研究者詳細 - 秋山　幸功

論文 - 秋山　幸功

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PHASE I/II STUDY OF TEMOZOLOMIDE PLUS NIMUSTINE CHEMOTHERAPY FOR RECURRENT MALIGNANT GLIOMAS: KYOTO NEURO-ONCOLOGY GROUP

Tomokazu Aoki, Yoshiki Arakawa, Tetsuya Ueba, Masashi Oda, Namiko Nishida, Yukinori Akiyama, Tetsuya Tsukahara, Koichi Iwasaki, Nobuhiro Mikuni, Susumu Miyamoto

NEURO-ONCOLOGY ( OXFORD UNIV PRESS INC ) 21 12 - 12 2019年11月

Total Resection of Unilateral Adult-onset Xanthogranuloma of the Orbit via a Transcranial Orbital Approach.

Tomoaki Tamada, Masahiko Wanibuchi, Hime Suzuki, Rintaro Yokoyama, Yusuke Kimura, Ken Yamashita, Mitsuhiro Tsujiwaki, Shintaro Sugita, Yukinori Akiyama, Takeshi Mikami, Tadashi Hasegawa, Nobuhiro Mikuni

NMC case report journal 6 ( 4 ) 121 - 124 2019年10月 [国内誌]

Adult orbital xanthogranuloma is rare and usually associated with systemic disease. There are several options available to treat this disorder. Periorbital lesions are treated with steroids, chemotherapy, radiotherapy, or local excision; however, there is still no consensus regarding optimal treatment. Here, we report a rare case of orbital xanthogranuloma that was not associated with systemic disease and was treated by transcranial surgery. The patient was a 52-year-old man who presented with a 2-year history of unilateral eye symptoms. A computed tomography scan revealed a well-defined mass in the right orbit. The mass was completely removed via a transcranial orbital approach. The histopathologic diagnosis was xanthogranuloma. No recurrence was observed during 15 months of postoperative follow-up. Complete surgical resection might be an effective treatment option for locally growing sporadic adult xanthogranulomatous disease of the orbit, and allows systemic steroids, chemotherapy, and irradiation to be avoided.

DOI PubMed

Meningioma Originating from the Hypoglossal Canal: Case Report and Review of Literature.

Yasuhiro Takahashi, Masahiko Wanibuchi, Yusuke Kimura, Yukinori Akiyama, Takeshi Mikami, Nobuhiro Mikuni

World neurosurgery 127 525 - 529 2019年07月 [国際誌]

BACKGROUND: Primary extracranial meningiomas are uncommon neoplasms. In particular, meningioma involving the hypoglossal canal is extremely rare, with only 4 cases reported in the literature so far. Given that each of these meningiomas originated in the juxtacondyle region with involvement of the hypoglossal canal, to the best of our knowledge, a meningioma that exists only within the hypoglossal canal has yet to be reported. CASE DESCRIPTION: We present a case of primary extracranial meningioma arising solely from the hypoglossal canal. A 62-year-old woman presented with long-term difficulty in tongue movement. Her tongue was deviated to the right, and neurologic examination revealed fasciculation and muscle wasting on the right side of the tongue. Computed tomography revealed a calcification in the right hypoglossal canal. Magnetic resonance imaging further demonstrated a hypointense tumor on both T1-weighted and T2-weighted images, with contrast enhancement in the right condyle. Total tumor removal was performed via a transcondylar approach, and histopathologic examination confirmed the presence of a transitional meningioma. No recurrence was observed at 14 months of follow-up. The patient's tongue atrophy was slightly improved, and the deviation completely disappeared. CONCLUSIONS: In this extremely rare case of hypoglossal canal meningioma, total tumor removal via a transcondylar approach resulted in the recovery of hypoglossal nerve function.

DOI PubMed

The Influence of Anesthesia on Corticocortical Evoked Potential Monitoring Network Between Frontal and Temporoparietal Cortices.

