著者

Takuya SUEMATSU Tomoaki MURAKAMI Yoshiko SUDO Tatsuya HAGIOKA Yuhei HOSHIKUMA Takamune ACHIHA Takeshi SHIMIZU Shingo TOYOTA Haruhiko KISHIMA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.329-335, 2022-12-31 (Released:2022-09-23)

参考文献数

21

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Intimal sarcomas (ISAs) are extremely rare malignant tumors that histologically occur in the tunica intima of large blood vessels of the systemic and pulmonary circulation. Herein, we describe a case of an ISA-based neoplastic aneurysm in the middle cerebral artery (MCA) that resulted in a subarachnoid hemorrhage (SAH). The patient presented to our hospital with severe consciousness disturbance (Glasgow Coma Scale E1V1M2) and anisocoria. On admission, computed tomography (CT) showed a diffuse SAH. At 8 months prior, he presented to a previous hospital with hoarseness. Thoracic CT revealed a threatened rupture of the aorta of the arch. After total arch replacement, he had been diagnosed with ISA from the pathological findings of the resected aorta. Thereafter, he had been treated with adjuvant chemotherapy and radiotherapy without any cerebral vascular imaging studies, before admission at our hospital. Angiogram revealed a multilobar fusiform aneurysm on the right MCA. We performed a superficial temporal artery-MCA anastomosis, trapping, and resection of the affected MCA (including the aneurysm), followed by external decompression. Microscopic hematoxylin-eosin staining showed proliferation of atypical spindle-shaped cells with enlarged nuclei in the lumen of the affected MCA. Immunostaining showed CD31 (±), ERG (+), MDM2 (+), CDK4 (+, slightly), SMA (±), MIB-1 index 13.9%, factor VIII (±), and desmin (−). These pathological findings indicated metastasis of the ISA, which formed the neoplastic aneurysm. An ISA can cause a neoplastic cerebral aneurysm. Therefore, once a patient is diagnosed with an ISA, it is necessary to check periodically the cerebral arteries.

著者

Ryota HAGIHARA Makoto ISOZAKI Masamune KIDOGUCHI Hidetaka ARISHIMA Ken-ichiro KIKUTA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.319-322, 2022-12-31 (Released:2022-09-23)

参考文献数

8

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A 38-year-old woman presented with impaired consciousness and anisocoria due to a subarachnoid hemorrhage and an intracerebral hemorrhage of the left temporal lobe. Examination revealed severe tortuosity in the left middle cerebral artery and three sequential bead-like aneurysms. She underwent a craniotomy in the acute phase to stop rebleeding at the rupture site and remove the intracerebral hematoma. During the chronic phase, endovascular treatment with superselective balloon test occlusion (ssBTO) was performed for the remaining aneurysms. Preoperative ssBTO was useful in evaluating collateral circulation and assessing the curability of the treatment.

著者

Yoshitaka NAGASHIMA Yusuke NISHIMURA Hiroshi ITO Tomoya NISHII Takahiro OYAMA Ryuta SAITO

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.295-299, 2022-12-31 (Released:2022-09-15)

参考文献数

20

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Arachnoiditis ossificans (AO) is a rare disease, wherein ossified lesions in the subarachnoid space obstruct the flow of spinal fluid or compress the spinal cord, thereby causing myelopathy. Here we describe a rare case of AO and discuss the diagnosis and treatment strategies for this disease. A 66-year-old man with a history of subarachnoid hemorrhage presented with gait disturbance and dysuria for 7 months. Spinal magnetic resonance imaging and computed tomography (CT) myelography showed syringomyelia at the T5-T8 level and dorsally tethered spinal cord at the T8-T10 level. Preoperative noncontrast CT was not performed. The patient was diagnosed with adhesive arachnoiditis and underwent arachnoidolysis. However, intraoperative findings showed the presence of ossification lesions on the dorsal surface of the spinal cord, and intraoperative ultrasound (IOU) showed a hyperintense lesion with acoustic shadowing on the dorsal surface of the spinal cord, with limited visibility of the spinal cord. After removal of the lesions, IOU showed untethered and well-decompressed spinal cord and restoration of cerebrospinal fluid pulsation. Based on these findings, the patient was finally diagnosed with AO, which is an extremely rare disease, with an unknown frequency of occurrence. Therefore, all patients with adhesive spinal arachnoiditis require a preoperative noncontrast CT scan to evaluate for ossification lesions. In this case, we were fortunate to be able to treat AO with IOU, which demonstrated specific findings.

