記述言語：英語   出版者・発行元：Auris Nasus Larynx  

Hearing is an essential sensation, and its deterioration leads to a significant decrease in the quality of life. Thus, great efforts have been made by otologists to preserve and recover hearing. Our knowledge regarding the field of otology has progressed with advances in technology, and otologists have sought to develop novel approaches in the field of otologic surgery to achieve higher hearing recovery or preservation rates. This requires knowledge regarding the anatomy of the temporal bone and the physiology of hearing. Basic research in the field of otology has progressed with advances in molecular biology and genetics. This review summarizes the current views and recent advances in the field of otology and otologic surgery, especially from the viewpoint of young Japanese clinician-scientists, and presents the perspectives and future directions for several topics in the field of otology. This review will aid next-generation researchers in understanding the recent advances and future challenges in the field of otology.

DOI： 10.1016/j.anl.2024.02.009

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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50歳女性で、嗄声および誤嚥を主訴に4年前に某大学病院を受診し、画像精査の結果、左頸静脈孔に進展する副咽頭間隙腫瘍を指摘された。その後、徐々に腫瘍は増大したため、近医を経由して当科へ紹介された。その後、患者の希望に沿って外来経過観察を行っていたが、手術による摘出を希望されたため当科入院となった。患者に複数の手術アプローチを提示した結果、内視鏡下経口アプローチを希望された。腫瘍内減圧を行った後、腫瘍被膜と神経周膜の間の剥離操作を尾側から頸側に進め、頸静脈孔内の腫瘍も腫瘍被膜で剥離が可能であり、術中ナビゲーションを用いて頸静脈孔内の腫瘍が摘出できていることを確認、最終的に腫瘍は肉眼的に全摘できた。術後5日目に気管カニューレを抜去し、術後7日目から嚥下訓練を開始、術後25日目に自宅退院となった。

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1411203691

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：Clinical Anatomy  

Endoscopic endonasal skull base surgery is increasingly prevalent, with its scope expanding from pathogens in the midline region to those in the paramedian region. Maximizing anterior sphenoidectomy is important for the median approach, and lateralizing the pterygopalatine fossa is crucial for the paramedian approach. Maximizing the surgical corridor in the nasal cavity and minimizing damage to neurovascular structures are vital for establishing a surgical field with minimal bleeding, ensuring safe, precise, and gentle procedures. However, the relationship between the maxillofacial and skull base bones in endoscopic endonasal skull base surgery is difficult to understand because these bones are intricately articulated, making it challenging to visualize each bone's outline. Understanding important bones and their related neurovascular structures is essential for all skull base surgeons to maximize the surgical corridor and minimize iatrogenic injury to neurovascular structures. This study aimed to elucidate the role of the palatine bone from a microsurgical anatomical perspective. Three dry skulls were used to demonstrate the structure of the palatine bone and its relationship with surrounding bones. A formalin-perfused cadaveric head was dissected to show the related neurovascular structures. The arteries and veins of the cadaveric heads were injected with red- and blue-colored silicon. Dissection was performed using a surgical microscope and endoscope. In addition, the utilization of the palatine bone as a landmark to identify neurovascular structures, which aids in creating a wider surgical field with less bleeding, was shown in two representative cases. The palatine bone consists of unique complex structures, including the sphenoidal process, ethmoidal crest, pterygopalatine canal, and sphenopalatine notch, which are closely related to the sphenopalatine artery, maxillary nerve, and its branches. The ethmoidal crest of the palatine bone is a well-known structure that is useful for identifying the sphenopalatine foramen, controlling the sphenopalatine artery and nerve, and safely opening the pterygopalatine fossa. The sphenoidal process of the palatine bone is a valuable landmark for identifying the palatovaginal artery, which is a landmark used to safely and efficiently expose the vidian canal. The sphenoidal process is easily cracked with an osteotome and removed to expose the palatovaginal artery, which runs along the pharyngeal groove, just medial to the vidian canal. By opening the pterygopalatine canal (also known as the greater palatine canal), further lateralization of the periosteum-covered pterygopalatine fossa contents can be achieved. Overall, the sphenoidal process and ethmoidal crest can be used as important landmarks to maximize the surgical corridor and minimize unnecessary injury to neurovascular structures.

DOI： 10.1002/ca.24170

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記述言語：その他   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Immunotherapy  

In the tumor microenvironment, wherein cytotoxic lymphocytes interact with cancer cells, lymphocyte exhaustion, an immune checkpoint inhibitor target, is promoted. However, the efficacy of these inhibitors is limited, and improving response rates remains challenging. We previously reported that protein tyrosine phosphatase nonreceptor type (PTPN) 3 is a potential immune checkpoint molecule for activated lymphocytes and that PTPN3 inhibition should be a focus area for cancer immunotherapy development. Therefore, in this study, we focused on PTPN3-suppressive therapy in terms of lymphocyte exhaustion under hypoxic conditions, which are a cancer microenvironment, and investigated measures for improving the response to anti-programmed death receptor (PD)-1 antibody drugs. We found that PTPN3 expression was upregulated in activated lymphocytes under hypoxic conditions, similar to the findings for other immune checkpoint molecules, such as PD-1, T cell immunoglobulin mucin-3, and lymphocyte-activation gene-3; furthermore, it functioned as a lymphocyte exhaustion marker. In addition, PTPN3-suppressed activated lymphocytes promoted the mammalian target of rapamycin (mTOR)-Akt signaling pathway activation and enhanced proliferation, migration, and cytotoxic activities under hypoxic conditions. Furthermore, PTPN3 suppression in activated lymphocytes increased PD-1 expression and enhanced the antitumor effects of anti-PD-1 antibody drugs against head and neck cancer in vitro and in vivo. These results suggest that the suppression of PTPN3 expression in activated lymphocytes enhances the therapeutic effect of anti-PD-1 antibody drugs in head and neck cancer, especially under hypoxic conditions that cause lymphocyte exhaustion.

DOI： 10.1097/CJI.0000000000000503

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出版者・発行元：東京医学社  

DOI： 10.24479/ohns.0000000997

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掲載種別：研究論文（学術雑誌）   出版者・発行元：PloS one  

[This corrects the article DOI: 10.1371/journal.pone.0271907.].

DOI： 10.1371/journal.pone.0303720

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記述言語：その他   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Cancer  

Background: Rhabdomyosarcoma is the most common soft tissue sarcoma in children, but rare in adults. Para-meningeal rhabdomyosarcoma in head and neck (PM-HNRMS) is less applicable for surgery due to the anatomic reason. PM-HNRMS has a poor prognosis in children. However, its clinical outcomes remain unclear in adults due to the rarity. Further, there is almost no detailed data about salvage therapy. Methods: We retrospectively examined the adult patients with PM-HNRMS treated at institutions belonging to the Kyushu Medical Oncology Group from 2009 to 2022. We evaluated the overall survival (OS) and progression-free survival (PFS) of the patients who received a first-line therapy. We also reviewed the clinical outcomes of patients who progressed against a first-line therapy and received salvage therapy. Results: Total 11 patients of PM-HNRMS received a first-line therapy. The characteristics were as follows: median age: 38 years (range 25 – 63 years), histology (alveolar/spindle): 10/1, and risk group (intermediate/high): 7/4. As a first-line therapy, VAC and ARST0431-based regimen was performed in 10 and 1 patients, respectively. During a first-line therapy, definitive radiation for all lesions were performed in seven patients. The median PFS was 14.2 months (95%CI: 6.0 – 25.8 months): 17.1 months (95%CI: 6.0 – not reached (NR)) for patients with stage I-III and 8.5 months (95%CI: 5.2 – 25.8 months) for patients with stage IV. The 1-year and 3-year PFS rates were 54.5% and 11.3% for all patients. Median OS in all patients was 40.8 months (95%CI: 12.1 months–NR): 40.8 months (95%CI: 12.1 – NR) for patients with stage I-III and NR for patients with stage IV. The 5-year OS rate was 48.5% for all patients. Among seven patients who received salvage therapy, three are still alive, two of whom remain disease-free for over 4 years after completion of the last therapy. Those two patients received multi-modal therapy including local therapy for all detected lesions. Conclusion: The cure rate of adult PM-HNRMS is low in spite of a first-line therapy in this study. Salvage therapy might prolong the survival in patients who received the multi-modal therapy including local therapy for all detected lesions.

DOI： 10.1186/s12885-023-11528-4

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記述言語：日本語  

記述言語：その他   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

Abstract

Squamous cell carcinoma of the external auditory canal (EACSCC) is an extraordinarily rare and aggressive malignant disease. Establishment of EACSCC cell line with robust molecular characteristics is essential for the basic and translational research of EACSCC. Here, we show the newly established EACSCC cell line SCEACono2, derived from a patient with well-to-moderately differentiated EACSCC. We analyzed histologic and genetic features of SCEACono2 hiring multiple experiments, including next-generation sequencing (NGS). Immunocytochemical staining of SCEACono2 showed positivity of p53 and SCC1/2. Furthermore, SCEACono2 exhibited a unique characteristic that cytokeratin, vimentin as well as cancer stem cell markers (CD44, CD133, ALP and Oct3/4) were positive. SCEACono2 had an ability to form tumors at the temporal lesion xenograft nude mice model. NGS revealed that SCEACono2 harbored the somatic mutations of TP53 (p.G245S) and NOTCH1 (p.A465T). RNA-seq and downstream bioinformatics analysis revealed significant enrichment of genes involved in inflammation and cell adhesion in SCEACono2 compared to SCC-9 and HSC-4. STR profiling indicated no evidence of cross-contamination. In conclusion, SCEACono2 could serves as a promising and robust research resource of EACSCC in vitro and in vivo.

DOI： 10.1038/s41598-023-46926-y

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その他リンク： https://www.nature.com/articles/s41598-023-46926-y

記述言語：日本語   出版者・発行元：(一社)日本耳科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本耳鼻咽喉科頭頸部外科学会  

<p>　外側頭蓋底外科領域は, 非常にチャレンジングな領域である. 比較的発生頻度の低い腫瘍が多く, 単一施設で経験できる症例が非常に限られている. 近年の経鼻内視鏡頭蓋底手術の発展に伴い, 外側頭蓋底外科領域においても顕微鏡単独手術だけではなく, 内視鏡補助下もしくは内視鏡単独での手術も選択肢の一つとして検討すべき時代になってきている. さらに, 外視鏡の登場は, 内視鏡との連携をより向上させた. 顕微鏡や外視鏡での手術の際に死角となる領域を内視鏡では接近して, さらに鮮明に拡大して確認することができる. また, 経鼻内視鏡頭蓋底手術もその適応が頭蓋底正中から, より外側へ拡大し, 外側頭蓋底領域へも内視鏡単独で経鼻的に到達可能になってきた. 外側頭蓋底領域へアプローチする際は, 腫瘍の血流, 内頸動脈を含む血管系との位置関係, 腫瘍の組織型などから総合的に判断して適切なアプローチを選択する必要がある. その際, 顕微鏡下もしくは外視鏡下での手術なのか, 内視鏡単独でのアプローチなのか, 内視鏡補助下手術なのか, 顕微鏡下もしくは外視鏡下でのアプローチと経鼻 (経口) 内視鏡頭蓋底手術との combined approach なのかを検討する. 内視鏡頭蓋底手術では, 3-hand や 4-hand technique は非常に有効で, 経皮, 経口, 経鼻などといった複数のポートを利用した multiportal technique も検討する価値がある.</p>

DOI： 10.3950/jibiinkotokeibu.126.10_1112

CiNii Research

記述言語：日本語  

細径の蝸牛軸巻き付き型の人工内耳電極は挿入時に蝸牛内で屈曲(tip fold-over)することがある.この問題は電極が曲がる向きと蝸牛が曲がる向きが一致しないミスアライメントという状態のときに起こりやすい.このため,執刀医は電極のカイル平面をなるべく蝸牛のコイル平面に一致させて電極を挿入する必要がある.われわれは,手術中に視認できるキヌタ骨を利用して蝸牛コイル平面を想定する方法を検討した.2017年から2021年の期間に,一人の執刀医が施行した人工内耳植込み術症例のうち内耳奇形症例を除外した65耳(右29耳,左36耳)について検討した.キヌタ骨平面と蝸牛コイル平面が為す角度をキヌタ-蝸牛角と定義し集計した.キヌタ-蝸牛角は平均では34.6°であった.左右および手術時年齢による統計的な有意差は見られなかった.本研究により,手術中に確認できるキヌタ骨平面を利用して蝸牛コイル平面を正確に想定することが可能とわかった.(著者抄録)

記述言語：日本語   出版者・発行元：(一社)日本耳科学会  

細径の蝸牛軸巻き付き型の人工内耳電極は挿入時に蝸牛内で屈曲(tip fold-over)することがある.この問題は電極が曲がる向きと蝸牛が曲がる向きが一致しないミスアライメントという状態のときに起こりやすい.このため,執刀医は電極のカイル平面をなるべく蝸牛のコイル平面に一致させて電極を挿入する必要がある.われわれは,手術中に視認できるキヌタ骨を利用して蝸牛コイル平面を想定する方法を検討した.2017年から2021年の期間に,一人の執刀医が施行した人工内耳植込み術症例のうち内耳奇形症例を除外した65耳(右29耳,左36耳)について検討した.キヌタ骨平面と蝸牛コイル平面が為す角度をキヌタ-蝸牛角と定義し集計した.キヌタ-蝸牛角は平均では34.6°であった.左右および手術時年齢による統計的な有意差は見られなかった.本研究により,手術中に確認できるキヌタ骨平面を利用して蝸牛コイル平面を正確に想定することが可能とわかった.(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本耳科学会  

細径の蝸牛軸巻き付き型の人工内耳電極は挿入時に蝸牛内で屈曲(tip fold-over)することがある.この問題は電極が曲がる向きと蝸牛が曲がる向きが一致しないミスアライメントという状態のときに起こりやすい.このため,執刀医は電極のカイル平面をなるべく蝸牛のコイル平面に一致させて電極を挿入する必要がある.われわれは,手術中に視認できるキヌタ骨を利用して蝸牛コイル平面を想定する方法を検討した.2017年から2021年の期間に,一人の執刀医が施行した人工内耳植込み術症例のうち内耳奇形症例を除外した65耳(右29耳,左36耳)について検討した.キヌタ骨平面と蝸牛コイル平面が為す角度をキヌタ-蝸牛角と定義し集計した.キヌタ-蝸牛角は平均では34.6°であった.左右および手術時年齢による統計的な有意差は見られなかった.本研究により,手術中に確認できるキヌタ骨平面を利用して蝸牛コイル平面を正確に想定することが可能とわかった.(著者抄録)

記述言語：日本語   出版者・発行元：一般社団法人 日本聴覚医学会  

DOI： 10.4295/audiology.66.409

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人 日本聴覚医学会  

DOI： 10.4295/audiology.66.442

CiNii Research

記述言語：日本語  

記述言語：日本語  

記述言語：日本語   出版者・発行元：(一社)日本聴覚医学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00125&link_issn=&doc_id=20230915480148&doc_link_id=%2Fdm7audio%2F2023%2F006605%2F150%2F0442-0442%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdm7audio%2F2023%2F006605%2F150%2F0442-0442%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本聴覚医学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00125&link_issn=&doc_id=20230915480115&doc_link_id=%2Fdm7audio%2F2023%2F006605%2F117%2F0409-0409%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdm7audio%2F2023%2F006605%2F117%2F0409-0409%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

BACKGROUND: Positive-margin resection of external auditory canal squamous cell carcinoma (EAC-SCC) is still a major cause of recurrence. The aim of this study is to examine the clinical impact of positive-margin resection of EAC-SCCs. METHODS: We retrospectively reviewed 40 surgical cases with en bloc temporal bone resection of EAC-SCC at a tertiary referral center from October 2016 to March 2022. RESULTS: Two-year disease-specific, overall, and disease-free survival rates for all 40 cases reviewed were 85.2&#37;, 88.85&#37;, and 76.96&#37;, respectively. En bloc resection with a negative margin significantly improved patient prognosis (p < 0.001). Positive-margin resection was observed in 9/40 cases (22.5&#37;). Insufficient assessment of preoperative images was the cause in two of these cases. Postoperative lymph node metastasis and distant metastasis were observed in cases in which vascular, lymphatic duct or perineural invasion was found on postoperative pathological examination. In addition, three cases in which no vascular, lymphatic duct, or perineural invasion was found exhibited local recurrence during the follow-up period. Of the nine positive-margin resection cases, only two showed no postoperative recurrence. CONCLUSIONS: Once positive-margin resections are confirmed, cases might have a high risk of tumor recurrence, even with the addition of postoperative adjuvant chemoradiotherapy.