Yuto Suzuki, Rei Enatsu, Aya Kanno, Rintaro Yokoyama, Hime Suzuki, Shunsuke Tachibana, Yukinori Akiyama, Takeshi Mikami, Satoko Ochi, Michiaki Yamakage, Nobuhiro Mikuni

World neurosurgery 123 e685-e692 2019年03月 [国際誌]

BACKGROUND: Previous studies have reported the usefulness of intraoperative corticocortical evoked potentials (CCEPs) for preserving language function during brain surgery. OBJECTIVE: This study aimed to assess the influence of depth of anesthesia on CCEP to establish its clinical utility. METHODS: Twenty patients with brain tumors or epilepsy who underwent awake craniotomy were included in this study. Before resection, the electrode plates were placed on the frontal and temporoparietal cortices, and 1-Hz alternating electrical stimuli were delivered to the pars opercularis/pars triangularis in a bipolar fashion. Electrocorticograms from the temporoparietal cortices time-locked to stimuli were averaged to obtain CCEP responses from a state of deep anesthesia until the awake state. The correlation between CCEP waveforms and bispectral index (BIS) was evaluated. RESULTS: CCEP amplitude increased with the increase in the BIS level. CCEP latency decreased in 5 patients and increased in 15 patients under anesthesia compared with the awake state. CCEP amplitudes decreased by 11.3% to 75.2% (median 31.3%) under anesthesia with <65 BIS level. These differences were statistically significant (P < 0.01, Wilcoxon signed-rank test). With respect to CCEP latencies, there was no significant difference between the awake and anesthetic states. CONCLUSIONS: CCEP amplitudes were correlated with depth of anesthesia, whereas CCEP latencies were not affected by anesthesia. The influence of anesthesia should be considered when applying this technique to intraoperative monitoring.

DOI PubMed

Flattening the curvature of synthetic materials to relieve scalp skin tension in cranioplasty.

Takeshi Mikami, Hime Suzuki, Ryo Ukai, Yusuke Kimura, Kei Miyata, Yukinori Akiyama, Masahiko Wanibuchi, Nobuhiro Mikuni

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 61 196 - 200 2019年03月 [国際誌]

BACKGROUND: Scalp tissue shrinkage and volume contraction is a major problem in cranioplasty, and sometimes a tissue expander must be set before cranioplasty. The procedure for placing scalp expanders is cumbersome. In this study, we present a method for flattening the curvature of synthetic materials to relieve scalp skin tension and discuss the feasibility and limitations of the method. METHODS: A total of 25 cranioplasty patients were included in this study. The optimal degree of curvature flattening for each piece of bone substitute material was determined based on cosmetic considerations and the extent of encephalomalacia or atrophy due to primary disease. In this series, the correlation between the degree of curvature flattening and the size or location of the bone flap was considered, and the amount of scalp surface area that could be obtained through curvature flattening was estimated. RESULTS: The median degree of curvature flattening was 5.0 mm. The degree of curvature flattening showed moderate correlation with the rate of change in the area of synthetic material achieved through curvature flattening (p < 0.001). The 21 cases of fronto-temporal craniectomy were divided into two groups according to the distance from the midline. There was a statistically significant difference between these two groups in degree of flattening curvature. CONCLUSIONS: In the present cranioplasty series using synthetic materials, curvature flattening was a non-invasive and convenient method for skin closure. This method can be beneficial especially in patients requiring a larger craniotomy including convexity regions.

DOI PubMed

Vertebral canal invasion of cervical lipoblastoma in childhood: A case report

Akira Takebayashi, Tsukasa Hori, Masaki Yamamoto, Kotoe Iesato, Keita Igarashi, Naoki Hatakeyama, Yukinori Akiyama, Masahiko Wanibuchi, Shintaro Sugita, Yoshiyuki Sakai, Minami Yoda, Hiroyuki Tsutsumi

Iranian Journal of Pediatrics ( Kowsar Medical Publishing Company ) 28 ( 6 ) 2018年12月

Introduction: Lipoblastoma is a benign tumor that originates in the embryonal fat. This tumor can arise from various anatomical sites such as the extremities, trunk, and neck, but it rarely invades the spinal canal. Case Presentation: We describe a 3-year-old girl with a dumbbell-shaped lipoblastoma that extended into the cervical spine. Although she had no neurological deficit, we performed semi-total resection for decompression to the cord and avoid torticollis. Although a residual tumor was present, she recovered well and developed no neurological sequelae. We have selected a wait-and-see strategy for the residual tumor. She is now well-being more than four-years after the surgery. Conclusions: Early surgical intervention and decompression of the tumor was effective to avoid neurological defects.

DOI

Surgical Anatomy of Rats for the Training of Microvascular Anastomosis.