著者

Yosuke OKAZAKI Tatsuya SASAKI Kouji KAWAI Kakeru HOSOMOTO Susumu SASADA Takao YASUHARA Tomoyuki AKIYAMA Yoshiyuki HANAOKA Isao DATE

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.307-312, 2022-12-31 (Released:2022-09-15)

参考文献数

23

---

Early-onset isolated (DYT1) dystonia is one of the most common forms of primary dystonia in childhood, and deep brain stimulation of the globus pallidus internus (GPi-DBS) is a highly effective treatment for it. However, the effectiveness of GPi-DBS in monozygotic twins with DYT1 dystonia has never been reported globally. Here, we report the cases of monozygotic twins with DYT1 dystonia who were treated using GPi-DBS, and we include a literature review. The younger brother showed an abnormal gait, with external rotation of the right lower leg at 6 years old. The symptoms gradually became so severe that he had difficulty walking on his own at 9 years of age. Treatment with levodopa-carbidopa partially resolved his symptoms, but most of the symptoms remained. Meanwhile, the older brother developed dystonia in both upper limbs at 8 years of age, with gradual symptom progression. At 13 years of age, they were diagnosed with DYT1 dystonia. Bilateral GPi-DBS was performed in both patients at 16 years of age. Their symptoms remarkably improved after surgery. The Burke-Fahn-Marsden dystonia rating scale (BFMDRS) movement score was reduced from 52 to 2 points for the younger brother and from 35 to 1 point for the older brother. Even if monozygotic twins have the same genes, the onset and severity of symptoms might vary in accordance with differences in epigenomic profiles. However, GPi-DBS treatment was very effective for the two cases; thus, we should consider the surgical interventions for each patient.

著者

Hayato TAKEUCHI Yoshinobu TAKAHASHI Seisuke TANIGAWA Takanari OKAMOTO Yoshinori KODAMA Yukiko SHISHIDO-HARA Ema YOSHIOKA Tomoko SHOFUDA Yonehiro KANEMURA Eiichi KONISHI Naoya HASHIMOTO

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.199-208, 2022-12-31 (Released:2022-07-08)

参考文献数

26

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Despite recent signs of progress in diagnostic radiology, it is quite rare that a glioblastoma (GBM) is detected asymptomatically. We describe two patients with asymptomatic nonenhancing GBMs that were not diagnosed with neoplasia at first. The patients had brain scans as medical checkups, and incidentally lesions were detected. In both cases, surgical specimens histopathologically showed no evidence of neoplasia, whereas molecular genetic findings were isocitrate dehydrogenase (IDH) -wildtype, O6-methylguanine-DNA methyltransferase promoter (pMGMT) unmethylated, and telomerase reverse transcriptase (TERT) promoter mutated, which matched to GBM. One patient was observed without adjuvant therapy and the tumor recurred 7 months later. Reoperation was performed, and histopathologically GBM was confirmed with the same molecular diagnosis as the first surgical specimen. Another patient was carefully observed, and chemoradiotherapy was begun 6 months after the operation following the extension of the lesion. Eventually, because of disease progression, both patients deceased. We postulate that in each case, the tumor was not lower-grade glioma but corresponded to the early growth phase of GBM cells. Thus far, cases of malignant transformation from lower-grade glioma or asymptomatic GBM with typical histologic features are reported. Nevertheless, to the best of our knowledge, no such case of nonenhancing, nonhistologically confirmed GBM was reported. We conjecture these cases shed light on the yet unknown natural history of GBM. GBM can take the form of radiological nonenhancing and histological nonneoplastic fashion before typical morphology. Molecular genetic analysis can diagnose atypical preceding GBM, and we recommend early surgical removal and adjuvant treatment.