DOI： 10.3390/cancers15174289

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記述言語：日本語   出版者・発行元：耳鼻と臨床会  

<p>MRI を撮影した人工内耳装用症例を 2021 年までに 18 例経験した。MRI の撮影範囲の内訳は頭頸部 9 例、胸髄 2 例、肩関節 1 例、肝臓 1 例、腰仙髄 2 例、脊椎 1 例、骨盤 2 例であった。このうち頭頸部 MRI を撮影した 8 例は撮影範囲に人工内耳のアーチファクトを認めた。MRI 撮影後の人工内耳トラブルが 4 例に生じ、うち 1 例で体内器の磁石を入れ替える手術を要した。MRI の強調像のうち、拡散強調像は磁石を入れた状態では評価困難であった。MRI 画像の欠損範囲や検査後のトラブルを把握しておくことで、他科の医師との MRI 検査計画を立てやすくなり、また患者の検査への理解を深めることに役立てることが可能と考えられた。</p>

DOI： 10.11334/jibi.69.3_153

CiNii Research

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1411203393

CiNii Research

記述言語：日本語  

MRIを撮影した人工内耳装用症例を2021年までに18例経験した。MRIの撮影範囲の内訳は頭頸部9例、胸髄2例、肩関節1例、肝臓1例、腰仙髄2例、脊椎1例、骨盤2例であった。このうち頭頸部MRIを撮影した8例は撮影範囲に人工内耳のアーチファクトを認めた。MRI撮影後の人工内耳トラブルが4例に生じ、うち1例で体内器の磁石を入れ替える手術を要した。MRIの強調像のうち、拡散強調像は磁石を入れた状態では評価困難であった。MRI画像の欠損範囲や検査後のトラブルを把握しておくことで、他科の医師とのMRI検査計画を立てやすくなり、また患者の検査への理解を深めることに役立てることが可能と考えられた。(著者抄録)

記述言語：日本語   出版者・発行元：耳鼻と臨床会  

MRIを撮影した人工内耳装用症例を2021年までに18例経験した。MRIの撮影範囲の内訳は頭頸部9例、胸髄2例、肩関節1例、肝臓1例、腰仙髄2例、脊椎1例、骨盤2例であった。このうち頭頸部MRIを撮影した8例は撮影範囲に人工内耳のアーチファクトを認めた。MRI撮影後の人工内耳トラブルが4例に生じ、うち1例で体内器の磁石を入れ替える手術を要した。MRIの強調像のうち、拡散強調像は磁石を入れた状態では評価困難であった。MRI画像の欠損範囲や検査後のトラブルを把握しておくことで、他科の医師とのMRI検査計画を立てやすくなり、また患者の検査への理解を深めることに役立てることが可能と考えられた。(著者抄録)

記述言語：日本語   出版者・発行元：耳鼻と臨床会  

MRIを撮影した人工内耳装用症例を2021年までに18例経験した。MRIの撮影範囲の内訳は頭頸部9例、胸髄2例、肩関節1例、肝臓1例、腰仙髄2例、脊椎1例、骨盤2例であった。このうち頭頸部MRIを撮影した8例は撮影範囲に人工内耳のアーチファクトを認めた。MRI撮影後の人工内耳トラブルが4例に生じ、うち1例で体内器の磁石を入れ替える手術を要した。MRIの強調像のうち、拡散強調像は磁石を入れた状態では評価困難であった。MRI画像の欠損範囲や検査後のトラブルを把握しておくことで、他科の医師とのMRI検査計画を立てやすくなり、また患者の検査への理解を深めることに役立てることが可能と考えられた。(著者抄録)

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記述言語：日本語   出版者・発行元：耳鼻と臨床会  

<p>2016 年から 2021 年にかけて当科で手術を行った側頭骨グロムス腫瘍の 4 例について報告する。4 例の内訳として鼓室型 2 例、頸静脈球型 2 例に対し治療を行った。鼓室型の 2 例では拍動性耳鳴を認めた。術前聴力検査では 3 例で患側の聴力低下と気骨導差を認めた。頸静脈球型のうち 1 例では生検、切除、再手術と 3 回の手術を必要とした。血管塞栓術は鼓室型、頸静脈球型それぞれ 1 例ずつ施行し、すべての症例において、術前後の神経脱落所見は認めなかった。1 例は残存病変があるものの増大なく経過しており、その他 3 例は再発・再々発なく経過している。グロムス腫瘍は血流豊富であり、栄養血管の塞栓や高周波バイポーラの使用が安全な手術に有用と考えられる。</p>

DOI： 10.11334/jibi.69.2_89

CiNii Research

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  

DOI： 10.11334/jibi.69.2_146

CiNii Research

記述言語：日本語  

2016年から2021年にかけて当科で手術を行った側頭骨グロムス腫瘍の4例について報告する。4例の内訳として鼓室型2例、頸静脈球型2例に対し治療を行った。鼓室型の2例では拍動性耳鳴を認めた。術前聴力検査では3例で患側の聴力低下と気骨導差を認めた。頸静脈球型のうち1例では生検、切除、再手術と3回の手術を必要とした。血管塞栓術は鼓室型、頸静脈球型それぞれ1例ずつ施行し、すべての症例において、術前後の神経脱落所見は認めなかった。1例は残存病変があるものの増大なく経過しており、その他3例は再発・再々発なく経過している。グロムス腫瘍は血流豊富であり、栄養血管の塞栓や高周波バイポーラの使用が安全な手術に有用と考えられる。(著者抄録)

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

High-risk human papillomavirus (HPV) is a risk factor for the development of several head and neck squamous cell carcinomas (SCCs). However, there have been few reports of high-risk HPV infection in temporal bone squamous cell carcinomas (TBSCCs), and thus the prevalence and clinicopathologic significance of high-risk HPV in TBSCCs are still unclear. We retrospectively collected 131 TBSCCs and analyzed them for transcriptionally active high-risk HPV infection using messenger RNA in situ hybridization; we also assessed the utility of p16-immunohistochemistry (IHC) and Rb-IHC to predict HPV infection. Eighteen (13.7&#37;) of the 131 TBSCCs were positive for p16-IHC, and five of them were positive for high-risk HPV infection (the estimated high-risk HPV positivity rate was 3.8&#37; [5/131]). Interestingly, all five HPV-positive patients were male and had TBSCC on the right side. In the p16-IHC+/HPV+ cases (n = 5), the Rb-IHC showed a partial loss pattern (n = 4) or complete loss pattern (n = 1). In contrast, all p16-IHC-negative cases (n = 113) showed an Rb-IHC preserved pattern. The positive predictive value (PPV) of p16-IHC positivity for high-risk HPV infection was low at 27.8&#37;, while the combination of p16-IHC+/Rb-IHC partial loss pattern showed excellent reliability with a PPV of 100&#37;. The prognostic significance of high-risk HPV infection remained unclear. High-risk HPV-related TBSCC is an extremely rare but noteworthy subtype.

DOI： 10.1007/s00428-023-03497-7

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記述言語：英語  

Various types of mucosal flaps can be used for skull base reconstruction after endoscopic endonasal skull base surgery (EESS). Preventing postoperative cerebrospinal fluid (CSF) leakage is essential. Flap creation during revision surgery can be problematic. We present a patient in whom a posterior septal nasal floor flap (PS-NF) was successfully reused for reconstruction after multiple reoperations for pituitary tumor resection. A 22-year-old female underwent EESS for resection of a pituitary tumor and experienced multiple recurrences after repeated operations. For the third recurrence, a skull base surgery team comprising otolaryngologists and neurosurgeons performed a binostril combined transnasal/transseptal approach and used a PS-NF for reconstruction. For the fourth recurrence, a PS-NF was successfully taken down and reused for reconstruction. No postoperative CSF leakage or intranasal complications occurred. Skull base reconstruction using a PS-NF is feasible and preserves the mucous membrane of the nasal septum and the morphology of the nasal cavity. PS-NF takedown and reuse is an option for revision EESS for recurrent pituitary tumors.

DOI： 10.7759/cureus.35932

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記述言語：日本語   出版者・発行元：耳鼻と臨床会  

2016年から2021年にかけて当科で手術を行った側頭骨グロムス腫瘍の4例について報告する。4例の内訳として鼓室型2例、頸静脈球型2例に対し治療を行った。鼓室型の2例では拍動性耳鳴を認めた。術前聴力検査では3例で患側の聴力低下と気骨導差を認めた。頸静脈球型のうち1例では生検、切除、再手術と3回の手術を必要とした。血管塞栓術は鼓室型、頸静脈球型それぞれ1例ずつ施行し、すべての症例において、術前後の神経脱落所見は認めなかった。1例は残存病変があるものの増大なく経過しており、その他3例は再発・再々発なく経過している。グロムス腫瘍は血流豊富であり、栄養血管の塞栓や高周波バイポーラの使用が安全な手術に有用と考えられる。(著者抄録)

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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：日本語   出版者・発行元：耳鼻と臨床会  

41歳女性。右顔面神経麻痺、右顔面痙攣の精査加療目的に当科へ紹介となった。精査の結果、側頭骨内顔面神経鞘腫と診断し、患者は手術を強く希望したため、右顔面神経腫瘍摘出術および顔面神経再建術が施行された。その結果、術後に右顔面痙攣は完全消失し、右顔面神経麻痺も回復傾向にあり、今後は外来にて顔面神経リハビリテーションを継続的に行っていく予定である。

記述言語：日本語   出版者・発行元：耳鼻と臨床会  

2016年から2021年にかけて当科で手術を行った側頭骨グロムス腫瘍の4例について報告する。4例の内訳として鼓室型2例、頸静脈球型2例に対し治療を行った。鼓室型の2例では拍動性耳鳴を認めた。術前聴力検査では3例で患側の聴力低下と気骨導差を認めた。頸静脈球型のうち1例では生検、切除、再手術と3回の手術を必要とした。血管塞栓術は鼓室型、頸静脈球型それぞれ1例ずつ施行し、すべての症例において、術前後の神経脱落所見は認めなかった。1例は残存病変があるものの増大なく経過しており、その他3例は再発・再々発なく経過している。グロムス腫瘍は血流豊富であり、栄養血管の塞栓や高周波バイポーラの使用が安全な手術に有用と考えられる。(著者抄録)

記述言語：日本語   出版者・発行元：耳鼻と臨床会  

<p>2013 年 1 月から 2021 年 7 月の期間に手術治療を行った錐体尖病変 15 例を検討した。コレステリン肉芽腫 4 例では、1 例が経乳突的に、3 例は経鼻的にドレナージルートを作成した。錐体尖真珠腫 11 例では初発例 5 例、再手術例が 6 例であり、進展経路は迷路上型が 7 例、広範迷路型 2 例、迷路下型 2 例であった。迷路上型では進展範囲の小さな症例は経上半規管法により低侵襲に摘出し得たが、進展例や再手術例では中頭蓋窩法や、中頭蓋窩法と経迷路法の combined approach が必要であった。広範迷路型では経蝸牛 ＋ 中頭蓋窩法の combined approach を行い、迷路下型では進展範囲に応じて蝸牛下法や迷路下法を用いた。コレステリン肉芽腫全例と錐体尖真珠腫の 3 例で聴力温存できた。錐体尖は側頭骨最深部に位置し、手術アプローチの選択が重要である。聴力や病変と解剖学的構造の位置関係を考慮して術式を選択する必要がある。</p>

DOI： 10.11334/jibi.69.1_1

CiNii Research

記述言語：日本語  

2013年1月から2021年7月の期間に手術治療を行った錐体尖病変15例を検討した。コレステリン肉芽腫4例では、1例が経乳突的に、3例は経鼻的にドレナージルートを作成した。錐体尖真珠腫11例では初発例5例、再手術例が6例であり、進展経路は迷路上型が7例、広範迷路型2例、迷路下型2例であった。迷路上型では進展範囲の小さな症例は経上半規管法により低侵襲に摘出し得たが、進展例や再手術例では中頭蓋窩法や、中頭蓋窩法と経迷路法のcombined approachが必要であった。広範迷路型では経蝸牛+中頭蓋窩法のcombined approachを行い、迷路下型では進展範囲に応じて蝸牛下法や迷路下法を用いた。コレステリン肉芽腫全例と錐体尖真珠腫の3例で聴力温存できた。錐体尖は側頭骨最深部に位置し、手術アプローチの選択が重要である。聴力や病変と解剖学的構造の位置関係を考慮して術式を選択する必要がある。(著者抄録)

記述言語：日本語   出版者・発行元：耳鼻と臨床会  

2013年1月から2021年7月の期間に手術治療を行った錐体尖病変15例を検討した。コレステリン肉芽腫4例では、1例が経乳突的に、3例は経鼻的にドレナージルートを作成した。錐体尖真珠腫11例では初発例5例、再手術例が6例であり、進展経路は迷路上型が7例、広範迷路型2例、迷路下型2例であった。迷路上型では進展範囲の小さな症例は経上半規管法により低侵襲に摘出し得たが、進展例や再手術例では中頭蓋窩法や、中頭蓋窩法と経迷路法のcombined approachが必要であった。広範迷路型では経蝸牛+中頭蓋窩法のcombined approachを行い、迷路下型では進展範囲に応じて蝸牛下法や迷路下法を用いた。コレステリン肉芽腫全例と錐体尖真珠腫の3例で聴力温存できた。錐体尖は側頭骨最深部に位置し、手術アプローチの選択が重要である。聴力や病変と解剖学的構造の位置関係を考慮して術式を選択する必要がある。(著者抄録)

記述言語：日本語   出版者・発行元：耳鼻と臨床会  

2013年1月から2021年7月の期間に手術治療を行った錐体尖病変15例を検討した。コレステリン肉芽腫4例では、1例が経乳突的に、3例は経鼻的にドレナージルートを作成した。錐体尖真珠腫11例では初発例5例、再手術例が6例であり、進展経路は迷路上型が7例、広範迷路型2例、迷路下型2例であった。迷路上型では進展範囲の小さな症例は経上半規管法により低侵襲に摘出し得たが、進展例や再手術例では中頭蓋窩法や、中頭蓋窩法と経迷路法のcombined approachが必要であった。広範迷路型では経蝸牛+中頭蓋窩法のcombined approachを行い、迷路下型では進展範囲に応じて蝸牛下法や迷路下法を用いた。コレステリン肉芽腫全例と錐体尖真珠腫の3例で聴力温存できた。錐体尖は側頭骨最深部に位置し、手術アプローチの選択が重要である。聴力や病変と解剖学的構造の位置関係を考慮して術式を選択する必要がある。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00581&link_issn=&doc_id=20230203030001&doc_link_id=10.11334%2Fjibi.69.1_1&url=https%3A%2F%2Fdoi.org%2F10.11334%2Fjibi.69.1_1&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：一般社団法人　日本耳科学会  

<p>細径の蝸牛軸巻き付き型の人工内耳電極は挿入時に蝸牛内で屈曲（tip fold-over）することがある．この問題は電極が曲がる向きと蝸牛が曲がる向きが一致しないミスアライメントという状態のときに起こりやすい．このため，執刀医は電極のコイル平面をなるべく蝸牛のコイル平面に一致させて電極を挿入する必要がある．われわれは，手術中に視認できるキヌタ骨を利用して蝸牛コイル平面を想定する方法を検討した．</p><p>2017年から2021年の期間に，一人の執刀医が施行した人工内耳植込み術症例のうち内耳奇形症例を除外した65耳（右29耳，左36耳）について検討した．キヌタ骨平面と蝸牛コイル平面が為す角度をキヌタ－蝸牛角と定義し集計した．キヌタ－蝸牛角は平均では34.6°であった．左右および手術時年齢による統計的な有意差は見られなかった．本研究により，手術中に確認できるキヌタ骨平面を利用して蝸牛コイル平面を正確に想定することが可能とわかった．</p>

DOI： 10.11289/otoljpn.33.170

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：Clinical Anatomy  

The jugular foramen harbors anatomically complex bony, venous and neural structures. It is closely associated with small canals including the mastoid, tympanic, and cochlear canaliculi, and the stylomastoid foramen. The minute intraosseous branches of Arnold's and Jacobson's nerves (<1 mm in length) remain difficult to study with current imaging techniques, and cadaveric dissection is the most reliable approach. Our aim was to examine the variations of Jacobson's and Arnold's canaliculi and nerves and to provide detailed cadaveric graphics. To reveal the anatomical structures of small canals around the jugular foramen, 25 sides of dry skulls and 14 sides of cadaveric heads were examined. Intraosseous branches varied more in Arnold's nerve than Jacobson's nerve. In our cadaveric dissection, all specimens formed a single canal for Jacobson's nerve connecting the jugular foramen to the tympanic cavity. The intraosseous course of Arnold's nerve varied in its communication with the facial nerve. A descending branch crossing the facial nerve was identified in five of 14 sides, an ascending branch in 13. In two specimens, an ascending branch clearly reached the base of the stapedius muscle. Classical anatomical studies of cadavers remain a supplementary tool for analyzing these tiny structures. The present study confirms Gray's findings of 1913. Variations of these nerves could be even more complex than previously reported. Our study provides additional information regarding the anatomy of Jacobson's and Arnold's nerves.

DOI： 10.1002/ca.23998

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記述言語：日本語   出版者・発行元：一般社団法人 日本耳鼻咽喉科頭頸部外科学会  

<p>　側頭骨悪性腫瘍に対する側頭骨一塊切除術は, 外側側頭骨切除術 (lateral temporal bone resection: LTBR), 側頭骨亜全摘術 (subtotal temporal bone resection: STBR), 側頭骨全摘術 (total temporal bone resection: TTBR) の3つの方法が報告されているが, 実臨床では, LTBR と STBR の二つが主に用いられる. STBR は, 頭蓋底チームが手術対応できる施設でのみ施行可能な術式である. 一方, LTBR は耳鼻咽喉科医単独で施行可能な術式で, 非常に洗練された画一的な手術手技である. 通常の乳突洞削開術を含む耳科手術の手技に加え, 側頭骨鼓室部の骨削除の方法を理解することで, 安全に手術を完遂できる. 本術式は通常の耳科手術に必要な外科解剖と手術手技を学ぶことができるため, 経験の浅い耳鼻咽喉科医にも積極的に関与してもらいたい術式である.</p><p>　手術手技の構成は, 通常の乳突洞削開術に後鼓室開放後の鼓室内操作, 上/前鼓室開放, 後鼓室開放の拡大と側頭骨鼓室部の骨削除などの手技を組み合わせたものとなっている. 通常の耳科手術で馴染みの少ない側頭骨鼓室部の削除が Key となる手技と思われる. 安全に側頭骨の鼓室部の削除を行うためには, 錐体鼓室縫合と鼓索神経の関係, 骨部耳管と内頸動脈との関係, そして下鼓室と vaginal process との関係を正確に知る必要がある.</p><p>　本稿では, LTBR を施行する上で必要な骨学と, 術前の留意点などに加えて, 実際の手術手技の手順について概説する.</p>

DOI： 10.3950/jibiinkotokeibu.125.10_1459

CiNii Research

記述言語：日本語  

記述言語：日本語  

記述言語：日本語   出版者・発行元：(一社)日本耳科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳科学会  

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記述言語：英語  

DOI： 10.1097/ONO.0000000000000017

PubMed

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1411203105

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記述言語：日本語   出版者・発行元：耳鼻と臨床会  

<p>ANCA 関連血管炎は腎障害や肺病変などの全身疾患で発症することが多い自己免疫性血管炎であるが、近年、中耳炎初発・耳限局型の ANCA 関連血管炎の報告が増加している。本症例は結核の既往がある 52 歳女性で、主症状は抗菌薬無効の中耳炎と難聴、頭痛であった。難治性中耳炎として ANCA 関連血管炎性中耳炎（OMAAV）を鑑別に挙げてはいたものの、ANCA 抗体陰性で生検組織は血管炎の所見が得られず、また、結核性中耳炎の可能性を懸念し診断に苦慮した。最終的に、OMAAV に特徴的とされる肥厚性硬膜炎の合併や、ANCA 関連血管炎やその他自己免疫疾患の診療経験が豊富な膠原病内科医による他臓器評価により除外診断を行い OMAAV の診断を得た。診断までに 1 年を要した OMAAV の症例を経験したため、主にその診断について若干の文献的考察を加えて報告する。</p>

DOI： 10.11334/jibi.68.4_266

CiNii Research

記述言語：日本語  

ANCA関連血管炎は腎障害や肺病変などの全身疾患で発症することが多い自己免疫性血管炎であるが、近年、中耳炎初発・耳限局型のANCA関連血管炎の報告が増加している。本症例は結核の既往がある52歳女性で、主症状は抗菌薬無効の中耳炎と難聴、頭痛であった。難治性中耳炎としてANCA関連血管炎性中耳炎(OMAAV)を鑑別に挙げてはいたものの、ANCA抗体陰性で生検組織は血管炎の所見が得られず、また、結核性中耳炎の可能性を懸念し診断に苦慮した。最終的に、OMAAVに特徴的とされる肥厚性硬膜炎の合併や、ANCA関連血管炎やその他自己免疫疾患の診療経験が豊富な膠原病内科医による他臓器評価により除外診断を行いOMAAVの診断を得た。診断までに1年を要したOMAAVの症例を経験したため、主にその診断について若干の文献的考察を加えて報告する。(著者抄録)

記述言語：その他   掲載種別：研究論文（学術雑誌）   出版者・発行元：PLoS ONE  

Objectives The benefit of sequential therapy after immune checkpoint inhibitor (ICI) treatment for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) has been recently reported. Furthermore, there is a growing interest in the impact of cetuximab (Cmab)-containing salvage chemotherapy (SCT) and the therapeutic efficacy and adverse events (AEs) of Cmab administration prior to ICI administration. Materials and methods We retrospectively reviewed the medical records of 52 patients with R/M HNSCC treated with SCT (weekly paclitaxel [PTX], n = 7, or weekly PTX and Cmab [PC], n = 45). Results The objective response rate (ORR) and a disease control rate (DCR) was 53.3&#37; and 91.1&#37; in the PC group and 42.9&#37; and 57.1&#37; in the PTX group, respectively. There was a significant difference in the DCR between the PC and PTX groups (p = 0.0143). The overall survival (OS) and progression-free survival were significantly better in the PC group than in the PTX group. On the other hand, the incidence of drug-induced interstitial pneumonia (DI-IP) in R/M HNSCC patients who received SCT was 21.2&#37;. Patients in the PC group were divided according to whether they received Cmab (Group A) or did not receive Cmab (Group B) as palliative therapy prior to ICIs. Group B had a significantly better OS than Group A. Furthermore, our findings suggest that the incidence rate of DI-IP during SCT might be higher in Group B. Conclusion Although PC following ICIs shows dramatic efficacy, careful monitoring of AEs, including DIIP, is recommended.

