination revealed that a CC-LELL with NGT was present in the extraspinal stalk, extending from the skin lesion to the intraspinal tethering tract. Conclusion: This histopathological finding indicates the presence of TMCC that could not be completely regressed and further supports the idea that these pathologies can be considered consequences of a continuum of regression failure during secondary neurulation.

DOI： 10.25259/SNI_479_2023

Scopus

PubMed

記述言語：英語   出版者・発行元：一般社団法人 日本てんかん学会  

<p><i>Introduction</i>: Although drug-resistant epilepsy is a frequent symptom in patients with tuberous sclerosis complex (TSC), there is conflicting evidence regarding whether the epileptogenic zone is present in the tuber itself or in the abnormally developed perituberal cortex.</p><p><i>Case report</i>: A 45-year-old man with TSC developed clustering of generalized tonic-clonic seizures (GTCSs) that lasted for approximately 1 day. Magnetic resonance imaging, including arterial spin labeling (ASL) perfusion images, was performed approximately 4 hours after the last apparent seizure. The fusion image of the ASL and fluid-attenuated inversion recovery sequence clearly demonstrated that the ASL hyperperfusion site was located in the perituberal cortex of the left frontal lobe, where the tubers were most prominent.</p><p><i>Conclusion</i>: The present study suggests epileptogenicity of the perituberal cortex for GTCSs in this patient. In the future, the epileptogenicity of TSC may be further clarified by conducting ictal or periictal ASL in a large number of TSC patients.</p>

DOI： 10.3805/eands.15.75

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We previously demonstrated the usefulness of periorbital electrodes in supplemental recording to detect epileptiform discharges in patients with mesial temporal lobe epilepsy (MTLE). However, eye movement may disturb periorbital electrode recording. To overcome this, we developed mandibular (MA) and chin (CH) electrodes and examined whether these electrodes could detect hippocampal epileptiform discharges. METHODS: This study included a patient with MTLE, who underwent insertion of bilateral hippocampal depth electrodes and video-electroencephalographic (EEG) monitoring with simultaneous recordings of extra- and intracranial EEG as part of a presurgical evaluation. We examined 100 consecutive interictal epileptiform discharges (IEDs) recorded from the hippocampus and two ictal discharges. We compared these IEDs from intracranial electrodes with those from extracranial electrodes such as MA and CH electrodes in addition to F7/8 and A1/2 of international EEG 10-20 system, T1/2 of Silverman, and periorbital electrodes. We analyzed the number, rate of laterality concordance, and mean amplitude of IEDs detected in extracranial EEG monitoring and characteristics of IEDs on the MA and CH electrodes. RESULTS: The MA and CH electrodes had nearly the same detection rate of hippocampal IEDs from other extracranial electrodes without contamination by eye movement. Three IEDs, not detected by A1/2 and T1/2, could be detected using the MA and CH electrodes. In two ictal events, the MA and CH electrodes detected the ictal discharges from the hippocampal onset as well as other extracranial electrodes. CONCLUSION: The MA and CH electrodes could detect hippocampal epileptiform discharges as well as A1/A2, T1/T2, and peri-orbital electrodes. These electrodes could serve as supplementary recording tools for detecting epileptiform discharges in MTLE.

DOI： 10.25259/SNI_1164_2022

PubMed

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記述言語：英語  

DOI： 10.25259/SNI_1164_2022

PubMed

掲載種別：研究論文（学術雑誌）  

DOI： 10.25259/SNI_1164_2022

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出版者・発行元：Surgical Neurology International  

Background: We previously demonstrated the usefulness of periorbital electrodes in supplemental recording to detect epileptiform discharges in patients with mesial temporal lobe epilepsy (MTLE). However, eye movement may disturb periorbital electrode recording. To overcome this, we developed mandibular (MA) and chin (CH) electrodes and examined whether these electrodes could detect hippocampal epileptiform discharges. Methods: This study included a patient with MTLE, who underwent insertion of bilateral hippocampal depth electrodes and video-electroencephalographic (EEG) monitoring with simultaneous recordings of extra- and intracranial EEG as part of a presurgical evaluation. We examined 100 consecutive interictal epileptiform discharges (IEDs) recorded from the hippocampus and two ictal discharges. We compared these IEDs from intracranial electrodes with those from extracranial electrodes such as MA and CH electrodes in addition to F7/8 and A1/2 of international EEG 10-20 system, T1/2 of Silverman, and periorbital electrodes. We analyzed the number, rate of laterality concordance, and mean amplitude of IEDs detected in extracranial EEG monitoring and characteristics of IEDs on the MA and CH electrodes. Results: The MA and CH electrodes had nearly the same detection rate of hippocampal IEDs from other extracranial electrodes without contamination by eye movement. Three IEDs, not detected by A1/2 and T1/2, could be detected using the MA and CH electrodes. In two ictal events, the MA and CH electrodes detected the ictal discharges from the hippocampal onset as well as other extracranial electrodes. Conclusion: The MA and CH electrodes could detect hippocampal epileptiform discharges as well as A1/A2, T1/T2, and peri-orbital electrodes. These electrodes could serve as supplementary recording tools for detecting epileptiform discharges in MTLE.