著者

Yutaka FUCHINOUE Kei UCHINO Sayaka TERAZONO Noyuki HARADA Kosuke KONDO Nobuo SUGO

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.231-236, 2022-12-31 (Released:2022-07-27)

参考文献数

21

被引用文献数

2

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Subependymoma (SE) is a rare, usually asymptomatic, brain tumor predominantly affecting older adults and occurring in the fourth and lateral ventricles. We report a rare case of SE with intratumoral hemorrhage that could be removed by neuroendoscopy. The 81-year-old patient had been followed as an outpatient for 10 years due to an intraventricular tumor. It did not grow over the patient's lengthy follow-up. The patient was transferred to our hospital after he fainted near his home; at the time of admission, he had mild consciousness disturbance, and his Glasgow Coma Scale score was 10 points (E3V3M4). Computed tomography showed intratumoral hemorrhage and slight ventricular enlargement. Magnetic resonance (MR) imaging showed a 4 cm-sized tumor in the anterior horn of the right lateral ventricle. The lesion appeared as a mixed-intensity solid tumor and showed irregular enhancement with gadolinium. The patient underwent neuroendoscopic tumor resection on the 30th day of the patient's hospital stay. A histopathological examination revealed small tumor cells with round nuclei scattered in the glial fibrillary background. Immunostaining was positive for glial fibrillary acidic protein; these findings are consistent with an SE diagnosis. The patient in this study had hypertension and used anticoagulants, risk factors for intratumoral hemorrhage. For intraventricular tumors with bleeding-particularly in older or more physically frail patients-minimally invasive neuroendoscopic surgery should be considered an option for tumor resection.

著者

Natsuki SUGIYAMA Hiroshi HASEGAWA Kentaro KUDO Ryo MIYAHARA Rikizo SAITO Chikashi MARUKI Masaru TAKASE Akihide KONDO Hidenori OISHI

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.225-230, 2022-12-31 (Released:2022-07-27)

参考文献数

18

---

There are only a few case reports in which cholesterol crystals were found in the thrombus retrieved by mechanical thrombectomy for cryptogenic stroke, leading to a definitive diagnosis. We herein report a case of aortogenic embolic stroke diagnosed by the presence of rich cholesterol crystals in the retrieved thrombus and review the previously reported cases. A woman in her 80s was transferred as an emergency due to consciousness disturbance, right conjugate deviation, and severe left hemiparesis. Magnetic resonance imaging showed occlusion of the right middle cerebral artery (MCA) and acute infarction in the territory. The MCA was recanalized by thrombectomy using an aspiration catheter and stent retriever, and the symptoms improved. Although the physiological examination did not detect the embolic source during hospitalization, pathological examination of the thrombus revealed atheroma with numerous cholesterol crystal clefts and intermixing of fibrin. Contrast-enhanced computed tomography performed based on the pathological results showed atheromatous lesions in the aortic arch as the embolic source. As a subsequent treatment, medications of a strong statin and an antiplatelet agent were continued, and the patient had no recurrence. The finding that the retrieved thrombus is a simple atheroma containing cholesterol crystals with poor hemocytes suggests embolism due to plaque rupture. Pathological examination of the thrombus obtained by thrombectomy is one of the useful diagnostic approaches for stroke etiology and the determination of its treatment.

著者

Takashi ASAHI Takuto NAKAMURA Michi SATO Yuki KON Hiroyuki KAJIMOTO Shuji SATO

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.60, no.11, pp.525-530, 2020 (Released:2020-11-15)

参考文献数

16

被引用文献数

1 7

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The hanger reflex is a phenomenon characterized by the involuntary rotation of the head when a wire hanger is worn around the head such that a force is applied to the frontal temporal area by the longer side of the hanger. The application of a shearing force on the skin is thought to be the cause of this phenomenon. Attempts have been made to treat cervical dystonia using equipment designed to induce the hanger reflex. This reflex may have implications in the treatment of headaches, cervical pain, and adhesive capsulitis. The hanger reflex is seen not only in the head region but is also in other parts of the body. Thus, it could be used in the treatment of systemic dystonias. The hanger reflex may help develop inexpensive and non-invasive treatment for dystonia or other neurological diseases and is expected to be the focus of research in the future.