DOI： 10.1371/journal.pone.0271907

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PubMed

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記述言語：日本語   出版者・発行元：耳鼻と臨床会  

ANCA関連血管炎は腎障害や肺病変などの全身疾患で発症することが多い自己免疫性血管炎であるが、近年、中耳炎初発・耳限局型のANCA関連血管炎の報告が増加している。本症例は結核の既往がある52歳女性で、主症状は抗菌薬無効の中耳炎と難聴、頭痛であった。難治性中耳炎としてANCA関連血管炎性中耳炎(OMAAV)を鑑別に挙げてはいたものの、ANCA抗体陰性で生検組織は血管炎の所見が得られず、また、結核性中耳炎の可能性を懸念し診断に苦慮した。最終的に、OMAAVに特徴的とされる肥厚性硬膜炎の合併や、ANCA関連血管炎やその他自己免疫疾患の診療経験が豊富な膠原病内科医による他臓器評価により除外診断を行いOMAAVの診断を得た。診断までに1年を要したOMAAVの症例を経験したため、主にその診断について若干の文献的考察を加えて報告する。(著者抄録)

記述言語：日本語   出版者・発行元：耳鼻と臨床会  

ANCA関連血管炎は腎障害や肺病変などの全身疾患で発症することが多い自己免疫性血管炎であるが、近年、中耳炎初発・耳限局型のANCA関連血管炎の報告が増加している。本症例は結核の既往がある52歳女性で、主症状は抗菌薬無効の中耳炎と難聴、頭痛であった。難治性中耳炎としてANCA関連血管炎性中耳炎(OMAAV)を鑑別に挙げてはいたものの、ANCA抗体陰性で生検組織は血管炎の所見が得られず、また、結核性中耳炎の可能性を懸念し診断に苦慮した。最終的に、OMAAVに特徴的とされる肥厚性硬膜炎の合併や、ANCA関連血管炎やその他自己免疫疾患の診療経験が豊富な膠原病内科医による他臓器評価により除外診断を行いOMAAVの診断を得た。診断までに1年を要したOMAAVの症例を経験したため、主にその診断について若干の文献的考察を加えて報告する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00581&link_issn=&doc_id=20220826100006&doc_link_id=10.11334%2Fjibi.68.4_266&url=https%3A%2F%2Fdoi.org%2F10.11334%2Fjibi.68.4_266&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Neurological Surgery, Part B: Skull Base  

Objective  En bloc and margin-negative surgical resection seems to offer the best prognosis for patients with temporal bone squamous cell carcinoma (TB-SCC). In this study, we summarize the outcomes of surgical cases of advanced TB-SCC (T3-T4) that were managed in two institutions, with an accompanying description of the surgical procedure that was utilized: modified subtotal temporal bone resection (STBR), which involves the en bloc removal of the temporal bone including or transecting the otic capsule. Design  This is a case series study with chart review. Setting  The study was conducted at two academic tertiary care medical centers. Participants  Chart information was collected for all patients who underwent surgical resection of advanced TB-SCC between July 1998 and February 2019. The resulting dataset contained 43 patients with advanced TB-SCC who underwent en bloc resection during the review period. Tumor staging followed the modified Pittsburgh classification. Disease-specific survival (DSS) rates were calculated according to the Kaplan-Meier method. Main Outcome Measure  This study shows disease-specific 5-year DSS rate. Results  The 5-year DSS rate of the cases who underwent en bloc resection was 79.7&#37;. En bloc lateral temporal bone resection was employed in a total of 25 cases (DSS: 79.0&#37;). En bloc modified STBR was utilized in 18 cases (DSS: 81.7&#37;). Conclusion  En bloc margin-negative resection is a reliable treatment strategy for advanced TB-SCC. Modified STBR can be a treatment option for TB-SCC without marked posterior extension.

DOI： 10.1055/s-0041-1722930

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記述言語：その他   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本耳鼻咽喉科頭頸部外科学会  

DOI： 10.3950/jibiinkotokeibu.125.5_916

CiNii Research

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記述言語：日本語  

記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科頭頸部外科学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J07551&link_issn=&doc_id=20220530470017&doc_link_id=10.3950%2Fjibiinkotokeibu.125.5_916&url=https%3A%2F%2Fdoi.org%2F10.3950%2Fjibiinkotokeibu.125.5_916&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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   出版者・発行元：(一社)日本耳鼻咽喉科頭頸部外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科頭頸部外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科頭頸部外科学会  

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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：Cancer Medicine  

There is no useful biomarker to evaluate treatment response and early relapse in head and neck squamous cell carcinoma (HNSCC). Circulating tumor DNA (ctDNA) is a promising biomarker for detecting minimal residual diseases and monitoring treatment effect. We investigated whether individualized ctDNA analysis could help monitor treatment response and relapse in HNSCC. Mutation analysis of tumor and peripheral blood mononuclear cell (PBMC) DNAs of 26 patients with HNSCC was performed using a custom squamous cell carcinoma (SCC) panel. The identified individualized mutated genes were defined as ctDNA candidates. We investigated whether frequent ctDNA monitoring via digital PCR (dPCR) is clinically valid for HNSCC patients. TP53 was the most frequently mutated gene and was detected in 14 of 24 cases (58.2%), wherein two cases were excluded owing to the absence of tumor-specific mutations in the SCC panel. Six cases were excluded because of undesignable and unusable primer-probes for dPCR. Longitudinal ctDNA was monitored in a total of 18 cases. In seven cases, ctDNA tested positive again or did not test negative, and all seven cases relapsed after initial curative treatment. In 11 cases, after initial curative treatment, ctDNA remained negative and patients were alive without recurrence. Patients who remained negative for ctDNA during follow-up after initial curative treatment (n = 11) had a significantly better prognosis than those who reverted to ctDNA positivity (n = 7; p < 0.0001; log-rank test). Individualized ctDNA monitoring using SCC panel and dPCR might be a novel and promising biomarker for HNSCC.

DOI： 10.1002/cam4.4726

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記述言語：日本語   出版者・発行元：一般社団法人 日本耳鼻咽喉科頭頸部外科学会  

DOI： 10.3950/jibiinkotokeibu.125.2_213

CiNii Research

記述言語：日本語  

記述言語：日本語  

症例は72歳男性で、左側口蓋部の腺様嚢胞癌と診断され、全身麻酔下に口腔内アプローチ・鼻腔内視鏡アプローチを併用して腫瘍切除術を施行した。腫瘍摘出術後、硬口蓋・軟口蓋移行部の口腔側左寄りに40×40mm程度、軟口蓋鼻腔側に20×20mmほどの粘膜欠損が生じ、口腔内と鼻腔内との交通が生じたため、口腔側は右側茎の硬口蓋粘膜骨膜弁、鼻腔側左鼻中隔粘膜弁で再建した。術後9日目に硬口蓋粘膜弁に小範囲の表層壊死および小瘻孔を認めデブリードマンおよび再縫合を施行したが、その後経過は良好で、術後20日目に経管栄養併用で経口摂取を再開し、術後27日目には食事全量摂取が可能となった。術後8ヵ月経過現在、鼻咽腔逆流はなく経口摂取も可能であり、開鼻声などの機能障害も認めていない。

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3390/cancers13184556

記述言語：英語  

DOI： 10.1111/coa.13796

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Currently, only lateral temporal bone resection (LTBR) and subtotal temporal bone resection (STBR) are widely utilized for the surgical treatment of advanced squamous cell carcinoma of the external auditory canal (EAC‐SCC). However, there are few descriptions of variations on these surgical ap-proaches. This study aimed to elucidate the variations of en bloc resection for advanced EAC‐SCC. We dissected the four sides of cadaveric heads to reveal the anatomical structures related to temporal bone resection. From the viewpoint of surgical anatomy, surgical patterns of temporal bone cutting can be divided into four categories: conventional LTBR, extended LTBR, conventional STBR, and modified STBR. Extended LTBR is divided into four types: superior, inferior, anterior, and posterior extensions. Several extension procedures can be combined based on the extension of the tumor. Furthermore, en bloc resection with the temporomandibular joint or glenoid fossa increases the technical difficulty of a surgical procedure because the exposure and manipulation of the petrous segment of the internal carotid artery are limited from the middle cranial fossa. Surgical approaches for advanced SCC of the temporal bone are diverse. They require accurate preoperative evaluation of the tumor extension and preoperative con-sideration of the exact line of resection to achieve marginal negative resection.

DOI： 10.3390/cancers13184556

記述言語：日本語  

中頭蓋より発生し中耳進展した髄膜腫の1例を経験した。髄膜腫はクモ膜細胞より発生する良性腫瘍でクモ膜顆粒の分布領域に沿って発生しやすいとされており、頭蓋外に発生する頻度は低く中耳腫瘍として経験することは少ない。本症例は、難聴を主訴に耳鼻咽喉科を受診したところ中耳腫瘍を指摘された。当院での画像所見および組織生検時の術中所見から、中頭蓋窩髄膜腫が上鼓室天蓋を介して中耳進展を来したと考えられた。中頭蓋窩法を併用した乳突洞削開を行い、中頭蓋窩腫瘍、中耳・乳突洞内の腫瘍を全摘し得た。(著者抄録)

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE/HYPOTHESIS: Squamous cell carcinoma (SCC) of the temporal bone is an extremely rare condition. This rarity has led to a delay in the establishment of a standard treatment protocol and adequate staging system. Identification of prognostic markers of this disease from a variety of fields is desirable in the establishment of treatment guidelines for temporal bone SCC. The aim of this study is to assess the prognostic role of inflammation-based prognostic scores in cases of temporal bone SCC. STUDY DESIGN: Case reries with chart review. METHODS: A total of 71 cases of primary malignancy eligible for curative treatment at a single tertiary medical institute were retrospectively analyzed. Univariate and multivariate regression analyzes were used to investigate the association between the inflammation-based scores and 5-year overall survival. RESULTS: Univariate Cox regression analyzes showed that a high neutrophil-to-lymphocyte ratio, high platelet-to-lymphocyte ratio, low lymphocyte-to-monocyte ratio, a Glasgow prognostic score of 2, and the systemic inflammation score of 2 were significantly associated with a poor prognosis, as well as a classification of T4 stage, presence of cervical lymph node metastasis, high white blood cell counts, and high C-reactive protein levels. The multivariate analysis showed that a clinical stage of T4 and a systemic inflammation score of 2 were independent prognostic markers. CONCLUSIONS: Inflammation-based prognostic markers are associated with the survival of patients with temporal bone SCC, as well as other head and neck SCCs. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1782-1789, 2021.

DOI： 10.1002/lary.29421

記述言語：その他   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The inferior petroclival vein (IPV) courses along the extracranial surface of the petroclival fissure. It is occasionally involved in vascular diseases and has recently been used for vascular access to the cavernous sinus. However, detailed descriptions of its anatomy are currently lacking. OBJECTIVE: To define the anatomic relationship between the IPV and its surrounding structures based on cadaveric dissection and radiological analysis. METHODS: A dry skull and an injected cadaver head were examined to reveal the relationships between the IPV and its surrounding structures. The existence of the IPV and its relationships with other venous structures were also examined by contrast-enhanced, fat-suppressed T1-weighted magnetic resonance imaging in 26 patients (51 sides). RESULTS: The entire course of the IPV was shown via stepwise cadaver dissection from below. Its relationships with surrounding structures, such as the jugular bulb, sigmoid sinus, inferior petrosal sinus, petrosal venous confluence, and the posterior, lateral, and anterior condylar veins, were also shown. In the radiological analysis, the IPV was identified on all sides. The rostral end of the vein was connected to the venous plexus around the carotid artery on all sides. The vein drained into the caudal end of the inferior petrosal sinus (49/51 sides, 96.1&#37;) or into the anterior condylar vein (2/51 sides, 3.9&#37;). CONCLUSION: A precise understanding of the anatomy of the IPV will enable endovascular and skull base surgeons to achieve diagnoses and gain safe access to lesions involving the IPV.

DOI： 10.1093/ons/opab099

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Primary temporal bone squamous cell carcinoma is sporadic. According to previous studies, margin-negative resection provides the best prognosis (Nakagawa et al., 2006; Moody et al., 2000; Yin et al., 2006; Komune et al., 2021 [1–4]). When tumors extend behind the tympanic membrane, lateral temporal bone resection, which is a well-established procedure, is insufficient to achieve a tumor-free margin. For these cases, subtotal temporal bone resection (STBR) can achieve a complete en bloc resection with a tumor-free margin. Furthermore, STBR en bloc with surrounding structures, including the temporomandibular joint and parotid gland, complicates surgical techniques. We previously reported this surgical procedure in a stepwise manner using cadaveric dissection (Komune et al., 2014 [5]). The STBR en bloc with the parotid gland and temporomandibular joint is composed of three approaches according to our previous report: high cervical exposure (neck dissection), a subtemporal-infratemporal fossa approach, and a retromastoid-paracondylar approach. However, we currently lack demonstrative surgical videos. According to our previous report, this video first demonstrates STBR en bloc with the parotid gland and temporomandibular joint (Komune et al., 2014 [5]). The histopathological diagnosis of a 57-year-old woman suffering from a large tumor protruding from her auricle indicated squamous cell carcinoma; after the diagnosis she was referred to our hospital. Computed tomography revealed the full extent of the tumor, which was about 8 cm in diameter and had damaged the middle cranial base, mastoid bone, and middle ear cavity. Magnetic resonance imaging indicated invasion of the glenoid fossa and parotid gland, equivalent to a Pittsburg stage cT4 tumor. The patient underwent STBR en bloc with the parotid gland and temporomandibular joint. Lower cranial nerves (CN IX-XII) were preserved, and the patient achieved normal oral intake without additional procedures after surgery. At six months post-operation, no recurrence was noted. In this video, we first demonstrate the surgical procedure of the STBR en bloc with the parotid gland and temporomandibular joint for far-advanced temporal bone squamous cell carcinoma, and it can be one of the surgical options to achieve the complete resection without exposure of the tumor. Informed consent was obtained from the patient. The video was reproduced with the written informed consent of the patient. Primary temporal bone squamous cell carcinoma is sporadic. According to previous studies, margin-negative resection provides the best prognosis (Nakagawa et al., 2006; Moody et al., 2000; Yin et al., 2006; Komune et al., 2021 [1–4]). When tumors extend behind the tympanic membrane, lateral temporal bone resection, which is a well-established procedure, is insufficient to achieve a tumor-free margin. For these cases, subtotal temporal bone resection (STBR) can achieve a complete en bloc resection with a tumor-free margin. Furthermore, STBR en bloc with surrounding structures, including the temporomandibular joint and parotid gland, complicates surgical techniques. We previously reported this surgical procedure in a stepwise manner using cadaveric dissection (Komune et al., 2014 [5]). The STBR en bloc with the parotid gland and temporomandibular joint is composed of three approaches according to our previous report: high cervical exposure (neck dissection), a subtemporal-infratemporal fossa approach, and a retromastoid-paracondylar approach. However, we currently lack demonstrative surgical videos. According to our previous report, this video first demonstrates STBR en bloc with the parotid gland and temporomandibular joint (Komune et al., 2014 [5]). The histopathological diagnosis of a 57-year-old woman suffering from a large tumor protruding from her auricle indicated squamous cell carcinoma; after the diagnosis she was referred to our hospital. Computed tomography revealed the full extent of the tumor, which was about 8 cm in diameter and had damaged the middle cranial base, mastoid bone, and middle ear cavity. Magnetic resonance imaging indicated invasion of the glenoid fossa and parotid gland, equivalent to a Pittsburg stage cT4 tumor. The patient underwent STBR en bloc with the parotid gland and temporomandibular joint. Lower cranial nerves (CN IX-XII) were preserved, and the patient achieved normal oral intake without additional procedures after surgery. At six months post-operation, no recurrence was noted. In this video, we first demonstrate the surgical procedure of the STBR en bloc with the parotid gland and temporomandibular joint for far-advanced temporal bone squamous cell carcinoma, and it can be one of the surgical options to achieve the complete resection without exposure of the tumor. Informed consent was obtained from the patient. The video was reproduced with the written informed consent of the patient.

DOI： 10.1016/j.amjoto.2021.103081

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To obtain new insights into research questions on how executive function and social interaction would be observed to change after the introduction of hearing aids (HAs) in older people with hearing impairment. DESIGN: Multi-institutional prospective single-arm observational study. SETTING AND PARTICIPANTS: Outpatients with complaints of hearing difficulty who visited HA clinics between October 18, 2017, and June 30, 2019, in 7 different university hospitals in Japan. METHODS: The inclusion criteria of the study named Hearing-Aid Introduction for Hearing-Impaired Seniors to Realize a Productive Aging Society-A Study Focusing on Executive Function and Social Activities Study (HA-ProA study) were age ≥60 years and no history of HA use. A series of multi-institution common evaluations including audiometric measurements, the digit symbol substitution test to assess executive functions, convoy model as an index of social relations, and hearing handicap inventory for the elderly (HHIE) were performed before (pre-HA) and after 6 months of the HA introduction (post-HA). RESULTS: Out of 127 enrollments, 94 participants completed a 6-month follow-up, with a mean age of 76.9 years. The digit symbol substitution test score improved significantly from 44.7 at baseline to 46.1 at 6 months (P = .0106). In the convoy model, the social network size indicated by the number of persons in each and whole circles were not significantly different between pre- and post-HA; however, the total count for kin was significantly increased (P = .0344). In the analyses of HHIE, the items regarding the family and relatives showed significant improvement. CONCLUSIONS AND IMPLICATIONS: HA use could benefit older individuals beginning to use HAs in executive function and social interaction, though the results should be interpreted cautiously given methodological limitations such as a single-arm short 6 months observation. Reduction in daily hearing impairment would have a favorable effect on relationships with the family.