DOI： 10.25259/SNI_1164_2022

Scopus

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Surgical Neurology International  

Background: Development of dermoid or epidermoid cysts in myelomeningocele (MMC) sites is generally thought to occur in a delayed fashion due to implantation of dermal elements during initial repair surgery. Another theory is that dermal and dermoid elements may already be present within dysplastic neural structures at birth. Methods: We experienced histopathological presence of dermal elements in resected tissues at initial repair surgery in four out of 18 cases with MMC who required resection of parts or margins of the neural structures to perform cord untethering. Since one of these cases has already been reported, we describe the clinicopathological findings for the remaining three cases. Results: In Case1, cryptic dermoid elements were discovered in the terminal filum-like structure (FT-LS) caudal to the open neural placode (NP). The FT-LS had histopathological characteristics similar to the retained medullary cord. In Case 2, dermoid elements were discovered in the caudal margin of the dysplastic conus medullaris. In Case 3, a thin squamous epithelial layer overlapped the rostral margin of the NP where the NP was located near the skin. Case 1 developed an epidermoid cyst at 1 year and 2 months of age, which was totally resected. Conclusion: Prenatally existing cryptic dermoid elements in the caudal portion of neural structures and remnants of dermal elements overlapping the rostral margin of the NP are associated with delayed occurrence of dermoid/ epidermoid cysts. Postoperative histopathological investigation of the resected specimens is recommended. Once dermal elements are revealed, repeated imaging examination and additional surgery should be considered.

DOI： 10.25259/SNI_989_2022

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記述言語：英語   出版者・発行元：一般社団法人 日本てんかん学会  

<p>The hemodynamics of ictal hyperperfusion in dual pathology was evaluated using arterial spin labeling perfusion images (ASL) with triple postlabeling delays (PLDs). A 62-year-old man with epileptogenic right parietal hematoma cavity and bilateral hippocampal atrophy, particularly on the right, underwent ASL examination during subtle non-convulsive status epilepticus immediately after focal-to-bilateral tonic-clonic seizures. ASL at PLD of 1.5 s showed increased signals in the gray matter of both hemispheres, in addition to the peri-cavitary cortex. At PLD of 1.75 s, these signals were mostly washed out, and there was a marked increase in signals localized to bilateral hippocampal heads. The hippocampal signals were also mostly washed out at PLD of 2.0 s. These findings indicate a close relationship between activities originating from the peri-cavitary cortex and the hippocampus in this case. In terms of the mechanism of hippocampal atrophy, the oxygen supply required for large epileptic activities could not be met.</p>

DOI： 10.3805/eands.15.26

CiNii Research

記述言語：英語   出版者・発行元：Surgical Neurology International  

Background: A heterotopic dorsal root ganglion (DRG) is sometimes observed in the vicinity of dysplastic neural structures during surgery for open spinal dysraphism; however, it is rarely associated with closed spinal dysraphism. Distinguish from neoplasms by preoperative imaging study is difficult. Although the embryopathogenesis of a heterotopic DRG has been speculated to be migration disorder of neural crest cells from primary neural tube, its details remain unelucidated. Case Description: We report a pediatric case with an ectopic DRG in cauda equina associated with a fatty terminal filum and bifid sacrum. The DRG mimicked a schwannoma in the cauda equina on preoperative magnetic resonance imaging. Laminotomy at L3 revealed that the tumor was entangled in the nerve roots, and small parts of the tumor were resected for biopsy. Histopathologically, the tumor consisted of ganglion cells and peripheral nerve fibers. Ki-67 immunopositive cells were observed at the periphery of the ganglion cells. These findings indicate the tumor comprised DRG tissue. Conclusion: We report detailed neuroradiological, intraoperative and histological findings and discuss the embryopathogenesis of the ectopic DRG. One should be aware of the possibility of ectopic or heterotopic DRGs when cauda equina tumors are observed in pediatric patients with neurulation disorders.

DOI： 10.25259/SNI_1089_2022

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記述言語：英語   出版者・発行元：(一社)日本てんかん学会  

症例は62歳男性で、てんかん原性右頭頂血腫腔および両側海馬萎縮を呈していた。54歳時および58歳時に自損事故を起こしていた。post labeling delay(PLD) 1.5秒のarterial spin labelingでは、大脳皮質周囲に加え、両側半球灰白質に信号強度の増強がみられた。PLD 1.75秒の場合、これらの信号はほとんど認められず、両側海馬頭部に限局した信号の増加が顕著であった。PLD 2.0秒で海馬の信号も認められなくなった。レベチラセタムを静注し、抗てんかん薬を増量した。その結果、翌日には完全に意識を取り戻し、5日後に退院となった。

記述言語：英語   出版者・発行元：一般社団法人 日本てんかん学会  

<p><i>Introduction:</i> Magnetic resonance (MR) perfusion imaging with arterial spin labeling (ASL) can easily detect periictal hyperperfusion accompanying epileptic seizures. Herein, we report two cases in which ASL performed immediately after a seizure was useful for the initial suspicion of temporal lobe epilepsy (TLE).</p><p><i>Case report:</i> Patients 1 and 2 developed focal-to-bilateral tonic-clonic and focal impaired awareness seizures, respectively, and were subsequently transferred to our facility for out-of-hours service. On emergent ASL MR perfusion imaging, a slight increase in signals from the hippocampus and lateral temporal lobe was observed in both patients. However, routine electroencephalography (EEG) performed from 12 h to two days later showed corresponding paroxysmal discharges only in Patient 2.</p><p><i>Conclusion:</i> These cases suggest that MR imaging with ASL perfusion, which can be performed 24 hours a day, is useful for the initial suspicion of TLE, compensating for the limitation of routine EEG. However, to ensure a definitive diagnosis, it is important to evaluate the result together with clinical history, seizure semiology and findings of other modalities centered on EEG.</p>