著者

Yu NOMURA Masato NARAOKA Nozomi FUJIWARA Shouhei KINOSHITA Keita YANAGIYA Takao SASAKI Ryouta WATANABE Kouta UENO Norihito SHIMAMURA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.165-169, 2022-12-31 (Released:2022-06-15)

参考文献数

18

被引用文献数

1

---

Chronic subdural hematoma (CSDH) typically develops in the supratentorial region in elderly patients. We treated a case of unilateral supratentorial and bilateral infratentorial CSDH, whereby the patient had a coronavirus disease 2019 (COVID-19) infection combined with disseminated intravascular coagulation 2 months earlier. The patient had not experienced any head trauma before the onset of the CSDH. The postoperative course was uneventful, and the patient experienced no neurological deficit. We propose that we should be aware not only of acute ischemic or hemorrhagic diseases after COVID-19 infection but also of chronic subdural hematoma caused by coagulopathy after a COVID-19 infection.

著者

Narihide SHINODA Shogo TAMURA Masafumi MORI Mitsugu NAKAMURA Kazuyoshi KOROSUE Shigeru KOSE

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.63-67, 2022-12-31 (Released:2022-04-01)

参考文献数

21

被引用文献数

1

---

Coronavirus disease 2019 (COVID-19) -related intracranial hemorrhage (ICH) is believed to be associated with at least one known risk factor for ICH, such as hypertension, hyperlipidemia, diabetes mellitus, severe pneumonia, or anticoagulation therapy. However, in this study, we report a case of ICH in a 14-year-old boy with mild COVID-19 infection without pneumonia who had no such risk factors. The only abnormal laboratory finding was temporary depletion of vitamin K-dependent coagulation factors. This case indicates that COVID-19 infection may cause simultaneous asymptomatic intracranial microhemorrhages and temporary depletion of vitamin K-dependent coagulation factors. This temporary depletion might transform the intracranial microhemorrhages into symptomatic ICH.

著者

Tatsuya ISHIKAWA Naoki NAKAYAMA Junta MOROI Norikata KOBAYASHI Hideya KAWAI Tastushi MUTO Nobuyuki YASUI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.49, no.6, pp.273-278, 2009 (Released:2009-06-25)

参考文献数

18

被引用文献数

22 30

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The concept of optimum closure line was applied to a series of 51 consecutive middle cerebral artery aneurysms (14 ruptured, 37 unruptured) in 41 patients, 16 men and 25 women aged 29-79 years (mean 59.1 years). Visual inspection through the operating microscope revealed 3 types of aneurysm based on the origin of the aneurysm: bifurcation type (n = 39), trunk type (n = 9), and combined type (n = 3). Clipping along the optimum closure line should restore the vascular structure to the original configuration. Combination clip techniques were useful to form a curved closure line. This technique requires adequate operative fields with dissection of the aneurysm and related arteries from the neighboring structures as far as possible. The closure line concept is helpful to decide how to apply clips for particular aneurysms to avoid risks of ischemic complication and future recurrence. Combination clip techniques are often necessary to match a curved closure line.

著者

Sosho KAJIWARA Yu HASEGAWA Tetsuya NEGOTO Kimihiko ORITO Takayuki KAWANO Munetake YOSHITOMI Kiyohiko SAKATA Nobuyuki TAKESHIGE Yukako YAMAKAWA Hirofumi JONO Hideyuki SAITO Nobuhisa HIRAYU Osamu TAKASU Masaru HIROHATA Motohiro MORIOKA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.61, no.9, pp.528-535, 2021 (Released:2021-09-15)

参考文献数

21

被引用文献数

4

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This study aimed to examine the beneficial effects of a novel prophylactic barbiturate therapy, step-down infusion of barbiturates, using thiamylal with normothermia (NOR+sdB), on the poor outcome in the patients with severe traumatic brain injuries (sTBI), in comparison with mild hypothermia (MD-HYPO). From January 2000 to March 2019, 4133 patients with TBI were admitted to our hospital. The inclusion criteria were: a Glasgow coma scale (GCS) score of ≤8 on admission, age between 20 and 80 years, intracranial hematoma requiring surgical evacuation of the hematoma with craniotomy and/or external decompression, and patients who underwent management of body temperature and assessed their outcome at 6–12 months. Finally, 43 patients were included in the MD-HYPO (n = 29) and NOR+sdB (n = 14) groups. sdB was initiated intraoperatively or immediately after the surgical treatment. There were no significant differences in patient characteristics, including age, sex, past medical history, GCS on admission, type of intracranial hematoma, and length of hospitalization between the two groups. Although NOR+sdB could not improve the patient’s poor outcome either at discharge from the intensive care unit (ICU) or at 6–12 months after admission, the treatment inhibited composite death at discharge from the ICU. The mean value of the maximum intracranial pressure (ICP) in the NOR+sdB group was <20 mmHg throughout the first 120 h. NOR+sdB prevented composite death in the ICU in patients with sTBI, and we may obtain novel insights into the beneficial role of prophylactic barbiturate therapy from suppression of the elevated ICP during the first 120 h.