DOI： 10.1016/j.jamda.2021.02.035

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）  

There are no human cancer cell lines of external auditory canal origin available for research use. This report describes the establishment of a culture condition for external auditory canal squamous cell carcinoma, derived from human tumor tissue. Successive squamous cell carcinoma colonies were dissociated by trypsin, subcultured, and maintained on a feeder layer (MMC-TIG-1-20), yielding a clonally proliferating cell culture. Two morphological types of colony were observed: (a) densely packed colonies and (b) colonies with indistinct boundaries characterized by cell-cell complexes with fibroblast feeder cells. The SCC-like characteristics of these cells were evidenced by positivity for p53, SCCA1/2, cytokeratin, and vimentin, and cancer stem cell properties were indicated by positivity for CD44, CD133, Oct3/4, and alkaline phosphatase (ALP). One of the unique properties of cell cultures is their tendency to form steric colonies in vitro on feeder layer cells. In addition, in the presence of fresh macrophages, the cells very slowly transform to break away from colonies as free cells, a process that resembles the epidermal-mesenchymal transition, whereby cell-cell interactions are weakened and migration activity is enhanced. These factors are purported to play a key role in cancer cell metastasis.

DOI： 10.1002/2211-5463.13225

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: There is no guideline for hearing compensation after temporal bone resection. This study aimed to retrospectively analyze surgical cases with reconstruction for hearing preservation after temporal bone malignancy resection and propose a new alternative to compensate for hearing loss. METHODS: We retrospectively reviewed the medical records of 30 patients who underwent lateral temporal bone surgery for temporal bone malignancy at our institution and examined their hearing abilities after surgery. RESULT: The hearing outcomes of patients with an external auditory meatus reconstruction varied widely. The mean postoperative air-bone gap at 0.5, 1, 2, and 4 kHz ranged from 22.5 dB to 71.25 dB. On the other hand, the average difference between the aided sound field thresholds with cartilage conduction hearing aid and bone conduction thresholds at 0.5, 1, 2, and 4 kHz ranged from -3.75 to 41.25. More closely located auricular cartilage and temporal bone resulted in smaller differences between the aided sound field and bone conduction thresholds. CONCLUSIONS: There is still room for improvement of surgical techniques for reconstruction of the auditory meatus to preserve hearing after temporal bone resection. The cartilage conduction hearing aid may provide non-invasive postoperative hearing compensation after lateral temporal bone resection.

DOI： 10.3390/audiolres11020024

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES/HYPOTHESIS: The tumor immune microenvironment in temporal bone squamous cell carcinoma (TBSCC), including the programmed death-ligand 1 (PD-L1) expression and tumor-infiltrating lymphocytes (TILs), has not been established. STUDY DESIGN: Retrospective cohort study. METHODS: We performed immunohistochemistry analyses to retrospectively analyze 123 TBSCC cases for PD-L1 expression and TILs and their prognostic significance. We also evaluated the prognostic correlations between these immunomarkers and the therapeutic responses to chemoradiotherapy (CRT). RESULTS: PD-L1 expression (≥1&#37;) was detected in 62 (50.4&#37;) TBSCC cases and was significantly associated with worse prognosis: progression-free survival (PFS), P < .0001; overall survival (OS), P = .0009. A high density of CD8+ TILs was significantly associated with better prognosis (PFS, P = .0012; OS, P = .0120). In contrast, a high density of Foxp3+ TILs tended to be associated with an unfavorable prognosis (PFS, P = .0148; OS, P = .0850). With regard to the tumor microenvironment subtypes defined by CD8+ TILs and PD-L1 expression, the CD8low /PD-L1+ group showed significantly worse prognosis. Among the 36 neoadjuvant CRT-treated cases, PD-L1 expression was significantly associated with worse OS (P = .0132). Among the 32 CRT-treated cases without surgery, a high density of CD8+ TILs tended to be more highly associated with complete response to CRT compared to a low density of CD8+ TILs (P = .0702). CONCLUSIONS: These results indicate that the evaluation of the tumor immune microenvironment may contribute to the prediction of prognoses and the selection of an individualized therapeutic strategy for patients with TBSCC. LEVEL OF EVIDENCE: 4 Laryngoscope, 2021.

DOI： 10.1002/lary.29689

記述言語：日本語  

記述言語：日本語  

軟骨伝導補聴器は耳介の軟骨に振動子を当てることで外耳道内で軟骨が音を発生させ補聴効果をもたらす新しい原理の補聴器である。九州大学病院で軟骨伝導補聴器外来の運用を開始して約2年経過した現在までの軟骨伝導補聴器試聴と仮フィッティングした例の統計、購入者と非購入者の傾向を検討した。試聴した人の中で軟骨伝導補聴器を購入した人の割合は外耳道閉鎖/狭窄症、および中耳炎術後/慢性耳漏例の患者に高かった。聴力では、裸耳音場閾値に比べ装用閾値が低い患者に購入が多かった。しかし、それまで補聴器を使っていた人の装用閾値と比べて軟骨伝導補聴器の装用閾値が必ずしも低くなくても購入する人が多く、他の補聴器との比較の際は、装用閾値だけで決めていないことが示唆された。(著者抄録)

記述言語：日本語  

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Although negative pressure wound therapy (NPWT) is widely used, its application to the head and neck region remains challenging due to anatomical complexities. This report presents the case of a female patient presenting with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes, uncontrolled diabetes and severe bilateral sensorineural hearing loss. The patient had undergone cochlear implant surgery and five months later the wound was infected with methicillin-resistant Staphylococcus aureus (MRSA). NPWT was started shortly after removing the internal receiver and was stopped 11 days later. NPWT helped in controlling infection and led to a successful wound closure. In this case, NPWT was effective in treating infectious wounds around the auricle after cochlear implant surgery. Declaration of interest: The authors have no financial support for this article and no conflict of interest directly relevant to the content of this article.

DOI： 10.12968/jowc.2020.29.10.568

記述言語：日本語  

記述言語：日本語  

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Recent studies have suggested the benefit of salvage chemotherapy (SCT) after immune checkpoint inhibitor (ICI) treatment for recurrent and metastatic head and neck squamous cell carcinoma (R/M HNSCC). We retrospectively examined the outcome of SCT and the usefulness of the serum C-reactive protein level (CRP) and neutrophil-to-lymphocyte ratio (NLR) as prognostic biomarkers. Thirty-nine patients with R/M HNSCC were enrolled in this study. Twenty-five patients (64.1&#37;) received combination chemotherapy of weekly paclitaxel and cetuximab (PC) as SCT, and 14 patients (35.9&#37;) received S1, an oral fluoropyrimidine. In all patients, the response rate, disease control rate, median progression-free survival (PFS), and median overall survival (OS) were 45.2&#37;, 85.7&#37;, 6.5 months, and 13.5 months, respectively. No chemotherapy-related deaths were observed. These PC groups had low CRP (<1.2 mg/dL) or low NLR (<7.0) values at the time of SCT induction, which was significantly associated with an improved OS (p = 0.0440, p = 0.0354). A multivariate analysis also showed that a lower CRP value was significantly associated with a better OS (p = 0.0078). We clarified the usefulness of the PC and S1 regimens as SCT. In addition, SCT with the PC regimen showed a better prognosis with a lower CRP or NLR at induction than a higher CRP or NLR This is the first report on biomarkers of SCT in R/M HNSCC.

DOI： 10.3390/cancers12082299

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2020 Objective: To develop a registration procedure to achieve a higher degree of registration accuracy in image-guided otological surgery, paying particular attention to the registration centroid. Methods: A head phantom was used to measure the target registration error (TRE) at measurement points at various depth from the surface of the head. The surface-matching registration was performed using a commercially available surgical navigation system. We registered the phantom using only one ear of either side (right 100&#37; - left 0&#37;, or right 0&#37; - left 100&#37;) or using both ears with variable ratios (right 75&#37; - left 25&#37;, right 50&#37; - left 50&#37;, or right 25&#37; - left 75&#37;). Results: The overall TRE was the smallest when registration was performed equally on both sides. However, the TRE at 20–50 mm from the surface was the smallest when the fiducial points for the registration were collected asymmetrically at a ratio of 75:25 and weighed heavier on the operating side, and this difference was statistically significant. Conclusion: The accuracy of image-guided surgery can be improved by carefully planning the registration procedure without changing the procedure itself. Accurate image-guided surgery at the middle and inner ear was achieved using 75&#37; of the point cloud for the operating side and 25&#37; of that for the opposite side for the registration.

DOI： 10.1016/j.anl.2020.01.007

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2020 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association. External auditory canal squamous cell carcinoma (EACSCC) is an extremely rare and aggressive malignancy. Due to its rarity, the molecular and genetic characteristics of EACSCC have not yet been elucidated. To reveal the genetic alterations of EACSCC, we performed whole exome sequencing (WES) on 11 primary tumors, 1 relapsed tumor and 10 noncancerous tissues from 10 patients with EACSCC, including 1 with a rare case of synchronous bilateral EACSCC of both ears. WES of the primary tumor samples showed that the most frequently mutated gene is TP53 (63.6&#37;). In addition, recurrent mutations in CDKN2A, NOTCH1, NOTCH2, FAT1 and FAT3 were detected in multiple samples. The mutational signature analysis of primary tumors indicated that the mutational processes associated with the activation of apolipoprotein B mRNA-editing enzyme catalytic polypeptide-like (APOBEC) deaminases are the most common in EACSCC, suggesting its similarity to SCC from other primary sites. Analysis of arm-level copy number alterations detected notable amplification of chromosomes 3q, 5p and 8q as well as deletion of 3p across multiple samples. Focal chromosomal aberrations included amplifications of 5p15.33 (ZDHHC11B) and 7p14.1 (TARP) as well as deletion of 9p21.3 (CDKN2A/B). The protein expression levels of ZDHHC11B and TARP in EACSCC tissues were validated by immunohistochemistry. Moreover, WES of the primary and relapsed tumors from a case of synchronous bilateral EACSCC showed the intrapatient genetic heterogeneity of EACSCC. In summary, this study provides the first evidence for genetic alterations of EACSCC. Our findings suggest that EACSCC mostly resembles other SCC.

DOI： 10.1111/cas.14515

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© Copyright © 2020 Komune, Miyazaki, Sato, Sagiyama, Hiwatashi, Hongo, Koike, Noda, Uchi, Kogo, Akagi Tsuchihashi, Masuda and Nakagawa. Objective: The extreme rarity of temporal bone squamous cell carcinoma (TB-SCC) has delayed the accumulation of high-quality clinical evidence. Our objective here was to explore anatomical factors associated with the prognosis of T4 TB-SCC cases. Study Design: Case series with chart review. Setting: Two academic tertiary care medical centers. Subjects and Methods: The medical records of all TB-SCC cases were retrospectively reviewed in two institutions. The resulting data set contained 30 cases of primary T4 cancer eligible for initial definitive (curative) treatment. Disease-specific survival was calculated according to the Kaplan–Meier method. Cox proportional hazards model was used to identify anatomical prognosis factors. Results: The disease-specific 5-years survival rate of 30 cases of T4 TB-SCC was 53.9&#37;. The tumor invasion to the pterygoid muscle, posterior fossa dura, and sigmoid sinus and destruction of the ossicles were associated with poor prognosis in univariate analysis. The multivariate analysis reveals that the invasion of the ossicles, posterior fossa dura, and sigmoid sinus is an independent prognostic factor [hazard ratio (HR): 4.528 (95&#37; CI: 1.161–17.658), p = 0.030; HR: 5.135 (95&#37; CI: 1.616–16.315), p = 0.006; HR: 4.292 (95&#37; CI: 1.385–13.303), p = 0.012]. The invasion of the carotid canal, petrous apex, middle fossa dura, otic capsule, pterygoid muscle, and middle ear had a high HR (HR > 2). The more invaded anatomical factors present in patients resulted in a poorer patient disease-specific prognosis, with a statistically significant difference. Conclusions: Assessing which anatomical structures are susceptible to invasion by tumors may be important for predicting TB-SCC patient prognosis and selecting appropriate treatment planning, especially surgical intervention. In addition to previously reported factors, the destruction of the ossicles in the middle ear cavity can be an anatomical prognosis factor.

DOI： 10.3389/fonc.2020.01229

記述言語：日本語  

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2020 Elsevier GmbH Introduction: Ossification of the pterygospinous and pterygoalar ligaments has been well documented forming pterygospinous and pterygoalar bars. However, the actual ligaments have been rarely shown in the existing literature. Therefore, this study aimed to reveal the anatomy of the pterygoalar ligament/bar and pterygospinous ligament/bar, and its relationship with the branches of the mandibular nerve. Methods: Thirty sides from fifteen Caucasian fresh frozen cadaveric heads were used in this study. The branches of the mandibular nerve and any ligaments or bony bridges between the lateral plate of the pterygoid process and spine of the sphenoid were observed. Results: A pterygospinous ligament/bar and pterygoalar ligament/bar were defined based on the relationship with the branches of the mandibular nerve. The pterygoalar ligament/bar was further classified into two types. Twenty-seven sides (90&#37;) had at least one pterygoalar ligament/bar or pterygospinous ligament/bar. A pterygospinous ligament/bar was found on 15 sides (50.0&#37;). A pterygoalar ligament/bar was found on 16 sides (53.3&#37;), and a type I on 11 sides and type II on 5 sides. Conclusions: This finding and classification are simple to understand and easy to apply for future studies, and have important implications regarding the clinical anatomy of trigeminal neuralgia and facial pain.

DOI： 10.1016/j.aanat.2020.151466

記述言語：その他   掲載種別：研究論文（その他学術会議資料等）  

© 2020 Elsevier Inc. Objective: To review the microsurgical anatomy of the donor arteries for extracranial-intracranial bypass, namely, the superficial temporal artery (STA), occipital artery (OA), and internal maxillary artery (IMA). Methods: Seven cadaveric specimens were dissected to identify the relationships between each artery and its surrounding structures. Nineteen computed tomographic angiographic images of Japanese adult patients (38 sides) were analyzed to examine the course of each artery and to measure the diameters and distances from various anatomic landmarks to each artery. Results: The courses of the STA, OA, and IMA, which must be exposed during revascularization procedures, were shown via cadaver dissection with special reference to the following relationships to surrounding structures: STA, soft tissue layers of the temporoparietal region and facial nerve; OA, suboccipital muscles; and IMA, mandibular nerve. In addition, we measured the diameter of the anastomotic site for each artery and its relationship with surrounding muscles. Conclusions: A precise understanding of the anatomic characteristics of the donor arteries and their relationships with surrounding structures provides safe access to these arteries.

DOI： 10.1016/j.wneu.2020.01.033

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2019 Elsevier B.V. Objective: Although nivolumab treatment is effective in extending the overall survival (OS) in patients with recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC), only a few patients benefit from this treatment. Recent studies have reported that chemotherapy and cetuximab might be effective for R/M HNSCC after nivolumab treatment. In the present study, we aimed to elucidate the effectiveness of chemotherapy after nivolumab treatment in patients with R/M HNSCC. Methods: This retrospective study included 10 patients with R/M HNSCC who were mainly treated with paclitaxel plus cetuximab (7/10, 70&#37;) or S-1 (3/10, 30&#37;) following nivolumab treatment. Chemotherapy was administered as a second-line or higher palliative treatment. The performance status of all patients ranged from 0 to 2. The progression-free survival (PFS) was analyzed using the Kaplan–Meier method. Results: The response rate (RR), clinical benefit rate, and median PFS were 60&#37;, 90&#37;, and 5.4 months, respectively. Regarding adverse effects, Grade 3 neutropenia and hypomagnesemia due to salvage chemotherapy administered after immunotherapy were observed in one patient. The treatment significantly increased the RR compared to that achieved with other palliative chemotherapies reported so far. Conclusion: A higher RR and clinical benefit rate were observed for our strategy than for any first-line regimen, suggesting that our strategy might improve the PFS. Palliative chemotherapy with/without cetuximab after nivolumab treatment might be useful in patients with R/M HNSCC. Although the results of this retrospective study are limited, this strategy can be a good treatment option for patients with R/M HNSCC because of its strong clinical benefits and acceptable toxicity.

DOI： 10.1016/j.anl.2019.05.001

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2020 The Author(s) Background: Perivascular epithelioid cell tumors (PEComas) of the skull base are extremely rare. Here we report the first description of a malignant PEComa mimicking jugular foramen schwannoma and presenting as Collet-Sicard syndrome, and we review the previous literature on PEComas of the head, neck and skull base. Case description: A 29-year-old woman presented with hoarseness, dysphagia, vomiting, and headache. She was first diagnosed with Collet-Sicard syndrome caused by thrombosis of the sigmoid and transverse sinuses. She was treated with anticoagulant therapy, and the hoarseness and paralysis of the accessory nerve improved. Later, at age 31, the hoarseness again worsened. At another hospital, enhanced computed tomography revealed a tumor in the jugular foramen extending to the neck and medially displacing the internal carotid artery. She was referred to our hospital for further examination and was diagnosed with jugular foramen schwannoma causing thrombosis of the sinuses. At the one-year follow-up, the tumor had grown rapidly and had started to surround the internal carotid artery. We therefore performed a tissue biopsy of the tumor in the jugular foramen and neck. Based on pathological analysis, we made a definitive diagnosis of malignant PEComa. Conclusions: It may be extremely challenging to reach an accurate diagnosis of PEComa in the skull-base region, which can cause a delay in treatment initiation. When atypical clinical features for a skull-base tumor are found, we recommend preliminary biopsy to obtain a definitive diagnosis and initiate an appropriate treatment strategy as early as possible.

DOI： 10.1016/j.heliyon.2020.e03200

記述言語：日本語  

記述言語：日本語  

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2019 Elsevier Inc. Objective: To describe the technical details of 3-piece orbitozygomatic (OZ) craniotomy using a diamond threadwire saw as an alternative to cutting the orbital rim and zygoma. Methods: The details of this procedure are presented by cadaver dissection and a surgical case. Results: Three-piece OZ craniotomy consists of 3 steps of bone flap elevation. First, the zygomatic arch is divided and reflected downward with the temporal muscle. This provides adequate exposure around the inferior orbital fissure with less skin flap retraction. In the second step, frontotemporal craniotomy is performed close to the skull base without the requirement for additional craniectomy. Finally, the superolateral wall of the orbital bone flap is elevated. Cutting the orbital rim and zygoma with a diamond threadwire saw allows reconstruction with a minimal bone gap. Conclusions: The herein-described 3-piece OZ craniotomy technique is simple and provides excellent brain exposure equivalent to that achieved by 1- and 2-piece OZ craniotomy while minimizing flap retraction and requiring less additional bone removal.