DOI： 10.3805/eands.15.67

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Surgical Neurology International  

Background: Our recent report showed that 1.5-T pulsed arterial spin labeling (ASL) magnetic resonance (MR) perfusion imaging (1.5-T Pulsed ASL [PASL]), which is widely available in the field of neuroemergency, is useful for detecting ictal hyperperfusion. However, the visualization of intravascular ASL signals, namely, arterial transit artifact (ATA), is more remarkable than that of 3-T pseudocontinuous ASL and is easily confused with focal hyperperfusion. To eliminate ATA and enhance the detectability of (peri) ictal hyperperfusion, we developed the subtraction of ictal-interictal 1.5-T PASL images co-registered to conventional MR images (SIACOM). Methods: We retrospectively analyzed the SIACOM findings in four patients who underwent ASL during both (peri) ictal and interictal states and examined the detectability for (peri) ictal hyperperfusion. Results: In all patients, the ATA of the major arteries was almost eliminated from the subtraction image of the ictal-interictal ASL. In patients 1 and 2 with focal epilepsy, SIACOM revealed a tight anatomical relationship between the epileptogenic lesion and the hyperperfusion area compared with the original ASL image. In patient 3 with situation-related seizures, SIACOM detected minute hyperperfusion at the site coinciding with the abnormal electroencephalogram area. SIACOM of patient 4 with generalized epilepsy diagnosed ATA of the right middle cerebral artery, which was initially thought to be focal hyperperfusion on the original ASL image. Conclusion: Although it is necessary to examine several patients, SIACOM can eliminate most of the depiction of ATA and clearly demonstrate the pathophysiology of each epileptic seizure.

DOI： 10.25259/SNI_723_2022

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記述言語：英語   出版者・発行元：一般社団法人 日本てんかん学会  

<p>Crossed cerebellar diaschisis (CCD) was originally defined as depression of metabolism and blood flow in the cerebellar hemisphere contralateral to a supratentorial lesion in hemispheric stroke. Arterial spin labeling (ASL) magnetic resonance (MR) perfusion imaging with multiple postlabeling delays (PLDs) is useful for non-invasive detection of the hemodynamics of (peri)ictal hyperperfusion. Previous reports using ASL with a 3-Tesla (T) MR machine showed crossed cerebellar hyperperfusion (CCH) associated with supratentorial hyperperfusion, probably through the same mechanism as CCD, in patients with epilepsy during the ictal period. However, there are no reports on 1.5-T ASL, which is widely used in neuroemergencies. Here we evaluated the hemodynamics of (peri) ictal hyperperfusion and CCH using 1.5-T ASL in an 84-year-old man with right lesional temporal lobe epilepsy who experienced three episodes of convulsive status epilepticus (CSE). The ASL obtained was evaluated on fusion images with conventional MR images and subtracting ictal-interictal 1.5-Tesla ASL images co-registered to conventional MR images. Repeated ASL examinations performed 1 day after the first CSE, immediately after the second CSE, and during the third CSE demonstrated CCH in addition to right hemispheric hyperperfusion. The CCH became progressively stronger with increase in visualization of right hemispheric hyperperfusion. Furthermore, both showed the same hemodynamics; the ASL signals increased at PLD of 1.5 s and gradually decreased at PLDs of 1.75 s and 2.0 s. Increase in signal intensity was noted on the right side of the midbrain and pons as well as somwehat in the contralateral cerebellar peduncle. In this case, 1.5-T ASL demonstrated that the cortico-pontine-cerebellar pathway was strongly involved in the development of CCH in epilepsy similar to CCD in stroke.</p>

DOI： 10.3805/eands.15.95

CiNii Research

記述言語：英語   出版者・発行元：一般社団法人 日本てんかん学会  

<p>Arterial spin labeling (ASL) imaging with multiple postlabeling delays (PLD) can demonstrate the hemodynamics of peri-ictal hyperperfusion. Labeling methods include pulsed ASL (PASL) and pseudocontinuous ASL (pCASL). Although PASL is more widely used in daily clinical practice, it has several disadvantages because of lower delivery of labeled magnetization. We compared pCASL and PASL images acquired after a 24-h interval, using a 1.5-Tesla machine, in a 62-year-old man with non-convulsive status epilepticus. The pCASL during electrographic status epilepticus clearly demonstrated that ASL signals in the grey matter of the right hemisphere, particularly in the posteromedial part of the right temporal lobe, increased at PLDs of 1.5 s and 1.75 s and were almost washed out at 2.0 s. Although PASL, which was obtained during the ictal-interictal continuum when there were no changes in ictal findings on diffusion-weighted images, showed a similar trend, the increased signals were less pronounced than those of pCASL, with more contamination of arte-rial transit artifact in the subarachnoid space. Although the electroencephalographic findings were not the same when both ASLs were performed, the present study confirms that PASL is somewhat inferior to pCASL in detecting peri-ictal hyperperfusion because of the greater effect of arterial transient artifacts.</p>