著者

Aiko HATA Masaya ODA Takahiro ONO Akira SUZUKI Noriaki HANYU Masataka TAKAHASHI Toshio SASAJIMA Manabu HASHIMOTO Taizen NAKASE Hiroaki SHIMIZU

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.61, no.7, pp.404-413, 2021 (Released:2021-07-15)

参考文献数

21

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The efficacy of stereotactic radiotherapy (SRT) has been well established for postoperative residual and recurrent nonfunctioning pituitary adenomas (NFPAs). However, the risk of visual impairment due to SRT for lesions adjacent to the optic pathways remains a topic of debate. Herein, we evaluated the long-term clinical outcomes of hypofractionated stereotactic radiotherapy (HFSRT) for perioptic NFPAs. From December 2002 to November 2015, 32 patients (18 males and 14 females; median age 63 years; range, 36–83 years) with residual or recurrent NFPAs abutting or displacing the optic nerve and/or chiasm (ONC) were treated with HFSRT. The median marginal dose was 31.3 Gy (range, 17.2–39.6) in 8 fractions (range, 6–15). Magnetic resonance imaging (MRI) and visual and hormonal examinations were performed before and after HFSRT. The median follow-up period was 99.5 months (range, 9–191). According to MRI findings at the last follow-up, the tumor size had decreased in 28 (88%) of 32 patients, was unchanged in 3 (9%), and had increased in 1 (3%). The successful tumor size control rate was 97%. Visual functions remained unchanged in 19 (60%) out of 32 patients, improved in 11 (34%), and deteriorated in 2 (6%). Two patients had deteriorated visual functions; no complications occurred because of the HFSRT. One patient developed hypopituitarism that required hormone replacement therapy. The result of this long-term follow-up study suggests that HFSRT is safe and effective for the treatment of NFPAs occurring adjacent to the ONC.

著者

Keiichi TSUJI Atsushi TSUJI Yayoi YOSHIMURA Hiroto KAWANO Ryo FUJISAWA Kazuhiko NOZAKI

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.8, no.1, pp.617-623, 2021 (Released:2021-09-16)

参考文献数

26

被引用文献数

1

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Brainstem venous congestion due to dural arteriovenous fistula (dAVF) can mimic brainstem glioma and infarction. We report a case of a 56-year-old woman with a transverse-sigmoid sinus (TS) dAVF. On MRI, she presented with brainstem edema that was difficult to distinguish from brainstem glioma and infarction. She was referred to our hospital for mild dysarthria with right hemiparesis and a suspected left pontine glioma. On MRI, contrast enhancement of the lesion was demarcated by the pontine raphe, and the ipsilateral vein of Rosenthal was dilated. Cerebral angiography revealed TS dAVF with an isolated sinus. Transarterial followed by transvenous coil embolization was performed to reduce shunt flow, resulting in symptom improvement and normal findings on MRI and cerebral angiography. Brainstem venous congestion due to TS dAVF is as rare as adult brainstem glioma. Differentiating the above-mentioned three diseases on the basis of diagnostic imaging findings and clinical course is necessary for appropriate and timely treatment.

著者

Naoko MIYAMOTO Isao NAITO Tatsuya SHIMIZU Yuhei YOSHIMOTO

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.55, no.2, pp.163-172, 2015 (Released:2015-02-15)