DOI： 10.1016/j.wneu.2019.04.235

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2019 Elsevier Inc. Objective: A profound understanding of the relationship between the deep cervical fasciae and the skull base is essential for skull base surgery. To our knowledge, there has been little research on the relationship between the deep cervical fasciae and inferior surface of the skull base; thus, this study aims to examine the fascial network of the skull base. Methods: Two cadaveric heads are dissected to reveal the fascial network of the skull base and 19 sides of cadaveric heads were used to reveal an anatomical variant of the pterygospinous and pterygoalar ligaments/muscles. Results: The interpterygoid fascia is attached to the skull base along the sphenopetrosal fissure and tympanosquamous suture. The tensor vascular styloid fascia extends from the inferior border of the tensor veli palatini and covers the tympanic bone and styloid apparatus laterally. The pharyngobasilar fascia attaches to the pharyngeal tubercle on the inferior surface of the basilar part of the occipital bone and petro-occipital synchondrosis. In the middle of the clivus, we found thick fibrocartilaginous tissue and the prevertebral fascia fused to this area. Fascia of the longus capitis, the tensor-vascular styloid fascia, and stylopharyngeal fascia extend laterally and form the complex fascial network around the internal jugular vein and the internal carotid artery. The carotid sheath attaches anteriorly to the vaginal process and posteriorly to the fibrocartilaginous tissue around the jugular foramen and carotid canal. Conclusions: This study comprehensively exposes the fascial network of the skull base. Our cadaveric dissection findings support those from previous imaging-anatomical studies. Precise knowledge of these fascial layers is essential for accurate diagnosis and understanding the spread of disease, as well as helping skull base surgeons safely perform challenging procedures.

DOI： 10.1016/j.wneu.2019.02.078

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: An understanding of the soft tissue layers in the mastoid region has become important for otologic reconstructive surgery. The objective of this study was to clarify the surgical anatomy of the soft tissue layers in the mastoid region and reveal its clinical significance. METHODS: Cadaveric study. RESULTS: Our dissections showed the soft tissue layers consisting of skin, subcutaneous layer, superficial and deep mastoid fasciae, and periosteum. The superficial mastoid fascia was continuous with the temporoparietal fascia cranially and the superficial cervical fascia caudally. The deep mastoid fascia could be clearly separated from the superficial mastoid fascia and has continuity to the loose alveolar layer in the temporoparietal region. However, it caudally fused with the fascia and ligament of the sternocleidomastoid. CONCLUSIONS: A comprehensive understanding of soft tissue layers would improve otologic reconstructive surgery. LEVEL OF EVIDENCE: NA.

DOI： 10.1002/lio2.271

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© AANS 2018, except where prohibited by US copyright law. OBJECTIVE A postoperative visual field defect resulting from damage to the occipital lobe during surgery is a unique complication of the occipital transtentorial approach. Though the association between patient position and this complication is well investigated, preventing the complication remains a challenge. To define the area of the occipital lobe in which retraction is least harmful, the surface anatomy of the brain, course of the optic radiations, and microsurgical anatomy of the occipital transtentorial approach were examined. METHODS Twelve formalin-fixed cadaveric adult heads were examined with the aid of a surgical microscope and 0 ° and 45 °endoscopes. The optic radiations were examined by fiber dissection and MR tractography techniques. RESULTS The arterial and venous relationships of the lateral, medial, and inferior surfaces of the occipital lobe were defined anatomically. The full course of the optic radiations was displayed via both fiber dissection and MR tractography. Although the stems of the optic radiations as exposed by both techniques are similar, the terminations of the fibers are slightly different. The occipital transtentorial approach provides access for the removal of lesions involving the splenium, pineal gland, collicular plate, cerebellomesencephalic fissure, and anterosuperior part of the cerebellum. An angled endoscope can aid in exposing the superior medullary velum and superior cerebellar peduncles. CONCLUSIONS Anatomical findings suggest that retracting the inferior surface of the occipital lobe may avoid direct damage and perfusion deficiency around the calcarine cortex and optic radiations near their termination. An accurate understanding of the course of the optic radiations and vascular relationships around the occipital lobe and careful retraction of the inferior surface of the occipital lobe may reduce the incidence of postoperative visual field defect.

DOI： 10.3171/2017.4.JNS162805

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2018 Elsevier Inc. Objective: This study aims to determine whether the line between the digastric point and posterior edge of the occipital condyle (DC line) could be a new surface landmark for the posterior margin of the horizontal part of the sigmoid sinus. Methods: Cadaveric specimens were used to show the relationship between the DC line and retrosigmoid craniotomy. Three-dimensional computed tomography angiography images of adult heads (56 sides) were analyzed to measure the distance between the DC line and the horizontal part of the sigmoid sinus at the digastric point, posterior edge of the condyle, and midpoint of the line. Results: The DC line was roughly parallel and posterior to the posterior margin of the sigmoid sinus. The distance between the DC line and the posterior edge of the sigmoid sinus at the digastric point, condyle, and midpoint of the line measured 4.7 ± 3.3 mm, 5.9 ± 2.6 mm, and 1.3 ± 2.2 mm, respectively. All sigmoid sinuses coursed anterior to the digastric point and condyle but in 17.9&#37; (10/56 sides) the posterior edge of the sigmoid sinus extended a maximum of 4.1 mm posterior to the midpoint of the DC line. Conclusions: The DC line can be used as a new surface landmark for estimating the position of the horizontal part of the sigmoid sinus. The posterior edge of the sinus may extend posterior to the line at the midpoint; thus, care should be taken to prevent sinus injury when drilling around the midpoint of the line.

DOI： 10.1016/j.wneu.2018.03.038

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2018 Glue otorrhea, or viscous otorrhea, is usually caused by eosinophilic otitis media and otitis media with effusion. However, bacterial infection can also cause viscous otorrhea. In this report, we present a case of chronic mastoiditis and petrositis with viscous otorrhea caused by Achromobacter xylosoxidans infection, and review previous literature regarding temporal bone infections involving this pathogen. In this case, the patient was not immunocompromised, and had bilateral viscous, easily relapsing, and intractable otorrhea. She was treated with long-term medication and a mastoidectomy. Our literature review shows that otitis media, mastoiditis, and petrositis caused by A. xylosoxidans are extremely rare, although viscous or mucinous otorrhea are sometimes caused by this organism. Though it is rare for an ear infection caused by A. xylosoxidans to be identified, such an infection should be treated appropriately, without consideration of the contaminants.

DOI： 10.1016/j.xocr.2018.03.003

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2018 Elsevier Inc. Objective: The endoscopic endonasal approach to the anatomically complex lateral skull base presents technical challenges. The use of the eustachian tube as a landmark to identify the petrous internal carotid artery has recently been reported, and this study aims to define the anatomic relationship between the eustachian tube and its surrounding structures using cadaveric dissection and radiologic analysis. Methods: To clarify the relationship of the eustachian tube with its surrounding structures, we performed endoscopic and microscopic dissection of 4 adult cadaveric heads and analyzed computed topography scans from 20 patients. Results: The eustachian tube is divided into the osseous and cartilaginous parts. The cartilaginous part can be further subdivided into the posterolateral, middle, and anteromedial parts, based on its relationship to the skull base. The eustachian tube is closely related to the pterygoid process of the sphenoid bone, the foramen lacerum, and the petrosal apex and is directed away from the oblique sagittal plane almost parallel to the vidian canal at 12.2° ± 6.2° (mean ± standard deviation). The relationship between the course of the vidian canal and the eustachian tube can aid the estimation of the anatomic course of the horizontal segment of the petrous carotid artery. Conclusions: The eustachian tube is a useful landmark for predicting the course of the internal carotid artery when accessing the lateral skull base regions via an endonasal route. A profound understanding of the relationship between the eustachian tube and the surrounding skull base structures is important for endoscopic endonasal skull base surgeries.

DOI： 10.1016/j.wneu.2018.01.003

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.wneu.2018.01.003. Epub 2018 Jan 8

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2018 Georg Thieme Verlag KG Stuttgart . New York. Objective This study aimed to review the anatomical and clinical characteristics of internal carotid-posterior communicating artery (IC-PC) aneurysms, especially those located close to the skull base. Methods The microsurgical anatomy around the posterior communicating artery (PComA) was examined in a dry skull and five formalin-fixed human cadaveric heads. The clinical characteristics of 37 patients with 39 IC-PC aneurysms, who were treated microsurgically between April 2008 and July 2016, were retrospectively reviewed. Results The anterior clinoid process (ACP), as well as the anterior petroclinoidal dural fold (APF), which forms part of the oculomotor triangle, are closely related to the origin of the PComA. Among the 39 IC-PC aneurysms, anterior clinoidectomy was performed on 4 (10.3&#37;) and a partial resection of the APF was performed on 2 (5.1&#37;). Both of these aneurysms projected inferior to the tentorium, or at least part of the aneurysm's dome was inferior to the tentorium. Conclusion Proximally located IC-PC aneurysms have an especially close relationship with the ACP and APF. We should be familiar with the anatomical relationship between IC-PC aneurysms and the structures of the skull base to avoid hazardous complications.

DOI： 10.1055/s-0037-1615804

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2017 Elsevier Inc. Objective The use of the retrosigmoid approach has recently been expanded by several modifications, including the suprameatal, transmeatal, suprajugular, and inframeatal extensions. Intradural temporal bone drilling without damaging vital structures inside or beside the bone, such as the internal carotid artery and jugular bulb, is a key step for these extensions. This study aimed to examine the microsurgical and endoscopic anatomy of the extensions of the retrosigmoid approach and to evaluate the clinical feasibility of an electromagnetic navigation system during intradural temporal bone drilling. Methods Five temporal bones and 8 cadaveric cerebellopontine angles were examined to clarify the anatomy of retrosigmoid intradural temporal bone drilling. Twenty additional cerebellopontine angles were dissected in a clinical setting with an electromagnetic navigation system while measuring the target registration errors at 8 surgical landmarks on and inside the temporal bone. Results Retrosigmoid intradural temporal bone drilling expanded the surgical exposure to allow access to the petroclival and parasellar regions (suprameatal), internal acoustic meatus (transmeatal), upper jugular foramen (suprajugular), and petrous apex (inframeatal). The electromagnetic navigation continuously guided the drilling without line of sight limitation, and its small devices were easily manipulated in the deep and narrow surgical field in the posterior fossa. Mean target registration error was less than 0.50 mm during these procedures. Conclusions The combination of endoscopic and microsurgical techniques aids in achieving optimal exposure for retrosigmoid intradural temporal bone drilling. The electromagnetic navigation system had clear advantages with acceptable accuracy including the usability of small devices without line of sight limitation.

DOI： 10.1016/j.wneu.2017.04.079

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© AANS, 2017. OBJECTIVE The application of the endoscope in the lateral skull base increases the importance of the middle ear cavity as the corridor to the skull base. The aim of this study was to define the middle ear as a route to the fundus (lateral end) of the internal acoustic canal and to propose feasible landmarks to the fundus. METHODS This was a cadaveric study; 34 adult cadaveric temporal bones and 2 dry bones were dissected with the aid of the endoscope and microscope to show the anatomy of the transcanal approach to the middle ear and fundus of the internal acoustic canal. RESULTS In the middle ear cavity, the cochleariform process is one of the key landmarks for accessing the fundus of the internal acoustic canal. The triangle formed by the anterior and posterior edges of the overhang of the round window and the cochleariform process provides a landmark to start drilling the bone to access the fundus of the internal acoustic canal. CONCLUSIONS The external acoustic canal and middle ear cavity combined, using endoscopic guidance, can provide a route to the fundus of the internal acoustic canal. A triangular landmark crossing the promontory has been described for reaching the meatal fundus. This transcanal approach requires an understanding of the relationship between the middle ear cavity and the fundus of the internal acoustic canal and provides a potential new area of cooperation between otology and neurosurgery for accessing pathology in this and the bordering skull base.

DOI： 10.3171/2016.5.JNS16261

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© AANS, 2017. OBJECTIVE A common approach to lesions of the pineal region is along the midline below the torcula. However, reports of how shifting the approach off midline affects the surgical exposure and relationships between the tributaries of the vein of Galen are limited. The purpose of this study is to examine the microsurgical and endoscopic anatomy of the pineal region as seen through the supracerebellar infratentorial approaches, including midline, paramedian, lateral, and far-lateral routes. METHODS The quadrigeminal cisterns of 8 formalin-fixed adult cadaveric heads were dissected and examined with the aid of a surgical microscope and straight endoscope. Twenty CT angiograms were examined to measure the depth of the pineal gland, slope of the tentorial surface of the cerebellum, and angle of approach to the pineal gland in each approach. RESULTS The midline supracerebellar route is the shortest and provides direct exposure of the pineal gland, although the culmen and inferior and superior vermian tributaries of the vein of Galen frequently block this exposure. The offmidline routes provide a surgical exposure that, although slightly deeper, may reduce the need for venous sacrifice at both the level of the veins from the superior cerebellar surface entering the tentorial sinuses and at the level of the tributaries of the vein of Galen in the quadrigeminal cistern, and require less cerebellar retraction. Shifting from midline to off-midline exposure also provides a better view of the cerebellomesencephalic fissure, collicular plate, and trochlear nerve than the midline approaches. Endoscopic assistance may aid exposure of the pineal gland while preserving the bridging veins. CONCLUSIONS Understanding the characteristics of different infratentorial routes to the pineal gland will aid in gaining a better view of the pineal gland and cerebellomesencephalic fissure and may reduce the need for venous sacrifice at the level of the tentorial sinuses draining the upper cerebellar surface and the tributaries of the vein of Galen.

DOI： 10.3171/2016.7.JNS16277

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2016 The American Laryngological, Rhinological and Otological Society, Inc. Objectives/Hypothesis: Image-guided optical tracking systems are being used with increased frequency in lateral skull base surgery. Recently, electromagnetic tracking systems have become available for use in this region. However, the clinical accuracy of the electromagnetic tracking system has not been examined in lateral skull base surgery. This study evaluates the accuracy of electromagnetic navigation in lateral skull base surgery. Study Design: Cadaveric and radiographic study. Methods: Twenty cadaveric temporal bones were dissected in a surgical setting under a commercially available, electromagnetic surgical navigation system. The target registration error (TRE) was measured at 28 surgical landmarks during and after performing the standard translabyrinthine and middle cranial fossa surgical approaches to the internal acoustic canal. In addition, three demonstrative procedures that necessitate navigation with high accuracy were performed; that is, canalostomy of the superior semicircular canal from the middle cranial fossa,1 cochleostomy from the middle cranial fossa,2 and infralabyrinthine approach to the petrous apex.3. Results: Eleven of 17 (65&#37;) of the targets in the translabyrinthine approach and five of 11 (45&#37;) of the targets in the middle fossa approach could be identified in the navigation system with TRE of less than 0.5 mm. Three accuracy-dependent procedures were completed without anatomical injury of important anatomical structures. Conclusion: The electromagnetic navigation system had sufficient accuracy to be used in the surgical setting. It was possible to perform complex procedures in the lateral skull base under the guidance of the electromagnetically tracked navigation system. Levels of Evidence: N/A. Laryngoscope, 2016 127:450–459, 2017.

DOI： 10.1002/lary.25998

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2016 AANS. Objective The object of this study was to examine the relationships of the cochlea as a guide for avoiding both cochlear damage with loss of hearing in middle fossa approaches and injury to adjacent structures in approaches directed through the cochlea. methods Twenty adult cadaveric middle fossae were examined using magnifcations of ×3 to ×40. results The cochlea sits below the?oor of the middle fossa in the area between and below the labyrinthine segment of the facial nerve and greater petrosal nerve (GPN) and adjacent to the lateral genu of the petrous carotid. Approximately one-third of the cochlea extends below the medial edge of the labyrinthine segment of the facial nerve, geniculate ganglion, and proximal part of the GPN. The medial part of the basal and middle turns are the parts at greatest risk in drilling the?oor of the middle fossa to expose the nerves in middle fossa approaches to the internal acoustic meatus and in anterior petrosectomy approaches. Resection of the cochlea is used selectively in extending approaches through the mastoid toward the lateral edge of the clivus and front of the brainstem. coNclusioNs An understanding of the location and relationships of the cochlea will reduce the likelihood of cochlear damage with hearing loss in approaches directed through the middle fossa and reduce the incidence of injury to adjacent structures in approaches directed through the cochlea.

DOI： 10.3171/2015.8.JNS151325

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2016, CARS. Purpose: Image-guided surgery (IGS) for otological procedures requires minimal invasiveness and a high degree of accuracy. We have recently developed a noninvasive registration method, the Surface Template-Assisted Marker Positioning (STAMP) method, which uses a rigid template of the surface of the temporal bone. However, the STAMP method is not applicable when the bony surface is not exposed, such as in endoscopic surgery. Thus, we extended our research to apply the STAMP method onto the skin and tested its feasibility in this study. Methods: We designed a phantom made of a rigid box and soft material for the study. The target registration error (TRE) was measured at preset measuring points in the phantom. We modified the STAMP method to be applicable for use on the skin around the ears (S-STAMP). The same phantom was also registered using the conventional, manually scanned surface matching method. We compared the TRE after the different registration methods. Results: The TRE after the S-STAMP registration method was significantly smaller than that of the conventional surface matching method at all error measurement points in the phantom. However, the TRE after the S-STAMP registration method was significantly larger than that of paired point registration using invasive fiducial markers. Conclusions: The S-STAMP method using a rigid template on the soft surface yields a significantly smaller TRE than that of conventional, manually scanned surface matching registration. This strategy provides an alternative option to improve the accuracy of IGS without loading patients with additional invasive procedures.

DOI： 10.1007/s11548-016-1441-0

記述言語：その他   掲載種別：研究論文（学術雑誌）  

©AANS, 2016. OBJECTIVE: The objective of this study was to describe the surgical anatomy and technical nuances of various vascularized tissue flaps. METHODS: The surgical anatomy of various tissue flaps and their vascular pedicles was studied in 5 colored silicone-injected anatomical specimens. Medical records were reviewed of 11 consecutive patients who underwent repair of extensive skull base defects with a combination of various vascularized flaps. RESULTS: The supraorbital, supratrochlear, superficial temporal, greater auricular, and occipital arteries contribute to the vascular supply of the pericranium. The pericranial flap can be designed based on an axial blood supply. Laterally, various flaps are supplied by the deep or superficial temporal arteries. The nasoseptal flap is a vascular pedicled flap based on the nasoseptal artery. Patients with extensive skull base defects can undergo effective repair with dual flaps or triple flaps using these pedicled vascularized flaps. CONCLUSIONS: Multiple pedicled flaps are available for reconstitution of the skull base. Knowledge of the surgical anatomy of these flaps is crucial for the skull base surgeon. These vascularized tissue flaps can be used effectively as single or combination flaps. Multilayered closure of cranial base defects with vascularized tissue can be used safely and may lead to excellent repair outcomes.