DOI： 10.3805/eands.15.17

CiNii Research

記述言語：英語   出版者・発行元：一般社団法人 日本てんかん学会  

<p><i>Introduction:</i> Arterial spin labeling (ASL) magnetic resonance (MR) perfusion imaging is useful for diagnosing non-convulsive status epilepticus (NCSE) as it visualizes ictal hyperperfusion in epileptically activated areas.</p><p><i>Case report:</i> A 94-year-old woman presented with inability to communicate. An electroencephalogram revealed generalized periodic discharges with triphasic morphology. However, as her liver and kidney function were normal, it was difficult to distinguish metabolic encephalopathy from NCSE. ASL showed not only diffuse hypoperfusion in the cerebral parenchyma, instead of ictal hyperperfusion, but also marked appearance of arterial transit artifact in the major arteries, probably due to stagnant flow. The patient was therefore diagnosed with hyperammonemic encephalopathy (ammonia level 128 mg/dL) induced by constipation. Along with normalization of the ammonia level, the mental status and ASL findings improved.</p><p><i>Conclusion:</i> In this case, ASL helped visualize the decreased blood flow and velocity secondary to hypometabolism. The addition of ASL to conventional MR images may be useful in differentiating metabolic encephalopathy from NCSE, particularly in neuroemergency situations.</p>

DOI： 10.3805/eands.15.59

CiNii Research

記述言語：英語   出版者・発行元：(一社)日本てんかん学会  

神経救急分野で広く用いられている1.5テスラのMRI装置を用いて、てんかん患者での交叉性小脳過灌流(CCH)現象を検出できるか試みた。被験者は病変性側頭葉てんかん患者の84歳男性とした。46歳時にバイク事故で脳挫創を負い、当院で保存的治療を受けて日常生活に復帰していた。その約1年後から全般性痙攣発作(CSE)が現れるようになったが、フェニトインで概ね制御できていた。しかし、81歳時には服薬遵守の不良と飲酒が原因で遷延性CSEを発症し、83歳時と84歳時の発症も合わせて計3回のCSEエピソードを経験していた。1.5テスラのMRI装置としてECHELON OVAL V6を使用した。上記したCSEの3エピソードのうち、初回では1日後、2回目では発作の直後、3回目ではその最中にarterial spin labelingによるMRIを実施した。その結果、右脳半球の過灌流に加え、CCHの存在も実証された。右脳半球の過灌流とCCHでは同様の血行動態を示すことなどの詳細も、動脈スピン標識信号から明らかになった。本症例では、1.5テスラでのarterial spin labelingを適用することで、てんかんでのCCH出現に皮質-橋-小脳経路が強く関与していることが証明された。

記述言語：日本語   出版者・発行元：福岡医学会  

Purpose : We investigated the relationship between the arterial transit artifact (ATA) of the petrous portion of the internal carotid artery (pICA) on 1.5-T pulsed arterial spin labeling (ASL) perfusion images and hemodynamic changes on digital subtraction angiography (DSA) before and after carotid artery stenting (CAS) in patients with ICA stenosis. Method : ASL images were taken with postlabeling delay (PLD) of 1.5 s and 2.0 s before and after CAS, and these findings were compared with those of DSA in nine patients. Results : On pre-CAS ASL, ATA of the pICA was visualized both on PLD 1.5 s and 2.0 s in six cases, in which DSA demonstrated stagnation of contrast medium in the pICA and delayed visualization of the distal MCA. Immediately after CAS, DSA showed improvement in these findings : pICA was either visualized or not visualized on ASL images at 1.5 s, and disappeared at 2.0s. Conclusion : The presence of ATA of the pICA both on PLD 1.5 and 2.0 s suggests stagnation of blood flow within pICA with delayed visualization of the MCA and its disappearance after the CAS demonstrates improvement of these findings.

DOI： 10.15017/6788682

CiNii Research

記述言語：英語  

DOI： 10.1016/j.isci.2022.105612

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PubMed

記述言語：日本語   出版者・発行元：福岡医学会  

内頸動脈の椎体骨部(pICA)におけるarterial transit artifact(ATA)描出の臨床的意義について、頸動脈ステント留置(CAS)前後の一定時間後(PLD)1.5秒、2.0秒のarterial spin labeling(ASL)所見と造影剤注入後1.5秒、2.0秒のDSA所見を比較検討した。2021年4月～2022年3月の期間に同一術者により行われたCAS症例のうち、術前後にtime-of-flight法によるMRAおよびASLを含むMRIとECD-SPECTを行った9例(全例男性、平均71.3歳)を対象とした。CAS前のASLでは非手術側のpICAのATAはPLD 1.5、2.0秒ともに描出されないか、1.5秒で描出されても2.0秒では消失した。しかし、手術側のpICAは6例において1.5秒で強く描出され、2.0秒でも消失せずに残存した。ICA狭窄におけるpICAのATAがPLD 1.5、2.0秒ともに描出されることは頭蓋内arterial transit timeの遅延を伴うpICA内の血流停滞を意味し、CAS後の消失はこれらの改善を示唆しているものと考えられた。

記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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出版者・発行元：Interdisciplinary Neurosurgery Advanced Techniques and Case Management  