参考文献数

29

被引用文献数

14 19

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The efficacy and limitations of transarterial acrylic glue embolization for the treatment of intracranial dural arteriovenous fistulas (DAVFs) were investigated. Thirty-four DAVFs treated by transarterial embolization using n-butyl cyanoacrylate were retrospectively reviewed. The locations of DAVFs were the transverse-sigmoid sinus in 11, tentorium in 10, cranial vault in 9, and superior sagittal sinus, jugular bulb, foramen magnum, and middle cranial fossa in 1 each. Borden classification was type I in 7, type II in 3, and type III in 24. Eight patients had undergone prior transvenous coil embolization. Complete obliteration rate was 56% immediately after embolization, 71% at follow-up angiography, and 85% after additional treatments (1 transvenous embolization and 4 direct surgery). Complications occurred in three patients, consisting of asymptomatic vessel perforations during cannulation in two patients and leakage of contrast medium resulting in medullary infarction in one patient. Transarterial glue embolization is highly effective for Borden type III DAVF with direct cortical venous drainage, but has limitations for Borden type I and II DAVFs in which the affected sinus is part of the normal venous circulation. Onyx is a new liquid embolic material and is becoming the treatment of choice for DAVF. The benefits of glue embolization compared to Onyx embolization are high thrombogenicity, and relatively low risks of cranial nerve palsies and of excessive migration into the draining veins of high flow fistula. Transarterial glue embolization continues to be useful for selected patients, and complete cure can be expected in most patients with fewer complications if combined with transvenous embolization or direct surgery.

著者

Takeshi FUNAKI Hiroharu KATAOKA Kazumichi YOSHIDA Takayuki KIKUCHI Yohei MINEHARU Masakazu OKAWA Yukihiro YAMAO Susumu MIYAMOTO

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.59, no.12, pp.517-522, 2019 (Released:2019-12-15)

参考文献数

29

被引用文献数

6 15

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Although direct bypass is effective at preventing intracranial hemorrhage in moyamoya disease, the optimal strategy for achieving this purpose has rarely been addressed. The tailored targeting bypass strategy is a novel technical modification of direct bypass focused on hemorrhage prevention. The strategy is based on the promising theory of periventricular anastomosis, which explains the mechanism of hemorrhage in moyamoya disease. The strategy is defined as the use of multi-imaging modalities to predetermine in a tailored manner a target vessel at the point at which the medullary artery directly extends from the periventricular anastomosis of interest. Direct bypass with a wide craniotomy was performed on 13 hemispheres in eight patients according to this strategy. Marked shrinkage of the periventricular anastomosis of interest was observed in all but one hemisphere after surgery, and no new hemorrhages have occurred as of this writing. The present case series illustrates the technical aspects and preliminary results of the tailored targeting bypass strategy, an approach that might expand the potential of direct bypass in preventing hemorrhage.

著者

Hideaki ABE Manabu NATSUMEDA Yu KANEMARU Jun WATANABE Yoshihiro TSUKAMOTO Masayasu OKADA Junichi YOSHIMURA Makoto OISHI Yukihiko FUJII

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.58, no.7, pp.290-295, 2018 (Released:2018-07-15)

参考文献数

49

被引用文献数

8 26

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Histone H3 mutations are frequently found in diffuse midline gliomas (DMGs), which include diffuse intrinsic pontine gliomas and thalamic gliomas. These tumors have dismal prognoses. Recent evidence suggests that one reason for the poor prognoses is that O6-methylguanine-DNA methyltransferase (MGMT) promoter frequently lacks methylation in DMGs. This review compares the epigenetic changes brought about by histone mutations to those by isocitrate dehydrogenase-mutant gliomas, which frequently have methylated MGMT promoters and are known to be sensitive to temozolomide.

著者

Satoshi MAESAWA Daisuke NAKATSUBO Masazumi FUJII Kentaro IIJIMA Sachiko KATO Tomotaka ISHIZAKI Masashi SHIBATA Toshihiko WAKABAYASHI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.58, no.10, pp.442-452, 2018 (Released:2018-10-15)

参考文献数

38

被引用文献数

5 18

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Epilepsy surgery aims to control epilepsy by resecting the epileptogenic region while preserving function. In some patients with epileptogenic foci in and around functionally eloquent areas, awake surgery is implemented. We analyzed the surgical outcomes of such patients and discuss the clinical application of awake surgery for epilepsy. We examined five consecutive patients, in whom we performed lesionectomy for epilepsy with awake craniotomy, with postoperative follow-up > 2 years. All patients showed clear lesions on magnetic resonance imaging (MRI) in the right frontal (n = 1), left temporal (n = 1), and left parietal lobe (n = 3). Intraoperatively, under awake conditions, sensorimotor mapping was performed; primary motor and/or sensory areas were successfully identified in four cases, but not in one case of temporal craniotomy. Language mapping was performed in four cases, and language areas were identified in three cases. In one case with a left parietal arteriovenous malformation (AVM) scar, language centers were not identified, probably because of a functional shift. Electrocorticograms (ECoGs) were recorded in all cases, before and after resection. ECoG information changed surgical strategy during surgery in two of five cases. Postoperatively, no patient demonstrated neurological deterioration. Seizure disappeared in four of five cases (Engel class 1), but recurred after 2 years in the remaining patient due to tumor recurrence. Thus, for patients with epileptogenic foci in and around functionally eloquent areas, awake surgery allows maximal resection of the foci; intraoperative ECoG evaluation and functional mapping allow functional preservation. This leads to improved seizure control and functional outcomes.