DOI： 10.3171/2015.5.JNS15529

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© 2015 Wiley Periodicals, Inc.. Background The variety of surgical approaches to jugular schwannomas makes selection of an approach difficult. The purpose of this study was to define the anatomic elements of these approaches. Methods Ten adult cadaveric heads were examined. Results There are lateral, posterior, and anterior routes that access various parts of the jugular foramen. Removal of the jugular process of the occipital bone provides access to the posterior aspect of the foramen, the infralabyrinthine mastoidectomy provides access to the lateral edge and dome of the jugular bulb, and the preauricular approaches provide access to the anterior margin of the bulb and foramen. Additions to these approaches may include cervical and vertebral artery exposure, facial nerve transposition, foramen magnum exposure, and external canal and condylar resection. Conclusion An understanding of the anatomy of the jugular foramen is crucial in achieving total tumor removal while minimizing risk.

DOI： 10.1002/hed.24156

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/hed.24156

記述言語：日本語  

ミトコンドリア脳筋症・乳酸アシドーシス・脳卒中様発作症候群(MELAS)は反復する脳卒中様発作を特徴とするミトコンドリア病の一種である。感音難聴はMELASの40-60&#37;に合併するといわれている。時に補聴器装用効果に乏しい重度難聴に陥るケースも経験するが、頻度が低いためか、MELASによる難聴に対し人工内耳埋込み術を行った報告は少ない。今回、われわれはミトコンドリア脳筋症3例に対して人工内耳埋込み術を施行し、2例で良好な聴取成績を得ることができた。ミトコンドリア脳筋症に伴う難聴は一般的に内耳性難聴が多いが、後迷路性難聴も否定できず、後迷路性難聴が疑われる場合の人工内耳適応については、これからも更なる検討が必要と考える。(著者抄録)

記述言語：その他   掲載種別：研究論文（学術雑誌）  

© AANS, 2015. OBJECT: There continues to be confusion over how best to preserve the branches of the facial nerve to the frontalis muscle when elevating a frontotemporal (pterional) scalp flap. The object of this study was to examine the full course of the branches of the facial nerve that must be preserved to maintain innervation of the frontalis muscle during elevation of a frontotemporal scalp flap. METHODS: Dissection was performed to follow the temporal branches of facial nerves along their course in 5 adult, cadaveric heads (n = 10 extracranial facial nerves). RESULTS: Preserving the nerves to the frontalis muscle requires an understanding of the course of the nerves in 3 areas. The first area is on the outer surface of the temporalis muscle lateral to the superior temporal line (STL) where the interfascial or subfascial approaches are applied, the second is in the area medial to the STL where subpericranial dissection is needed, and the third is along the STL. Preserving the nerves crossing the STL requires an understanding of the complex fascial relationships at this line. It is important to preserve the nerves crossing the lateral and medial parts of the exposure, and the continuity of the nerves as they pass across the STL. Prior descriptions have focused largely on the area superficial to the temporalis muscle lateral to the STL. CONCLUSIONS: Using the interfascial-subpericranial flap and the subfascial-subpericranial flap avoids opening the layer of loose areolar tissue between the temporal fascia and galea in the area lateral to the STL and between the galea and frontal pericranium in the area medial to the STL. It also preserves the continuity of the nerve crossing the STL. This technique allows for the preservation of the nerves to the frontalis muscle along their entire trajectory, from the uppermost part of the parotid gland to the frontalis muscle.

DOI： 10.3171/2014.10.JNS142061

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Copyright © 2015 by the Congress of Neurological Surgeons. BACKGROUND: Auditory brainstem implantation at the cochlear nuclei used mainly for neurofibromatosis type 2 patients with bilateral loss of the cochlear nerves has more recently been extended to the inferior colliculus. OBJECTIVE: To examine the microsurgical and endoscopic anatomy of the cochlear nuclei and inferior colliculus as seen through the translabyrinthine and retrosigmoid approaches used for cochlear nuclei and inferior collicular implantation. METHODS: Ten cerebellopontine angles of formalin-fixed adult cadaveric heads were examined with the aid of the surgical microscope and endoscope. The ascending auditory pathways between the cochlear nuclei and inferior colliculi and above were examined by the fiber dissection technique. RESULTS: Both the translabyrinthine and retrosigmoid routes provide sufficient exposure for concurrent tumor removal and implantation at either the cochlear nuclei or inferior colliculus. The position of the inferior colliculus in the auditory pathways and its accessibility in the infratentorial supracerebellar exposure directed through either the translabyrinthine or retrosigmoid approach makes it an alternative site for electrode placement if the cochlear nuclei are not functionally or structurally suitable for implantation. Endoscopic assistance may aid the exposure and electrode placement at either site. CONCLUSION: The translabyrinthine or retrosigmoid approaches provide access to the cochlear nuclei for implantation and also to the inferior colliculus through the translabyrinthine or retrosigmoid infratentorial supracerebellar route. The endoscope may aid in exposing either site.

DOI： 10.1227/NEU.0000000000000736

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Copyright © 2014 by the Congress of Neurological Surgeons. BACKGROUND: Although the lateral condylar vein has been encountered in some skull base approaches and used as a route to access the anterior condylar venous confluence, few descriptions can be found in the literature regarding its morphology. OBJECTIVE: To examine the anatomy of the lateral condylar vein and its clinical significance. METHODS: The craniocervical junctions of 3 cadaveric heads, 15 dry bones, and 25 computed tomography venography images were examined. RESULTS: The lateral condylar vein was identified in 88.0&#37; of paracondylar areas, with an average diameter of 3.6 mm. This vein originated near the jugular bulb, descended along the lateral surface of the occipital condyle and medial to the internal jugular vein, cranial nerves IX to XI, and rectus capitis lateralis muscle to drain into the vertebral venous plexus surrounding the vertebral artery. The veins were classified according to their origin from either (1) the anterior condylar confluence or (2) the internal jugular vein. In some specimens, the lateral condylar vein courses within a small osseous canal lateral to the occipital condyle, the paracondylar canal, which was identified in 16.7&#37; of paracondylar areas in the dry bones. CONCLUSION: The lateral condylar vein may be encountered in exposing the jugular bulb, hypoglossal canal, or foramen magnum. This vein has been reported to be a main draining route of dural arteriovenous fistulas, in which case it can be utilized as a transvenous route for endovascular treatment, or obliterated. An understanding of the anatomy of this vein may prove useful in planning skull base and endovascular procedures.

DOI： 10.1227/NEU.0000000000000570

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Background: The superior petrosal vein, one of the most constant and largest drainage pathways in the posterior fossa, may result in complications if occluded. This study calls attention to a unique variant in which the superior petrosal veins and sinus were absent unilaterally, and the venous drainage was through the galenic and tentorial drainage groups. Methods: This study examines one venogram and another anatomic specimen in which the superior petrosal vein and sinus were absent. Results: The superior petrosal veins, described as 1-3 bridging veins, emptying into the superior petrosal sinus, are the major drainage pathways of the petrosal group of posterior fossa veins. In the cases presented, the superior petrosal vein and sinus were absent and venous drainage was through the galenic and tentorial groups, including the lateral mesencephalic or bridging vein on the tentorial cerebellar surface. Conclusions: In cases in which the superior petrosal sinus and veins are absent, care should be directed to preserving the collateral drainage through the galenic and tentorial tributaries. Although surgical strategies for intraoperative management and preservation of venous structures are still controversial, knowledge of the possible anatomical variations is considered to be essential to improve surgical outcomes.

DOI： 10.4103/2152-7806.152147

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Object. Jugular foramen tumors often extend intra- and extracranially. The gross-total removal of tumors located both intracranially and intraforaminally is technically challenging and often requires a combined skull base approach. This study presents a suprajugular extension of the retrosigmoid approach directed through the osseous roof of the jugular foramen that allows the removal of tumors located in the cerebellopontine angle with extension into the upper part of the foramen, with demonstration of an illustrative case. Methods. The cerebellopontine angles and jugular foramina were examined in dry skulls and cadaveric heads to clarify the microsurgical anatomy around the jugular foramen and to define the steps of the suprajugular exposure. Results. The area drilled in the suprajugular approach is inferior to the acoustic meatus, medial to the endolymphatic depression and surrounding the superior half of the glossopharyngeal dural fold. Opening this area exposed the upper part of the jugular foramen and extended the exposure along the glossopharyngeal nerve below the roof of the jugular foramen. In the illustrative case, a schwannoma originating from the glossopharyngeal nerve in the cerebellopontine angle and extending below the roof of the jugular foramen and above the jugular bulb was totally removed without any postoperative complications. Conclusions. The suprajugular extension of the retrosigmoid approach will permit removal of tumors located predominantly in the cerebellopontine angle but also extending into the upper part of the jugular foramen without any additional skull base approaches. ©AANS, 2014.

DOI： 10.3171/2014.3.JNS132419

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Otosclerosis, which is characterized by disordered bone remodeling, occurs exclusively in the human temporal bone. The etiology of the disease is unknown, but a popular hypothesis is that it is caused by persistent measles virus (MV) infection. Paramyxovirus-like filamentous structures were found in otosclerotic lesions of stapes footplates from patients with otosclerosis. Although MV RNAs have been detected in otosclerotic samples by using reverse transcription-PCR, no complete MV mRNA sequence has been reported, nor has infectious virus been isolated from clinical samples. Furthermore, one study failed to obtain evidence of MV infection in otosclerotic bone samples. In this study, we tested, by three different protocols, for the presence of MV in clinical samples from patients with otosclerosis in Japan. We used a highly sensitive reverse transcription-quantitative PCR method which is able to detect viral mRNA in cells infected with MV at around one infectious unit per well. We obtained no evidence of MV infection in bone samples, primary cell cultures derived from stapes bones, or MV-susceptible cell lines (Vero/hSLAM and II-18 cells) cocultured with bone samples or primary cell cultures derived from them. Thus, our results do not support the hypothesis that persistent MV infection is involved in the pathoetiology of otosclerosis. Copyright © 2012, American Society for Microbiology. All Rights Reserved.

DOI： 10.1128/JCM.06163-11

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Inflammasomes are cytosolic protein complexes that stimulate the activation of caspase-1, which in turn induces the secretion of the inflammatory cytokines Interleukin-1β (IL-1β) and IL-18. Recent studies have indicated that the inflammasome known as the NOD-like-receptor-family, pyrin domain-containing 3 (NLRP3) inflammasome recognizes several RNA viruses, including the influenza and encephalomyocarditis viruses, whereas the retinoic acid-inducible gene I (RIG-I) inflammasome may detect vesicular stomatitis virus. We demonstrate that measles virus (MV) infection induces caspase-1-dependent IL-1β secretion in the human macrophage-like cell line THP-1. Gene knockdown experiments indicated that IL-1β secretion in MV-infected THP-1 cells was mediated by the NLRP3 inflammasome but not the RIG-I inflammasome. MV produces the nonstructural V protein, which has been shown to antagonize host innate immune responses. The recombinant MV lacking the V protein induced more IL-1β than the parental virus. THP-1 cells stably expressing the V protein suppressed NLRP3 inflammasome-mediated IL-1β secretion. Furthermore, coimmunoprecipitation assays revealed that the V protein interacts with NLRP3 through its carboxyl-terminal domain. NLRP3 was located in cytoplasmic granular structures in THP-1 cells stably expressing the V protein, but upon inflammasome activation, NLRP3 was redistributed to the perinuclear region, where it colocalized with the V protein. These results indicate that the V protein of MV suppresses NLRP3 inflammasome-mediated IL-1β secretion by directly or indirectly interacting with NLRP3. © 2011, American Society for Microbiology.

DOI： 10.1128/JVI.05942-11

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Although salicylate is one of the most widely used nonsteroidal anti-inflammatory drugs, it causes moderate hearing loss and tinnitus at high-dose levels. In the present study, salicylate effects on the K currents in inner hair cells were examined. Salicylate reversibly reduced the outward K currents (I K,f), but did not affect the inward current (I K,n). Salicylate blocked the outward K currents in a concentration-dependent manner according to Hill equation with a half-blocking concentration of 1.66mM, and the Hill coefficient of 1.86. © 2011 Elsevier Ireland Ltd.

DOI： 10.1016/j.neulet.2011.08.050

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Gadolinium (Gd)-based contrast media were introduced as alternatives to iodinated media for magnetic resonance imaging (MRI). Although originally thought to be non-nephrotoxic, Gd-based contrast media have recently been reported to be associated with acute kidney injury. The underlying mechanism of Gd-induced renal injury is not completely understood. We report an 80-year-old patient with buccal mucosa cancer for whom MRI with Gd-based contrast agent was conducted 3 times within 3 weeks. The patient developed rapid deterioration of pre-existing renal insufficiency, and developed uremic symptoms and pulmonary edema. The patient was hemodialyzed 3 times. This resulted in improvement of renal function and clinical symptoms. This case emphasizes the potential nephrotoxicity of Gd-based contrast media and suggests that renal insufficiency, diabetes mellitus, old age and high dose of Gd-based contrast medium are risk factors for acute kidney injury. ©2011 Dustri-Verlag Dr. K. Feistle.

DOI： 10.5414/CNP75251

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Hydrogen peroxide (H2O2) is a ubiquitous reactive oxygen species that can induce several inner ear disorders. In this study, we recorded the potassium (K) currents in acutely isolated inner hair cells of guinea pig cochlea, and investigated the effects of H2O2. We also observed the morphological changes in inner hair cells induced by H 2O2. In the H2O2 solutions, the amplitude of outward K currents (IK,f and IK,s) clearly decreased after perfusion for approximately 15 min. Despite the decrease in outward currents, small inward currents (IK,n) did not show any reduction. H2O2 induced morphological changes in the inner hair cells. All the inner hair cells in the H2O2 solutions showed shrinkage and granularity of the cell body and led to loss of viability. These results showed the vulnerability of inner hair cells to reactive oxygen species-induced inner ear disorders. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

DOI： 10.1097/WNR.0b013e32833fcb56

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Dyskeratosis congenita (DC) is an inherited disorder that is characterized by the triad of skin pigmentation, nail dystrophy, and mucosal leukoplakia. Individuals with DC suffer from premature mortality because of bone marrow failure, pulmonary disease, or malignant transformation within the areas of mucosal leukoplakia, caused by telomerase dysfunction. We present a case of a 31-year-old Japanese man with DC who developed laryngeal cancer (supraglottic T4aN0M0). To avoid the serious risks of accelerating the DC-associated complications by DNA-damaging therapies, he was treated with a total laryngectomy plus right modified neck dissection (levels IB, IIA, III, and IV). A contralateral nodal metastasis appeared 4 months after initial surgery and was salvaged by a left radical neck dissection. Our strategy to spare DNA-damaging therapies has proven effective so far. This is the first reported case of laryngeal cancer in a patient with DC in the English-language medical literature. © Japan Society of Clinical Oncology 2010.

DOI： 10.1007/s10147-010-0053-x

記述言語：その他   掲載種別：研究論文（学術雑誌）  

One of the potassium currents, IK,n, is already activated at the resting potential of the cell and thus determines the membrane potential. KCNQ4 channel has been identified as the molecular correlate of IK,n. In the present study, we measured IK,n in acutely isolated IHCs of guinea-pig cochlea using the whole-cell voltage-clamp techniques, and investigated the properties of the currents. IK,n was 70&#37; activated around the resting potential of -60 mV and deactivated on hyperpolarization. IK,n was blocked by the KCNQ-channel blockers, linopirdine (100 μM) and XE991 (10 μM), but was insensitive to both IK,f blocker, tetraethylammonium (TEA), and IK,s blocker, 4-aminopyridine (4-AP). There was no significant difference in the size of IK,n between the apical and basal turn IHCs. © 2010 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.heares.2010.01.002

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Objective: This study evaluated the ability of dihydrostreptomycin (DHSM) to go through the mechano-electric transduction (MET) channels in hair cells under physiological conditions. Materials and Methods: Tall hair cells were isolated from the chick basilar membrane (cochlea). Mechanical stimulation was applied by a glass rod attached to a piezoelectric bimorph, and MET currents were recorded with a whole-cell patch technique. The voltage-dependent block of DHSM to MET channel was estimated by calculating the relative conductances (the ratio of MET current in DHSM saline to DHSM-free saline) at various membrane potentials. Results and Conclusion: At membrane potentials between -100 and +50 mV, DHSM behaves as a voltage-dependent blocker according to a partial block model. At membrane potentials more negative than -100 mV, however, DHSM blocking decreased. This finding differed from the partial block model, but indicated that DHSM escaped through the channel pore into the cytoplasm by acting as a permeant channel blocker due to the large electrical driving force. Copyright © 2009 S. Karger AG.