Background: Sulcal hyperintensity on magnetic resonance images with fluid-attenuated inversion recovery sequences (FLAIR) can occur in patients without apparent cerebrospinal fluid (CSF) abnormalities. Taoka et al. speculated that pathological increases of the blood pool to CSF ratio within the sulcus, which could be caused by alterations in regional hemodynamics including venous congestion, do not suppress water signals on FLAIR images. However, few previous reports have described sulcal hyperintensity in patients with chronic subdural hematoma (CSDH). Methods: To demonstrate the pathophysiological mechanism and clinical significance of sulcal hyperintensity in CSDH, we retrospectively reviewed the chronological changes in clinical, electroencephalographic (EEG), and neuroradiological findings, including arterial spin labeling perfusion magnetic resonance imaging (ASL) with dual post-labeling delays (PLDs) of 1.5 and 2.5 s, of three patients who had sulcal hyperintensity. Results: In all three cases, sulcal hyperintensity was observed just below the CSDH with mass effect, and became more prominent as it went to the vertex. In patients 1 and 2, ASL with dual PLDs showed a prolonged arterial transit time (ATT) in the region with sulcal hyperintensity, and the sulcal hyperintensity disappeared along with the improvement of the prolonged ATT. In patient 3, in whom the degree of sulcal hyperintensity was mild, the prolongation of ATT was also very mild. In patient 2, a coinciding ictal EEG and ASL hyperperfusion findings were present in the cortex showing sulcal hyperintensity. In patients 1 and 3, the laterality of the sulcal hyperintensity was consistent with that of the epileptic symptoms, which were controlled by the administration of antiepileptic drugs. Conclusion: Although further studies with a larger number of patients are needed, the pathophysiological mechanism of sulcal hyperintensity in CSDH could be explained by the idea proposed by Taoka et al. Our findings also indicate that sulcal hyperintensity has a possible relationship with the development of epilepsy in the perioperative period of CSDH.

DOI： 10.1016/j.inat.2022.101571

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Interdisciplinary Neurosurgery Advanced Techniques and Case Management  

Purpose: Retained medullary cord (RMC) is a condition in which the cord-like structure (C-LS) is continuous from the conus and extends to the dural cul-de-sac, causing spinal cord tethering, which is thought to originate from the secondary neurulation failure. Although diagnostic criteria for RMC have not yet been fully established, the following three items are generally considered important: (1) Typical morphological features on neuroimaging and intraoperative view. (2) The electrophysiological border between the conus and C-LS. (3) Ependyma-lined canal with surrounding neuroglial tissues (E-LC w/NGT) on histopathological examination of C-LS. To clarify the differences with caudal lipoma, which are also considered to be secondary neurulation disorders, in their embryological backgrounds, the clinicopathophysiological findings were compared. Methods: Five patients with RMC and 11 with caudal lipomas participated in this study. Results: All five patients with RMC naturally satisfied all three items. Four patients histopathologically showed a small amount of fibroadipose tissue. Regarding the first item in caudal lipoma, neuroimages demonstrated C-LS running parallel with or in the lipoma in all patients. In terms of the second item, the electrophysiological border was identified in 3 out of 4 patients in whom a sufficient operative field was obtained. Concerning the third item, E-LC w/NGT was noted in 6 of 7 patients in whom the lipoma was resected as a column. Areas of fibroadipose tissue histopathologically accounted for more than half of the total area. Conclusion: The caudal lipomas fulfilled most of the three items, and the only prominent difference between these two is the difference in the proportions of fibroadipose and fibrocollagenous tissues. These findings provide further evidence for the idea that RMC and caudal lipoma can be considered consequences of a continuum of regression failure during secondary neurulation, and it may not be possible to distinguish between the two clearly.

DOI： 10.1016/j.inat.2022.101534

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記述言語：日本語   出版者・発行元：(一社)日本てんかん学会  

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記述言語：日本語   出版者・発行元：(一社)日本てんかん学会  

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記述言語：日本語   出版者・発行元：(一社)日本てんかん学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Interdisciplinary Neurosurgery Advanced Techniques and Case Management  

Introduction: Limited dorsal myeloschisis (LDM) with nonsaccular (flat) skin lesions has features similar to those of congenital dermal sinus (CDS); both show a tethering tract extending from the skin lesion to the intraspinal space. CDS may be found within the fibroneural LDM stalk because of the shared origin of the LDM and CDS. Thus, it can be difficult to distinguish between LDM and CDS. We surgically treated a boy in whom CDS and filar lipoma were located in close proximity to each other at the dural cul-de-sac, mimicking flat LDM. Herein, we describe the comprehensive clinicopathological findings of this patient. Case presentation: The patient was noted at birth to have a small dimple in the lumbosacral region. Magnetic resonance images showed a slender tethering tract that started from the skin lesion, entered the dural sac through the dural cul-de-sac, and joined the low-lying conus at L2-3, which is characteristic of LDM. However, the operative and histopathological findings revealed that the epidural stalk was pure CDS, terminating at the dura, and that the intradural stalk was a filar lipoma. Both were present in close proximity at the dural cul-de-sac and were approximately 1 mm in diameter. Conclusion: The diagnosis of LDM and CDS should be established on the basis of a comprehensive analysis of clinical, neuroradiological, operative, and histopathological findings.

DOI： 10.1016/j.inat.2021.101455

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Interdisciplinary Neurosurgery Advanced Techniques and Case Management  

Background: Few reports have described open spinal dysraphism in triplets or higher-order pregnancies, making details on the clinical course and the outcome of these cases scarce.Case reports: Among 61 neonates who underwent repair surgery for myelomeningocele (MMC) in our institutions, there were two cases of MMC occurring in one neonate from a fraternal triplet birth. Case 1 was a girl weighing 2086 g, born at 35 weeks of gestation by cesarean section prompted by the disabling abdominal protuberance of her mother. She had severe motor weakness in her lower extremities and other congenital malformations. Case 2 was a boy weighing 1573 g, born at 32 weeks of gestation by emergency cesarean section because of preterm rupture of membrane. He had respiratory disorders requiring continuous positive airway pressure (CPAP) management in the neonatal intensive care unit (NICU) for 51 days. Both patients underwent successful surgical repair of MMC, followed by placement of a ventriculoperitoneal shunt. In both cases, the other members of the triplet were low-birth-weight infants, with two of them requiring CPAP management in the NICU for 17-18 days due to pulmonary immaturity.Conclusion: The incidence of triplet pregnancies has been increasing. Because triplets are at an increased risk of premature birth and low-birth-weight, perioperative management of triplets with MMC requires careful procedures to manage blood loss, hypothermia, and cerebrospinal fluid leakage. The other members of the triplet may also be affected by prematurity and congenital anomalies that require management in NICU. The birth of triplets with MMC may overwhelm perinatal medical departments. The cases presented in this paper demonstrate that although management of a triplet with MMC is challenging, cooperation within the multidisciplinary medical team can result in favorable outcome.