著者

Shabierjiang JIAPAER Takuya FURUTA Shingo TANAKA Tomohiro KITABAYASHI Mitsutoshi NAKADA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.58, no.10, pp.405-421, 2018 (Released:2018-10-15)

参考文献数

154

被引用文献数

78 210

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Glioblastoma (GBM) is a highly malignant type of primary brain tumor with a high mortality rate. Although the current standard therapy consists of surgery followed by radiation and temozolomide (TMZ), chemotherapy can extend patient’s post-operative survival but most cases eventually demonstrate resistance to TMZ. O6-methylguanine-DNA methyltransferase (MGMT) repairs the main cytotoxic lesion, as O6-methylguanine, generated by TMZ, can be the main mechanism of the drug resistance. In addition, mismatch repair and BER also contribute to TMZ resistance. TMZ treatment can induce self-protective autophagy, a mechanism by which tumor cells resist TMZ treatment. Emerging evidence also demonstrated that a small population of cells expressing stem cell markers, also identified as GBM stem cells (GSCs), contributes to drug resistance and tumor recurrence owing to their ability for self-renewal and invasion into neighboring tissue. Some molecules maintain stem cell properties. Other molecules or signaling pathways regulate stemness and influence MGMT activity, making these GCSs attractive therapeutic targets. Treatments targeting these molecules and pathways result in suppression of GSCs stemness and, in highly resistant cases, a decrease in MGMT activity. Recently, some novel therapeutic strategies, targeted molecules, immunotherapies, and microRNAs have provided new potential treatments for highly resistant GBM cases. In this review, we summarize the current knowledge of different resistance mechanisms, novel strategies for enhancing the effect of TMZ, and emerging therapeutic approaches to eliminate GSCs, all with the aim to produce a successful GBM treatment and discuss future directions for basic and clinical research to achieve this end.

著者

Soichi OYA Fusao IKAWA Nao ICHIHARA Masahiko WANIBUCHI Yukinori AKIYAMA Hirofumi NAKATOMI Nobuhiro MIKUNI Yoshitaka NARITA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.61, no.2, pp.98-106, 2021 (Released:2021-02-15)

参考文献数

29

被引用文献数

2 10

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Although surgical resection is the most preferred treatment for intracranial meningiomas, a detailed analysis of the surgery-related risks based on large population data has not been conducted to date. In this study, we analyzed the nation-wide brain tumor registry to assess the surgical risk factors for intracranial meningiomas to provide information for an optimal treatment strategy. Data of 4081 meningioma patients who underwent initial resection between 2001 and 2008 were extracted from the Brain Tumor Registry of Japan (BTRJ) database and reviewed for postoperative mortality, aggravation of Karnofsky Performance Score (KPS), and complications. The total in-hospital mortality rate was 0.59%. Male sex and tumor size ≥30 mm were independent risk factors for mortality. Among 4081 cases, 4.4% of patients had KPS that were lowered by 20 or more points at the time of discharge after surgery. Age ≥65 years, higher WHO grading, tumor location at the skull base, tumor size ≥30 mm, and non-gross total resections were associated with lowering of KPS scores by 20 or more points. The overall incidence of surgical complications was 19.3%. The rate of occurrence of new postoperative seizure in patients with supratentorial meningioma was 10.9%. All complications except for vascular complications occurred with significantly lower frequencies in asymptomatic patients than in symptomatic patients. Our results provide useful information regarding the surgical risks when surgical intervention is being considered for intracranial meningiomas. Surgery is an important option for asymptomatic meningiomas as the mortality rate and complication rate in the current study were sufficiently low.