DOI： 10.1159/000219677

記述言語：日本語  

聴力正常の聴覚過敏患者24名(男性8名、女性16名)に対してSISI検査、MCL・UCL検査、自記オージオメトリー検査、Metz検査を行い、リクルートメント現象の陽性率を検討した。17名(71&#37;)が、聴力が正常であるにもかかわらず何らかの内耳機能検査で陽性であった。それぞれの検査の陽性率はSISI検査で27&#37;、MCL・UCL検査で38&#37;、自記オージオメトリー検査で38&#37;、Metz検査で33&#37;であった。片側のみの聴覚過敏は9名(37.5&#37;)、両側の聴覚過敏は15名(62.5&#37;)であった。片側聴覚過敏の場合、症状と陽性を示した検査側は必ずしも一致しなかった。(著者抄録)

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Objectives: The aim of this study is to investigate the salicylate-induced morphological changes of cochlear inner hair cells (IHCs) and outer hair cells (OHCs). Methods: IHCs and OHCs were acutely isolated from the guinea-pig cochlea. Cells were observed under the inverted microscope and 10 mmol/L sodium salicylate solutions or 0.01 mmol/L dexamethasone-plus-salicylate solutions were applied. The cell length or the ratio between the length and width was the indices of the morphological changes in cells. Results: Isolated IHCs did not demonstrate any significant changes in sodium salicylate solutions in 20 min and in 40 min, whereas OHCs were shortened by the 10 mmol/L sodium salicylate to 83&#37; in 20 min and 75&#37; in 40 min. There were no significant differences between in the dexamethasone-plus-salicylate solutions and in the control solutions after 20 min and 40 min both in IHCs and OHCs. Conclusions: Although salicylate affected the isolated OHCs from guinea-pig cochlea, IHCs were not changed morphologically by sodium salicylate applications. Dexamethasone inhibited the salicylate-induced morphological changes of OHCs. © 2008 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.anl.2008.05.005

記述言語：日本語  

内耳機能検査の中で、時間的な患者への負担が少なく実際の外来業務で施行しやすいDPOAE検査、SISI検査、MCL・UCL検査を112名、203耳に施行し比較した。DPOAE検査の異常率は1kHzで41&#37;、4kHzで69&#37;、SISI検査の陽性率は1kHzで20&#37;、4kHzで53&#37;、MCL・UCL検査の陽性率は1kHで43&#37;、4kHzで54&#37;であった。4kHzで聴力レベルの程度による各検査の陽性率(異常率)を比較すると、各検査とも約20dBより陽性を示したが、DPOAE検査では35dBで90&#37;以上が陽性となったのに対して、SISI検査、MCL・UCL検査では上昇は緩やかで55dBで約90&#37;が陽性となった。軽度の感音難聴ではDPOAEのみ異常となることが多いという結果を得た。(著者抄録)

記述言語：その他   掲載種別：研究論文（学術雑誌）  

Tetraethylammonium (TEA)-sensitive potassium currents in the cochlear inner hair cells (IHCs) possess the kinetics of fast inactivation. IHCs of guinea-pigs were separately isolated from the apical and basal turns and the tonotopic gradient of inactivation kinetics was investigated. TEA-sensitive potassium currents showed voltage-dependent time constant of the inactivation phase both in apical and basal IHCs, however, the degree of inactivation (compared to the ratio between the steady-state current and initial peak current) was voltage-independent. Inactivation time constant was faster in basal IHCs than in apical IHCs and the degree of inactivation was greater in basal IHCs than in apical IHCs, suggesting that inactivation was more predominant in basal IHCs than in apical IHCs. © 2008 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.brainres.2008.06.068

記述言語：日本語  

比較的大きな副咽頭間隙腫瘍(PPST)に対しては下顎骨正中離断によるアプローチがとられる傾向が見られたが、現在では、下顎骨正中離断を行わなくても、経頸部アプローチ(transcervical approach[TCA])あるいは経耳下腺-頸部アプローチ(transparotid-cervical approach[TPCA])で、大半のPPSTが比較的安全に摘出できることが確認されている。これらの手技に伴う適応、限界、ピットフォールを7cm以上のPPST 3例を通して解説したい。症例1は10cmの神経鞘腫、症例2は耳下腺深葉の悪性腫瘍、症例3は再発性の多形腺腫である。(著者抄録)

記述言語：日本語  

外耳道から中耳に及ぶ扁平上皮癌に、乳突洞削開による腫瘍摘出術と放射線治療を行った後、5年が経過して気脳症を発症した症例を経験した。髄膜炎と水頭症を併発し、意識レベル低下が見られて危篤状態となったが、保存的治療で症状は軽減した。最終的に内耳を含めて側頭骨腐骨部分を摘除し、死腔と硬膜損傷部位を遊離腹直筋弁で充填、閉鎖した。現在まで腫瘍も髄液瘻も再発していない。側頭骨へ照射を行った後に生じるさまざまな合併症の中に髄液漏や本疾患も含まれる。本疾患発症の場合、髄膜炎や脳炎など重篤な頭蓋内疾患を合併して致死的経過をたどる場合もあり、照射を行った患者に対する経過観察においては癌の再発のみならず本症例のような合併症にも留意すべきであると考えられた。(著者抄録)

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

食道癌取り扱い規約による、106以下の縦隔リンパ節に転移を来した分化型甲状腺癌の2症例に対し、各々胸骨・鎖骨切除による上方・前方からのアプローチと、胸腔鏡下のVATS(video assisted thoracoscopic surgery)を用いて縦隔郭清を行った。胸骨柄と胸骨の右半分(第二肋間の高さまで)・右鎖骨内側半分を合併切除した症例1では、右鎖骨下静脈周囲のリンパ節、105R,106pre,106recRまでを明視下に郭清したが、前方からのアプローチによる106tbR郭清の困難さを再認識させられた。これに対し、107の高さまで縦隔リンパ腫脹を認めた症例2に対しては、頸部およびVATSによるコンバインドアプローチで腫瘍摘出を行った。VATSにより、106tbR,107領域の郭清が良好な視野で行えた。en blocな郭清が困難、開胸・術中の体位変換・挿管チューブの交換が必要などの欠点もあるが、106tb以下のリンパ節に転移を来した分化型甲状腺癌症例に対する、VATSの有用性が認確された。(著者抄録)

DOI： 10.3950/jibiinkoka.110.758

記述言語：日本語  

下咽頭顆粒細胞腫の1例を経験した。症例は、29歳、女性。胃痛を自覚し、近医にて上部消化管内視鏡を施行した際、下部食道および下咽頭に黄白色調の隆起性病変を認めた。食道病変に対し、当院内科にて内視鏡的粘膜切除術を施行した。当科初診時、右梨状窩に直径1cm程度の黄白色調の表面顆粒状腫瘍を認め、CO2レーザーを用いた喉頭微細手術にて切除した。病理結果はgranular cell tumor(GCT)であった。手術による合併症は認めず、術後経過は良好であった。術後6ヵ月経過した現在、再発は認めていない。(著者抄録)

開催年月日： 2020年1月

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開催年月日： 2019年10月

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開催年月日： 2019年10月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2019年7月

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開催年月日： 2018年7月

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開催年月日： 2018年5月 - 2018年6月

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開催地：Coronado, California   国名：アメリカ合衆国  

開催年月日： 2017年6月

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開催年月日： 2017年5月

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開催年月日： 2017年3月

記述言語：英語  

開催地：New Orleans, Louisiana   国名：アメリカ合衆国  

Background: The jugular process forms the posterior border of the jugular foramen. This process is the critical structures for the access to the jugular foramen. However, the microsurgical anatomy of this structure has not been described well in most modern text. Object: The objective is to elucidate the microsurgical anatomy of the jugular process through cadaveric dissection and to investigate the radiological feature of the process. Materials and Methods: Cadaveric and radiological study. Five adult cadaveric specimens and a dry skull were examined to expose the detailed anatomy of the jugular process and its surrounding structures. Thirty one computed tomography angiography images (62 sides) were examined to investigate the relationships between the course of the sigmoid sinus and the morphological feature of the process. Results: Cadaveric study shows that the jugular process is closely related to the sigmoid sinus, jugular bulb, rectuc capitis lateralis muscle and lateral atranto-occcipital ligament, and the process is a key landmarks for the accessing the jugular foramen both from posterior and lateral. Radiographic study shows the morphological features of this process. Nine out of sixty-two sigmoid sinuses protrude inferiorly into the jugular process. The jugular bulb is categorized into two types: the sloped type and the morphologically bulbed type. The process located below the sigmoid sinus in the latter tends to have a steaper angle, thus proving more difficult to remove from the posterior aspect for the exposure of the posterior wall of the jugular foramen. Conclusion: The jugular process forms the posterior border of the jugular foramen. The resection of the jugular process is crucial in open the jugular foramen from the posterior and lateral aspect. The detailed knowledge of this structure is essential to approach the jugular foramen. The precise understanding the microsurgical anatomy of the process and preoperative evaluation of the relationships between the process and the sigmoid sinus makes surgical access to the jugular foramen safe and accurate.

開催年月日： 2017年3月

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開催年月日： 2016年5月

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開催年月日： 2015年5月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2014年10月

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開催年月日： 2014年7月

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開催年月日： 2011年9月

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記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

後天性外耳道閉鎖症とは,その発生原因から,(1)炎症性,(2)外傷性,(3)術後性,(4)腫瘍性の4つに分類される.後天性外耳道閉鎖症に対しては,難聴の程度により,適切な聴覚補償を行っていく必要がある.外耳道形成および鼓室形成術による聴力改善が困難である場合は,補聴器や人工聴覚器の中から選択する必要がある.現在,伝音もしくは混合性難聴に対しては,従来の骨導補聴器に加えて,軟骨伝導補聴器,接着型骨導補聴器,受動型骨導インプラント(Baha),能動型骨導インプラント(BONEBRIDGE),人工中耳(VIBRANT SOUNDBRIDGE),などといった幅広い選択肢から適切な聴覚補償の方法を選択していく必要がある.側頭骨手術後の後天性外耳道閉鎖症に対しては,術側の骨導閾値が保たれる症例に関しては,軟骨伝導補聴器も一つの有力な聴覚補償の選択肢として検討できる.(著者抄録)

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記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

後天性外耳道閉鎖症とは,その発生原因から,(1)炎症性,(2)外傷性,(3)術後性,(4)腫瘍性の4つに分類される.後天性外耳道閉鎖症に対しては,難聴の程度により,適切な聴覚補償を行っていく必要がある.外耳道形成および鼓室形成術による聴力改善が困難である場合は,補聴器や人工聴覚器の中から選択する必要がある.現在,伝音もしくは混合性難聴に対しては,従来の骨導補聴器に加えて,軟骨伝導補聴器,接着型骨導補聴器,受動型骨導インプラント(Baha),能動型骨導インプラント(BONEBRIDGE),人工中耳(VIBRANT SOUNDBRIDGE),などといった幅広い選択肢から適切な聴覚補償の方法を選択していく必要がある.側頭骨手術後の後天性外耳道閉鎖症に対しては,術側の骨導閾値が保たれる症例に関しては,軟骨伝導補聴器も一つの有力な聴覚補償の選択肢として検討できる.(著者抄録)

記述言語：日本語   出版者・発行元：(株)東京医学社  

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   出版者・発行元：(一社)日本耳科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳科学会  

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記述言語：日本語  

外側頭蓋底外科領域は,非常にチャレンジングな領域である.比較的発生頻度の低い腫瘍が多く,単一施設で経験できる症例が非常に限られている.近年の経鼻内視鏡頭蓋底手術の発展に伴い,外側頭蓋底外科領域においても顕微鏡単独手術だけではなく,内視鏡補助下もしくは内視鏡単独での手術も選択肢の一つとして検討すべき時代になってきている.さらに,外視鏡の登場は,内視鏡との連携をより向上させた.顕微鏡や外視鏡での手術の際に死角となる領域を内視鏡では接近して,さらに鮮明に拡大して確認することができる.また,経鼻内視鏡頭蓋底手術もその適応が頭蓋底正中から,より外側へ拡大し,外側頭蓋底領域へも内視鏡単独で経鼻的に到達可能になってきた.外側頭蓋底領域へアプローチする際は,腫瘍の血流,内頸動脈を含む血管系との位置関係,腫瘍の組織型などから総合的に判断して適切なアプローチを選択する必要がある.その際,顕微鏡下もしくは外視鏡下での手術なのか,内視鏡単独でのアプローチなのか,内視鏡補助下手術なのか,顕微鏡下もしくは外視鏡下でのアプローチと経鼻(経口)内視鏡頭蓋底手術とのcombined approachなのかを検討する.内視鏡頭蓋底手術では,3-handや4-hand techniqueは非常に有効で,経皮,経口,経鼻などといった複数のポートを利用したmultiportal techniqueも検討する価値がある.(著者抄録)

記述言語：日本語  

細径の蝸牛軸巻き付き型の人工内耳電極は挿入時に蝸牛内で屈曲(tip fold-over)することがある.この問題は電極が曲がる向きと蝸牛が曲がる向きが一致しないミスアライメントという状態のときに起こりやすい.このため,執刀医は電極のカイル平面をなるべく蝸牛のコイル平面に一致させて電極を挿入する必要がある.われわれは,手術中に視認できるキヌタ骨を利用して蝸牛コイル平面を想定する方法を検討した.2017年から2021年の期間に,一人の執刀医が施行した人工内耳植込み術症例のうち内耳奇形症例を除外した65耳(右29耳,左36耳)について検討した.キヌタ骨平面と蝸牛コイル平面が為す角度をキヌタ-蝸牛角と定義し集計した.キヌタ-蝸牛角は平均では34.6°であった.左右および手術時年齢による統計的な有意差は見られなかった.本研究により,手術中に確認できるキヌタ骨平面を利用して蝸牛コイル平面を正確に想定することが可能とわかった.(著者抄録)

記述言語：日本語   出版者・発行元：(一社)日本耳科学会  

細径の蝸牛軸巻き付き型の人工内耳電極は挿入時に蝸牛内で屈曲(tip fold-over)することがある.この問題は電極が曲がる向きと蝸牛が曲がる向きが一致しないミスアライメントという状態のときに起こりやすい.このため,執刀医は電極のカイル平面をなるべく蝸牛のコイル平面に一致させて電極を挿入する必要がある.われわれは,手術中に視認できるキヌタ骨を利用して蝸牛コイル平面を想定する方法を検討した.2017年から2021年の期間に,一人の執刀医が施行した人工内耳植込み術症例のうち内耳奇形症例を除外した65耳(右29耳,左36耳)について検討した.キヌタ骨平面と蝸牛コイル平面が為す角度をキヌタ-蝸牛角と定義し集計した.キヌタ-蝸牛角は平均では34.6°であった.左右および手術時年齢による統計的な有意差は見られなかった.本研究により,手術中に確認できるキヌタ骨平面を利用して蝸牛コイル平面を正確に想定することが可能とわかった.(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科頭頸部外科学会  

外側頭蓋底外科領域は,非常にチャレンジングな領域である.比較的発生頻度の低い腫瘍が多く,単一施設で経験できる症例が非常に限られている.近年の経鼻内視鏡頭蓋底手術の発展に伴い,外側頭蓋底外科領域においても顕微鏡単独手術だけではなく,内視鏡補助下もしくは内視鏡単独での手術も選択肢の一つとして検討すべき時代になってきている.さらに,外視鏡の登場は,内視鏡との連携をより向上させた.顕微鏡や外視鏡での手術の際に死角となる領域を内視鏡では接近して,さらに鮮明に拡大して確認することができる.また,経鼻内視鏡頭蓋底手術もその適応が頭蓋底正中から,より外側へ拡大し,外側頭蓋底領域へも内視鏡単独で経鼻的に到達可能になってきた.外側頭蓋底領域へアプローチする際は,腫瘍の血流,内頸動脈を含む血管系との位置関係,腫瘍の組織型などから総合的に判断して適切なアプローチを選択する必要がある.その際,顕微鏡下もしくは外視鏡下での手術なのか,内視鏡単独でのアプローチなのか,内視鏡補助下手術なのか,顕微鏡下もしくは外視鏡下でのアプローチと経鼻(経口)内視鏡頭蓋底手術とのcombined approachなのかを検討する.内視鏡頭蓋底手術では,3-handや4-hand techniqueは非常に有効で,経皮,経口,経鼻などといった複数のポートを利用したmultiportal techniqueも検討する価値がある.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J07551&link_issn=&doc_id=20231030470002&doc_link_id=%2Fdz0tokei%2F2023%2F012610%2F002%2F1112-1119%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdz0tokei%2F2023%2F012610%2F002%2F1112-1119%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科頭頸部外科学会  

外側頭蓋底外科領域は,非常にチャレンジングな領域である.比較的発生頻度の低い腫瘍が多く,単一施設で経験できる症例が非常に限られている.近年の経鼻内視鏡頭蓋底手術の発展に伴い,外側頭蓋底外科領域においても顕微鏡単独手術だけではなく,内視鏡補助下もしくは内視鏡単独での手術も選択肢の一つとして検討すべき時代になってきている.さらに,外視鏡の登場は,内視鏡との連携をより向上させた.顕微鏡や外視鏡での手術の際に死角となる領域を内視鏡では接近して,さらに鮮明に拡大して確認することができる.また,経鼻内視鏡頭蓋底手術もその適応が頭蓋底正中から,より外側へ拡大し,外側頭蓋底領域へも内視鏡単独で経鼻的に到達可能になってきた.外側頭蓋底領域へアプローチする際は,腫瘍の血流,内頸動脈を含む血管系との位置関係,腫瘍の組織型などから総合的に判断して適切なアプローチを選択する必要がある.その際,顕微鏡下もしくは外視鏡下での手術なのか,内視鏡単独でのアプローチなのか,内視鏡補助下手術なのか,顕微鏡下もしくは外視鏡下でのアプローチと経鼻(経口)内視鏡頭蓋底手術とのcombined approachなのかを検討する.内視鏡頭蓋底手術では,3-handや4-hand techniqueは非常に有効で,経皮,経口,経鼻などといった複数のポートを利用したmultiportal techniqueも検討する価値がある.(著者抄録)

記述言語：日本語  

記述言語：日本語   出版者・発行元：(一社)日本言語聴覚士協会  

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記述言語：日本語  

＜文献概要＞POINT ▼下位脳神経を確実に温存するには,外科解剖を三次元的に捉え,習熟することが必須である。▼頭蓋底直下では,舌咽神経は迷走神経・副神経よりも外側を走行し,茎突咽頭筋の後内側で容易に同定できる。▼頭蓋底直下では,副神経と内頸静脈との位置関係にバリエーションが存在する。▼頸静脈孔へのアプローチの際,側頭骨内の顔面神経は多くの場合は前方移動しなくても十分な術野を作ることが可能である。

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞POINT ▼下位脳神経を確実に温存するには,外科解剖を三次元的に捉え,習熟することが必須である。▼頭蓋底直下では,舌咽神経は迷走神経・副神経よりも外側を走行し,茎突咽頭筋の後内側で容易に同定できる。▼頭蓋底直下では,副神経と内頸静脈との位置関係にバリエーションが存在する。▼頸静脈孔へのアプローチの際,側頭骨内の顔面神経は多くの場合は前方移動しなくても十分な術野を作ることが可能である。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J02122&link_issn=&doc_id=20230502090008&doc_link_id=10.11477%2Fmf.1411203393&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1411203393&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞POINT　▼下位脳神経を確実に温存するには,外科解剖を三次元的に捉え,習熟することが必須である。▼頭蓋底直下では,舌咽神経は迷走神経・副神経よりも外側を走行し,茎突咽頭筋の後内側で容易に同定できる。▼頭蓋底直下では,副神経と内頸静脈との位置関係にバリエーションが存在する。▼頸静脈孔へのアプローチの際,側頭骨内の顔面神経は多くの場合は前方移動しなくても十分な術野を作ることが可能である。

記述言語：日本語  

記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科頭頸部外科学会  

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記述言語：日本語  

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：日本語  

41歳女性。右顔面神経麻痺、右顔面痙攣の精査加療目的に当科へ紹介となった。精査の結果、側頭骨内顔面神経鞘腫と診断し、患者は手術を強く希望したため、右顔面神経腫瘍摘出術および顔面神経再建術が施行された。その結果、術後に右顔面痙攣は完全消失し、右顔面神経麻痺も回復傾向にあり、今後は外来にて顔面神経リハビリテーションを継続的に行っていく予定である。

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)

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記述言語：日本語   出版者・発行元：耳鼻と臨床会  

41歳女性。右顔面神経麻痺、右顔面痙攣の精査加療目的に当科へ紹介となった。精査の結果、側頭骨内顔面神経鞘腫と診断し、患者は手術を強く希望したため、右顔面神経腫瘍摘出術および顔面神経再建術が施行された。その結果、術後に右顔面痙攣は完全消失し、右顔面神経麻痺も回復傾向にあり、今後は外来にて顔面神経リハビリテーションを継続的に行っていく予定である。