DOI： 10.1016/j.inat.2021.101372

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記述言語：英語   出版者・発行元：Surgical Neurology International  

Background: Glioependymal cysts (GECs) are rare, benign congenital intracranial cysts that account for 1% of all intracranial cysts. Surgical interventions are required for patients with symptomatic GECs. However, the optimal treatment remains controversial, especially in infants. Here, we report a male infant case of GECs that successfully underwent minimally invasive combined neuroendoscopic cyst wall fenestration and cyst-peritoneal (CP) shunt. Case Description: The boy was delivered transvaginally at 38 weeks and 6 days of gestation with no neurological deficits. Magnetic resonance imaging (MRI) at birth revealed multiple cysts with smooth and rounded borders and a non-enhancing wall in the right parieto-occipital region. The size of the cyst had increased rapidly compared to that of the prenatal MRI, which was performed at 37 weeks and 2 days. On the day of birth, Ommaya cerebrospinal fluid (CSF) reservoir was placed into the largest outer cyst. The patient underwent intermittent CSF drainage; however, he experienced occasional vomiting. At 2 months, he underwent combined neuroendoscopic cyst wall fenestration and CP shunt through a small hole. The patient's postoperative course was uneventful and there was no recurrence of the cyst. The pathological diagnosis was GEC. Conclusion: Combined neuroendoscopic cyst wall fenestration and CP shunt are a minimally invasive and effective treatment for infants with GECs.

DOI： 10.25259/SNI_133_2022

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PubMed

記述言語：英語   出版者・発行元：(一社)日本てんかん学会  

7歳女児。2年前から視覚障害を伴う意識減損焦点発作があり、抗てんかん薬に抵抗性であった。MRIにて、右後頭部に腫瘍を認め、頭蓋外と頭蓋内の脳波(EEG)を同時に実施した。頭蓋内で14Hz/6Hz陽性棘波(14Hz/6Hz PS)と発作間欠期てんかん性放電(IED)の高周波振動(HFO)分析を実施した。この分析では、14Hz/6Hz PSは頭蓋外と頭蓋内の両者の脳波において同一波形だが異なる振幅で記録された。各頭蓋内IEDに対応する頭蓋外IEDは記録されなかった。頭蓋内14Hz/6Hz PSには重ね合わせでのHFOを認めなかったが、頭蓋内IEDには高いγ活性などの重ね合わせにて周波振動を認めた。発作領域と興奮域の一致を認めたため切除した。細胞学的検査にて、腫瘍は多形黄色星細胞腫であった。術後2年経過し、頭蓋外EEGにてIEDは消失したが、14Hz/6Hz PSは残存した。

記述言語：英語   出版者・発行元：Pediatric Neurosurgery  

Introduction: The retained medullary cord (RMC) is a newly defined entity of closed spinal dysraphism that is thought to originate from regression failure of the medullary cord during the last phase of secondary neurulation. The terminal myelocystocele (TMC) is an unusual type of closed spinal dysraphism, characterized by localized cystic dilatation of the terminal part of the central canal that then herniates through a posterior spinal bifida. The co-occurrence of RMC and TMC is extremely rare. Case Presentation: We treated a baby girl with a huge sacrococcygeal meningocele-like sac with two components. Untethering surgery and repair surgery for the sac revealed that RMC, associated with intramedullary arachnoid cyst (IMAC), was terminated at the bottom of the rostral cyst, forming the septum of the two cystic components, and the caudal cyst was TMC derived from the central canal-like ependymal lining lumen (CC-LELL) of the RMC at the septum. IMAC within the RMC communicated with TMC, and both contained xanthochromic fluid with the same properties. Conclusion: We speculated that the mass effect of the coexistent IMAC impeded the flow of cerebrospinal fluid in the CC-LELL within the RMC and eventually formed a huge TMC. In surgical strategies for such complex pathologies, it is important to identify the electrophysiological border between the functional cord and nonfunctional RMC and the severe RMC to untether the cord, as with a typical or simple RMC.

DOI： 10.1159/000523976

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PubMed

記述言語：英語   出版者・発行元：Surgical Neurology International  

Background: A retained medullary cord (RMC) is a relatively newly defined entity of closed spinal dysraphism that is thought to originate from regression failure of the medullary cord during secondary neurulation. A congenital dermal sinus (CDS) may provide a pathway for intraspinal infections such as repeated meningitis. Intramedullary abscesses are the rarest but most serious complication of a CDS. Case Description: We treated a female infant with an intramedullary abscess in the thoracolumbar region, which was caused by infection of the CDS. Surgery revealed that the cord-like structure (C-LS) started from the cord with the intramedullary abscess, extended to the dural cul-de-sac, and further continued to the CDS tract and skin dimple. The boundary between the functional cord and the non-functional CL-S was electrophysiologically identified, and the entire length of the C-LS (the RMC) with an infected dermoid cyst was resected. As a result, the abscess cavity was opened and thorough irrigation and drainage of the pus could be performed. Histopathological examination of the C-LS revealed an infected dermoid cyst and abscess cavity with keratin debris in the fibrocollagenous tissue. The abscess cavity had a central canal-like ependymal lined lumen (CC-LELL), with surrounding glial fibrillary acidic protein (GFAP)-immunopositive neuroglial tissues. Conclusion: We demonstrated that the transmission of an infection through the RMC was involved in the development of the intramedullary abscess. A good postoperative outcome was obtained because a terminal ventriculostomy for pus drainage could be achieved by excising the nonfunctional RMC.

DOI： 10.25259/SNI_1197_2021

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Surgical Neurology International  

Background: Recent our reports showed that 3-T pseudocontinuous arterial spin labeling (3-T pCASL) magnetic resonance perfusion imaging with dual post labeling delay (PLD) of 1.5 and 2.5 s clearly demonstrated the hemodynamics of ictal hyperperfusion associated with non-convulsive status epilepticus (NCSE). We aimed to examine the utility of 1.5-T pulsed arterial spin labeling (1.5-T PASL), which is more widely available for daily clinical use, for detecting ictal hyperperfusion. Methods: We retrospectively analyzed the findings of 1.5-T PASL with dual PLD of 1.5 s and 2.0 s in six patients and compared the findings with ictal electroencephalographic (EEG) findings. Results: In patients 1 and 2, we observed the repeated occurrence of ictal discharges (RID) on EEG. In patient 1, with PLDs of 1.5 s and 2.0 s, ictal ASL hyperperfusion was observed at the site that matched the RID localization. In patient 2, the RID amplitude was extremely low, with no ictal ASL hyperperfusion. In patient 3 with lateralized periodic discharges (LPD), we observed ictal ASL hyperperfusion at the site of maximal LPD amplitude, which was apparent at a PLD of 2.0 s but not 1.5 sec. Among three patients with rhythmic delta activity (RDA) of frequencies <2.5 Hz (Patients 4–6), we observed obvious and slight increases in ASL signals in patients 4 and 5 with NCSE, respectively. However, there was no apparent change in ASL signals in patient 6 with possible NCSE. Conclusion: The detection of ictal hyperperfusion on 1.5-T PASL might depend on the electrophysiological intensity of the epileptic ictus, which seemed to be more prominent on 1.5-T PASL than on 3-T pCASL. The 1.5-T PASL with dual PLDs showed the hemodynamics of ictal hyperperfusion in patients with RID and LPD. However, it may not be visualized in patients with extremely low amplitude RID or RDA (frequencies <2.5 Hz).

DOI： 10.25259/SNI_841_2021

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記述言語：英語   出版者・発行元：Surgical Neurology International  

Background: Long-term outcomes after surgical treatment of arachnoid cysts (ACs) have not been reported adequately. Impaired visual acuity is not a common symptom of shunt dependency syndrome due to cyst-peritoneal (CP) shunt malfunction for ACs. We report a case of CP shunt malfunction, who presented only impaired visual acuity as a symptom, long after the initial surgical treatment. Case Description: A 16-year-old boy was surgically treated for the left frontal AC with CP shunting at 2 years of age. Extension of the peritoneal shunt catheter was performed at 15 years of age. A year later, he started experiencing impairment of visual acuity without headaches, which worsened to bilateral light perception. The presence of bilateral optic atrophy was confirmed. The AC in the left frontal lobe had enlarged very slightly, with shortening of the intracystic catheter, and the cerebrospinal fluid pressure was elevated to 30 cmH2O. He was treated with lumboperitoneal shunting. The visual acuity showed limited improvement. Conclusion: The possibility of CP shunt malfunction and shunt dependency syndrome should be considered, even if the patient presented only impaired visual acuity and no significant changes in the size of the ACs are observed.

DOI： 10.25259/SNI_1077_2021

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記述言語：英語   出版者・発行元：一般社団法人 日本てんかん学会  

<p><i>Background</i>: It is generally accepted that 14 and 6 Hz-positive spikes (14/6 Hz PS) are normal variant electroencephalographic (EEG) patterns. Analysis of high frequency oscillations (HFOs) including fast oscillations (FOs) of extracranial EEG containing 14/6 Hz PS is difficult.</p><p><i>Case report</i>: We performed an HFO analysis of the intracranial 14/6 Hz PS and interictal epileptiform discharges (IEDs) in a patient with occipital lobe epilepsy, who underwent simultaneous extracranial and intracranial EEG recordings. The 14/6 Hz PS were recorded on both extracranial and intracranial EEGs with the same waveform but different amplitudes. In contrast, the extracranial IEDs corresponding to every intracranial IED were not recorded. Intracranial 14/6 Hz PS did not have superimposing HFOs, while the intracranial IEDs had superimposing FOs such as high γ activities.</p><p><i>Conclusion</i>: The finding that no HFOs were detected in intracranial 14/6 Hz PS further supports the notion that 14/6 Hz PS are not epileptogenic.</p>