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記述言語：日本語  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語  

側頭骨悪性腫瘍に対する側頭骨一塊切除術は,外側側頭骨切除術(lateral temporal bone resection:LTBR),側頭骨亜全摘術(subtotal temporal bone resection:STBR),側頭骨全摘術(total temporal bone resection:TTBR)の3つの方法が報告されているが,実臨床では,LTBRとSTBRの二つが主に用いられる.STBRは,頭蓋底チームが手術対応できる施設でのみ施行可能な術式である.一方,LTBRは耳鼻咽喉科医単独で施行可能な術式で,非常に洗練された画一的な手術手技である.通常の乳突洞削開術を含む耳科手術の手技に加え,側頭骨鼓室部の骨削除の方法を理解することで,安全に手術を完遂できる.本術式は通常の耳科手術に必要な外科解剖と手術手技を学ぶことができるため,経験の浅い耳鼻咽喉科医にも積極的に関与してもらいたい術式である.手術手技の構成は,通常の乳突洞削開術に後鼓室開放後の鼓室内操作,上/前鼓室開放,後鼓室開放の拡大と側頭骨鼓室部の骨削除などの手技を組み合わせたものとなっている.通常の耳科手術で馴染みの少ない側頭骨鼓室部の削除がKeyとなる手技と思われる.安全に側頭骨の鼓室部の削除を行うためには,錐体鼓室縫合と鼓索神経の関係,骨部耳管と内頸動脈との関係,そして下鼓室とvaginal processとの関係を正確に知る必要がある.本稿では,LTBRを施行する上で必要な骨学と,術前の留意点などに加えて,実際の手術手技の手順について概説する.(著者抄録)

記述言語：日本語  

外耳道癌の発生頻度は非常に稀である.組織型としては,扁平上皮癌が主であり,続いて腺様嚢胞癌,基底細胞癌,耳垢腺癌,などが挙げられる.その希少性から確立した治療ガイドラインの構築が遅れているのが現状である.標準治療は確立しておらず,特に根治手術不能な症例に対しての治療方針は施設によって様々である.いずれの組織型に対しても,断端陰性での一塊切除が予後に寄与するため,文献的には世界的にコンセンサスの得られている治療法ということができる.しかし,積極的に外耳道癌を疑う症状を呈するまでに時間を要する症例も含まれる.また,難治性外耳道炎などの外耳道の炎症性疾患との鑑別が初期の段階では難しい症例も含まれ,専門施設への紹介が遅れることもしばしばである.可能な限り,切除可能な時期に専門施設へ紹介することが重要である.(著者抄録)

記述言語：日本語  

記述言語：日本語  

記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

外耳道癌の発生頻度は非常に稀である.組織型としては,扁平上皮癌が主であり,続いて腺様嚢胞癌,基底細胞癌,耳垢腺癌,などが挙げられる.その希少性から確立した治療ガイドラインの構築が遅れているのが現状である.標準治療は確立しておらず,特に根治手術不能な症例に対しての治療方針は施設によって様々である.いずれの組織型に対しても,断端陰性での一塊切除が予後に寄与するため,文献的には世界的にコンセンサスの得られている治療法ということができる.しかし,積極的に外耳道癌を疑う症状を呈するまでに時間を要する症例も含まれる.また,難治性外耳道炎などの外耳道の炎症性疾患との鑑別が初期の段階では難しい症例も含まれ,専門施設への紹介が遅れることもしばしばである.可能な限り,切除可能な時期に専門施設へ紹介することが重要である.(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科頭頸部外科学会  

側頭骨悪性腫瘍に対する側頭骨一塊切除術は,外側側頭骨切除術(lateral temporal bone resection:LTBR),側頭骨亜全摘術(subtotal temporal bone resection:STBR),側頭骨全摘術(total temporal bone resection:TTBR)の3つの方法が報告されているが,実臨床では,LTBRとSTBRの二つが主に用いられる.STBRは,頭蓋底チームが手術対応できる施設でのみ施行可能な術式である.一方,LTBRは耳鼻咽喉科医単独で施行可能な術式で,非常に洗練された画一的な手術手技である.通常の乳突洞削開術を含む耳科手術の手技に加え,側頭骨鼓室部の骨削除の方法を理解することで,安全に手術を完遂できる.本術式は通常の耳科手術に必要な外科解剖と手術手技を学ぶことができるため,経験の浅い耳鼻咽喉科医にも積極的に関与してもらいたい術式である.手術手技の構成は,通常の乳突洞削開術に後鼓室開放後の鼓室内操作,上/前鼓室開放,後鼓室開放の拡大と側頭骨鼓室部の骨削除などの手技を組み合わせたものとなっている.通常の耳科手術で馴染みの少ない側頭骨鼓室部の削除がKeyとなる手技と思われる.安全に側頭骨の鼓室部の削除を行うためには,錐体鼓室縫合と鼓索神経の関係,骨部耳管と内頸動脈との関係,そして下鼓室とvaginal processとの関係を正確に知る必要がある.本稿では,LTBRを施行する上で必要な骨学と,術前の留意点などに加えて,実際の手術手技の手順について概説する.(著者抄録)

記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科頭頸部外科学会  

側頭骨悪性腫瘍に対する側頭骨一塊切除術は,外側側頭骨切除術(lateral temporal bone resection:LTBR),側頭骨亜全摘術(subtotal temporal bone resection:STBR),側頭骨全摘術(total temporal bone resection:TTBR)の3つの方法が報告されているが,実臨床では,LTBRとSTBRの二つが主に用いられる.STBRは,頭蓋底チームが手術対応できる施設でのみ施行可能な術式である.一方,LTBRは耳鼻咽喉科医単独で施行可能な術式で,非常に洗練された画一的な手術手技である.通常の乳突洞削開術を含む耳科手術の手技に加え,側頭骨鼓室部の骨削除の方法を理解することで,安全に手術を完遂できる.本術式は通常の耳科手術に必要な外科解剖と手術手技を学ぶことができるため,経験の浅い耳鼻咽喉科医にも積極的に関与してもらいたい術式である.手術手技の構成は,通常の乳突洞削開術に後鼓室開放後の鼓室内操作,上/前鼓室開放,後鼓室開放の拡大と側頭骨鼓室部の骨削除などの手技を組み合わせたものとなっている.通常の耳科手術で馴染みの少ない側頭骨鼓室部の削除がKeyとなる手技と思われる.安全に側頭骨の鼓室部の削除を行うためには,錐体鼓室縫合と鼓索神経の関係,骨部耳管と内頸動脈との関係,そして下鼓室とvaginal processとの関係を正確に知る必要がある.本稿では,LTBRを施行する上で必要な骨学と,術前の留意点などに加えて,実際の手術手技の手順について概説する.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J07551&link_issn=&doc_id=20221031390007&doc_link_id=%2Fdz0tokei%2F2022%2F012510%2F007%2F1459-1463%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdz0tokei%2F2022%2F012510%2F007%2F1459-1463%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本鼻科学会  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

外耳道癌の発生頻度は非常に稀である.組織型としては,扁平上皮癌が主であり,続いて腺様嚢胞癌,基底細胞癌,耳垢腺癌,などが挙げられる.その希少性から確立した治療ガイドラインの構築が遅れているのが現状である.標準治療は確立しておらず,特に根治手術不能な症例に対しての治療方針は施設によって様々である.いずれの組織型に対しても,断端陰性での一塊切除が予後に寄与するため,文献的には世界的にコンセンサスの得られている治療法ということができる.しかし,積極的に外耳道癌を疑う症状を呈するまでに時間を要する症例も含まれる.また,難治性外耳道炎などの外耳道の炎症性疾患との鑑別が初期の段階では難しい症例も含まれ,専門施設への紹介が遅れることもしばしばである.可能な限り,切除可能な時期に専門施設へ紹介することが重要である.(著者抄録)

記述言語：日本語  

記述言語：日本語   出版者・発行元：(一社)日本言語聴覚士協会  

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記述言語：日本語  

＜文献概要＞POINT ▼外来診療において,耳痛・耳漏を伴うcommon diseaseのなかから,危険な疾患を見逃さないように努める義務がある。▼悪性外耳道炎(頭蓋底骨髄炎),外耳道悪性腫瘍,耳性頭蓋内合併症などは,早期診断が重要である。▼診断確定のための組織生検は積極的に検討すべきであるが,組織生検を先行すべきか,画像精査を先行すべきかを十分に検討する必要がある。▼50歳以上の高齢者の耳痛で,耳内所見が正常であれば,巨細胞性動脈炎も鑑別に挙げる必要がある。

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞POINT　▼外来診療において,耳痛・耳漏を伴うcommon diseaseのなかから,危険な疾患を見逃さないように努める義務がある。▼悪性外耳道炎(頭蓋底骨髄炎),外耳道悪性腫瘍,耳性頭蓋内合併症などは,早期診断が重要である。▼診断確定のための組織生検は積極的に検討すべきであるが,組織生検を先行すべきか,画像精査を先行すべきかを十分に検討する必要がある。▼50歳以上の高齢者の耳痛で,耳内所見が正常であれば,巨細胞性動脈炎も鑑別に挙げる必要がある。

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞POINT ▼外来診療において,耳痛・耳漏を伴うcommon diseaseのなかから,危険な疾患を見逃さないように努める義務がある。▼悪性外耳道炎(頭蓋底骨髄炎),外耳道悪性腫瘍,耳性頭蓋内合併症などは,早期診断が重要である。▼診断確定のための組織生検は積極的に検討すべきであるが,組織生検を先行すべきか,画像精査を先行すべきかを十分に検討する必要がある。▼50歳以上の高齢者の耳痛で,耳内所見が正常であれば,巨細胞性動脈炎も鑑別に挙げる必要がある。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J02122&link_issn=&doc_id=20220804080005&doc_link_id=10.11477%2Fmf.1411203105&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1411203105&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

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   出版者・発行元：(一社)日本耳鼻咽喉科頭頸部外科学会  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科頭頸部外科学会  

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記述言語：日本語  

記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科頭頸部外科学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J07551&link_issn=&doc_id=20220301460020&doc_link_id=10.3950%2Fjibiinkotokeibu.125.2_213&url=https%3A%2F%2Fdoi.org%2F10.3950%2Fjibiinkotokeibu.125.2_213&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

頸静脈孔周囲へ安全にアプローチするには、頸静脈孔に関連する複雑な微小外科解剖と手術アプローチの両方を正確に理解することが必要である。いくつかの類似のアプローチが別々の名前で呼ばれていることが多少の混乱を招いていることは否めない。その現状の中で、腫瘍の組織型と局在に応じて、過去の報告から適切なアプローチを選択していく必要がある。頸静脈孔への外側/後方からの手術アプローチは、3つのkey approachと2つのkey stepから構成される。その中で、頸静脈突起は非常に重要な解剖学的ランドマークである。近年、内視鏡手術の発展に伴い、前方からの頸静脈孔へのアプローチの重要性も再認識されるようになってきた。前方からアプローチする際は、側頭骨鼓室部の鞘状突起が重要となる。本稿では、頸静脈孔周囲へアプローチする際に必要となる微小外科解剖と基本的なアプローチ法について解説する。(著者抄録)

記述言語：日本語  

症例はChiari奇形I型を有する19歳男性.初発から2ヵ月後に細菌性髄膜炎を再発した.15歳から右聴力低下があり,側頭骨高分解能CTで右外耳道壁から錐体骨にわたる骨破壊と軟部陰影を認めた.外耳道組織生検で髄液漏と気脳症をきたし,CT cisternographyで側頭骨髄液漏を確認した.MRIで錐体尖前面に硬膜欠損が示唆され,術中所見で大錐体神経上部にくも膜顆粒による骨欠損を同定した.外傷,手術,内耳奇形等はなく,特発性髄液漏と診断した.臨床的に髄液耳漏や中耳内液貯留がなくとも特発性髄液漏は存在し,髄膜炎の原因となり得るため注意が必要である.(著者抄録)

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

人工聴覚器手術は標準化された術式である。標準化された術式とはいえ,ときに予期せぬ手術合併症をまねいたり,手術困難症例に遭遇する。基本的な手術解剖を覚えることは必須であるが,より深く正確な手術解剖の知識を身につけ,患者ごとの解剖学的構造物の特徴を術前に評価・把握することが,合併症のリスクを下げて,かつ,手術困難を乗り越える助けとなることは言うまでもない。本稿では,人工聴覚器手術,特に人工内耳植込み術の際に必要な微小外科解剖を解説する。内耳奇形を伴わない側頭骨解剖のバリエーションという観点から外科解剖を提示する。(著者抄録)

記述言語：日本語  

記述言語：日本語  

側頭骨扁平上皮癌の発生頻度は非常に低く、質の高い治療エビデンスの構築が遅れている疾患である。今回我々は、過去20年間に九州大学病院耳鼻咽喉・頭頸部外科を受診した側頭骨扁平上皮癌患者103症例の検討を行った。内訳はT1が13症例、T2が19症例、T3が21症例、そしてT4が50症例であった。疾患特異的生存率(5年生存率)は、T1で92&#37;、T2で87&#37;、T3で87&#37;、T4で37&#37;であり、T4症例のみ有意に生存率の低下を認めた。手術介入症例では、断端陰性切除群が断端陽性群に比べて有意に生存率が高かった。一般的に、T3およびT4の進行側頭骨扁平上皮癌は予後不良と言われているが、断端陰性切除可能症例は予後が比較的良好であった。そのため側頭骨扁平上皮癌に対する標準治療は、進行癌であっても断端陰性による切除が有効であると考えられた。(著者抄録)

記述言語：日本語  

＜文献概要＞ここを押さえておこう ●耳介腫脹の診断は,問診と視診・触診が非常に重要である.●耳介腫脹から鑑別が必要になる全身疾患が存在する.●治療介入の遅れが,耳介変形などの後遺症につながる.

記述言語：日本語  

14歳女児。頭痛、左顔面感覚低下を主訴に、近医より当科へ紹介となった。頭部画像所見では左側頭骨錐体尖に病変を認め、anterior transpetrosal approachで腫瘍を摘出し、病理検査にて錐体尖CG(コレステリン肉芽腫)と診断された。しかし、術後1ヵ月で症状の再燃増悪を認めたため、infrapetrous transpterygoid approachを用いて錐体尖の開放を行った。その結果、症状の著明な改善を認め、良好な術後経過が得られた。

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  

2014年の「小児人工内耳適応基準」の改定により、「音声を用いてさまざまな学習を行う小児に対する補聴の基本は両耳聴であり、両耳聴の実現のために人工内耳の両耳装用が有用な場合にはこれを否定しない」と記載されたことで、本邦でも両側の人工内耳植込み術症例が増加してきている。両側人工内耳植込み術には、逐次手術と同日手術が存在する。いずれも、両側の人工内耳が左右対称に植込まれるように術者は配慮するが、整容的に左右対称に植込むことは実際には容易ではない。今回われわれは、当科で施行した両側人工内耳植込み術の際の、整容面に配慮するための術前の工夫について報告する。(著者抄録)

記述言語：日本語  

症例は31歳女性で、嘔吐を伴う後頭部痛で救急外来を受診した。検査では特に異常なくいったん帰宅したが、右頸部腫脹が出現し、39℃台の発熱を認めた。右舌半分の違和感や呂律不良を自覚した。頸部造影CTで右内頸静脈血栓を認め、血栓性静脈炎・静脈洞血栓症と診断した。抗凝固療法と抗生剤治療を行い、治療後は後遺症である呂律障害は徐々に軽減した。激しい頭痛が出現し、造影CTで左頸部にも血栓症の疑いを再度指摘された。再度強い頭痛、嗄声と嘔吐、右腕挙上困難、嚥下障害症状が出現し、対症療法のみで頭痛は改善した。右上肢の挙上困難と膿下障害は徐々に改善するも、右声帯麻痺が残存した。頸部CTAを施行し、右頸静脈の途絶を認めた。その結果、右内頸静脈・S状静脈・横静脈血栓症に合併したCollet-Sicard症候群と診断した。嗄声の増悪を認め、CTで内頸動脈を外側から圧排する腫瘤影を指摘された。頸部および頸静脈孔内より開放腫瘍生検を施行し、血管類上皮細胞腫瘍と診断した。脳血管バイパス術、腫瘍栄養血管塞栓術および右内頸動脈塞栓術を施行した。今後は残存病変に対し放射線照射を行う予定である。

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  

背景:眼窩先端部症候群の診断後短期間で死亡に至った症例を報告する。症例:73歳、男性。左眼の眼瞼下垂、眼痛を主訴に近医脳神経外科を受診しステロイド投与を施行されたが症状改善は得られず、CT上で蝶形骨洞に軟部陰影が出現した。脳神経外科初診1ヵ月後九州大学耳鼻科に紹介され、視機能評価目的に九州大学眼科を初診した。眼科初診時右視力(0.7)、左視力光覚なし。左眼全方向性眼球運動障害、眼球運動時痛を伴っていた。眼科初診翌日に耳鼻科で蝶形骨洞手術施行し病変を可能な限り切除したところ、組織は低分化癌であった。画像上多発骨転移、リンパ節転移を認め、積極的治療は適応外であった。その後呼吸状態の悪化により発症から2ヵ月、眼科初診から1ヵ月で死亡した。結論:眼窩先端部症候群は致死的な経過をたどることがあり、原因疾患の早急な特定が重要である。(著者抄録)

記述言語：日本語  

記述言語：その他  

DOI： 10.1007/978-3-319-60955-3_2

記述言語：日本語  

記述言語：日本語  

58歳女。両側耳漏を主訴とした。近医にて好酸球性中耳炎の疑いで加療されるも症状の改善と再燃を繰り返し、当科初診時には両側鼓室内貯留液と左鼓膜の膨隆がみられた。両側の鼓室内には非常に粘稠なにかわ状の貯留液を認め、細菌検査でAchromobacter xylosoxidansが単離されたため、同菌による慢性乳突蜂巣炎・錐体尖炎と診断した。抗生剤投与により左耳漏は停止したが、右耳漏が再燃したため、右乳突洞削開術と乳突蜂巣の開放洗浄、ドレーン留置を行い、錐体尖の蜂巣の含気が確認できるまでミノサイクリンを投与した。ミノサイクリン中止後は両側とも耳漏の再燃を認めていない。難治性の炎症性疾患の細菌検査でA.xylosoxidansが同定された際には、起炎菌になり得るかを慎重に検討する必要があると考えられた。

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

種別：大会・シンポジウム等 

種別：大会・シンポジウム等 

種別：査読等 

外国語雑誌　査読論文数：1

日本語雑誌　査読論文数：6

種別：査読等 

外国語雑誌　査読論文数：1

日本語雑誌　査読論文数：2

種別：大会・シンポジウム等