DOI： 10.3805/eands.14.10

CiNii Research

記述言語：英語   出版者・発行元：Surgical Neurology International  

Background: There is scarce evidence regarding focal resection surgery for super-refractory status epilepticus (SRSE), which is resistant to general anesthetic treatment over 24 h. We report two patients with SRSE, in whom good seizure outcomes were obtained following focal resection surgery. Case Description: Patient 1: A 58-year-old man who underwent left anterior temporal lobectomy with hippocampectomy at the age of 38 years after being diagnosed left medial temporal lobe epilepsy. After 19 years of surgery with no epileptic attacks, the patient developed SRSE. Electroencephalogram (EEG) demonstrated persistence of lateralized periodic discharges in the left frontotemporal region. On the 20th day after SRSE onset, resection of the frontal lobe and temporal lobe posterior to the resection cavity was performed. Patient 2: A 62-year-old man underwent craniotomy for anaplastic astrocytoma in the left frontal lobe at the age of 34 years. Since the age of 60 years, he developed SRSE 3 times over 1 and 1/12 years. On EEG, repeated ictal discharges were observed at the medial part of the left frontal region during the three SRSEs. Corresponding to the ictal EEG findings, high signals on diffusion-weighted magnetic resonance images and focal hypermetabolism on fluorodeoxyglucose-positron emission tomography were observed around the supplementary motor area, medial to the resection cavity. Resection surgery of the area was performed during the interictal period. Conclusion: Good seizure outcome was obtained in the two cases which provide additional support for the recent concept of focal resection surgery as an indication for SRSE.

DOI： 10.25259/SNI_152_2022

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

It remains unclear whether epileptogenic networks in focal epilepsy develop on physiological networks. This work aimed to explore the association between the rapid spread of ictal fast activity (IFA), a proposed biomarker for epileptogenic networks, and the functional connectivity or networks of healthy subjects. We reviewed 45 patients with focal epilepsy who underwent electrocorticographic (ECoG) recordings to identify the patients showing the rapid spread of IFA. IFA power was quantified as normalized beta-gamma band power. Using published resting-state functional magnetic resonance imaging databases, we estimated resting-state functional connectivity of healthy subjects (RSFC-HS) and resting-state networks of healthy subjects (RSNs-HS) at the locations corresponding to the patients' electrodes. We predicted the IFA power of each electrode based on RSFC-HS between electrode locations (RSFC-HS-based prediction) using a recently developed method, termed activity flow mapping. RSNs-HS were identified using seed-based and atlas-based methods. We compared IFA power with RSFC-HS-based prediction or RSNs-HS using non-parametric correlation coefficients. RSFC and seed-based RSNs of each patient (RSFC-PT and seed-based RSNs-PT) were also estimated using interictal ECoG data and compared with IFA power in the same way as RSFC-HS and seed-based RSNs-HS. Spatial autocorrelation-preserving randomization tests were performed for significance testing. Nine patients met the inclusion criteria. None of the patients had reflex seizures. Six patients showed pathological evidence of a structural etiology. In total, we analyzed 49 seizures (2-13 seizures per patient). We observed significant correlations between IFA power and RSFC-HS-based prediction, seed-based RSNs-HS, or atlas-based RSNs-HS in 28 (57.1%), 21 (42.9%), and 28 (57.1%) seizures, respectively. Thirty-two (65.3%) seizures showed a significant correlation with either seed-based or atlas-based RSNs-HS, but this ratio varied across patients: 27 (93.1%) of 29 seizures in six patients correlated with either of them. Among atlas-based RSNs-HS, correlated RSNs-HS with IFA power included the default mode, control, dorsal attention, somatomotor, and temporal-parietal networks. We could not obtain RSFC-PT and RSNs-PT in one patient due to frequent interictal epileptiform discharges. In the remaining eight patients, most of the seizures showed significant correlations between IFA power and RSFC-PT-based prediction or seed-based RSNs-PT. Our study provides evidence that the rapid spread of IFA in focal epilepsy can arise from physiological RSNs. This finding suggests an overlap between epileptogenic and functional networks, which may explain why functional networks in patients with focal epilepsy frequently disrupt.

DOI： 10.1016/j.neuroimage.2021.118104

記述言語：英語  

BACKGROUND: Chemotherapy in childhood leukemia potentially induces brain lesions and neurological sequelae. Paroxysmal sympathetic hyperactivity (PSH) is known as a treatment-associated complication; however, the full clinical spectra of PSH remain to be elusive. CASE REPORT: A 5-year-old girl was diagnosed of acute myeloid leukemia (AML) M5. After the intensification therapy, she developed recurrent symptoms of episodic tachycardia, hypertension and perspiration lasting for several hours per day. The low-frequency-high-frequency ratio on Holter electrocardiography was rapidly increased from 0.84 to 2.24 at the onset of the paroxysmal event, whereas the video-monitoring electroencephalography (EEG) never identified ictal patterns of epileptiform discharges during the episodes. Thus, the diagnosis of PSH was given at 7 years of age. Myoclonic and generalized tonic-clonic seizures frequently appeared from 10 years of age, which poorly responded to anticonvulsants. EEG showed diffuse slow-wave bursts with multifocal spikes. Serial head magnetic resonance imaging (MRI) revealed diffuse cerebral and hippocampal atrophy, but not inflammatory lesions in the limbic system. CONCLUSION: We first demonstrate a pediatric case with PSH who developed drug-resistant epilepsy 3 years after the onset of PSH. Our data suggest the pathophysiological link of persistent PSH with chemotherapy-associated brain damage.

DOI： 10.1016/j.braindev.2021.07.001

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）   出版者・発行元：Clinical EEG and Neuroscience  

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

Web of Science

Scopus

PubMed

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：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：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  

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 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   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）  

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）  

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）  

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）  

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）  

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）  

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：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：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  

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  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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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  

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  

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記述言語：日本語  

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記述言語：日本語  

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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