Takeshi Mikami, Hime Suzuki, Ryo Ukai, Katsuya Komatsu, Yusuke Kimura, Yukinori Akiyama, Masahiko Wanibuchi, Nobuhiro Mikuni

World neurosurgery 120 e1310-e1318 2018年12月 [国際誌]

BACKGROUND: Microvascular anastomosis is an essential procedure in neurosurgery, but the opportunity to perform the surgery has gradually decreased for neurosurgeons. Therefore, training is necessary for obtaining and maintaining the skills required for the procedure. We describe the detailed anatomy of cervical and femoral regions in rats and discuss the advantages for practicing microvascular anastomosis. METHODS: Cervical regions of Sprague-Dawley rats were dissected under intraperitoneal anesthesia. The step-by-step anatomic description was documented using a high-resolution charge-coupled device image sensor and recording systems. Using this model, temporal occlusion time and patency were measured, and these measures were compared between the trainee and trainer groups. The number of times the training needs to be completed to attain competency in the bypass procedure was estimated. RESULTS: After exposing the carotid triangle, a half-ring was created by end-to-side anastomosis. Anastomosis was performed at the common carotid artery using the contralateral side of the carotid artery as a graft. The cutoff value for the temporal occlusion time was 79.3 minutes in the receiver operating characteristic curve based on a target temporal occlusion time for beginners determined during the training. CONCLUSIONS: Using a living animal model, a trainee has the opportunity to learn not only anastomotic techniques but also hemostatic control as well as overcoming mental strain during surgery. Living animal models are important in training because the fidelity of a living animal model is superior to nonliving models. Applying training using a half-ring model contributes to safe and efficient surgery.

DOI PubMed

Giant petrous internal carotid aneurysm causing epistaxis: A case report.

Tomoaki Tamada, Takeshi Mikami, Yukinori Akiyama, Yusuke Kimura, Masahiko Wanibuchi, Nobuhiro Mikuni

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 58 221 - 223 2018年12月 [国際誌]

Aneurysms of the internal carotid artery (ICA) arising from the petrous portion are extremely rare, and most cases are asymptomatic or cause a mass effect leading to palsy of the adjacent cranial nerves. In rupture cases, massive nasal and ear bleeding occurs, which may cause death. We describe a 73-year-old man with a giant ICA aneurysm arising from the petrous portion and presenting as epistaxis. The patient had no history of trauma or clotting disorders. Computed tomography angiography demonstrated a giant petrous carotid aneurysm and erosion of a part of the left temporal bone. The patient was treated by trapping of the aneurysm with high-flow bypass using a radial artery. From an anatomical view point, rupture of ICA aneurysms of this portion might be caused by thinness of the bone partition between the ICA and the sphenoidal sinus. It should be noted that petrous carotid aneurysms are usually asymptomatic but may cause massive epistaxis in cases of rupture.

DOI PubMed

Interhemispheric Asymmetry of Network Connecting Between Frontal and Temporoparietal Cortices: A Corticocortical-Evoked Potential Study.

Aya Kanno, Rei Enatsu, Satoshi Ookawa, Shouhei Noshiro, Shunya Ohtaki, Kengo Suzuki, Yuto Suzuki, Rintaro Yokoyama, Satoko Ochi, Yukinori Akiyama, Takeshi Mikami, Takuro Nakae, Takayuki Kikuchi, Takeharu Kunieda, Susumu Miyamoto, Riki Matsumoto, Nobuhiro Mikuni

World neurosurgery 120 e628-e636 2018年12月 [国際誌]

BACKGROUND: The connection between the ventrolateral frontal and temporoparietal cortices has an important role in language function on the language-dominant side and spatial awareness on the nondominant side. However, the laterality of these pathways remains controversial. We investigated the laterality of this connection using corticocortical-evoked potentials (CCEPs). METHODS: From April 2014 to March 2016, 27 patients who had undergone frontotemporal craniotomy were enrolled. With the patients under general anesthesia, subdural electrodes were placed on both frontal and temporoparietal areas intraoperatively. Alternating 1-Hz electrical stimuli were delivered to the pars opercularis and pars triangularis with a stimulus intensity of 10 mA. CCEPs were obtained from temporoparietal areas by averaging the electrocorticogram time-locked to the stimulus onset. The amplitudes and latencies of the CCEP N1 components were compared between the dominant and nondominant sides. RESULTS: The median amplitudes of the CCEPs were 335.1 μV (range, 60.2-750) and 125.65 μV (range, 55.1-634) on the dominant and nondominant sides, respectively. The CCEP amplitudes were significantly larger on the dominant side than on the nondominant side (P = 0.013). In contrast, the median latency was 27.8 ms (range, 19.3-36.6) on the language-dominant side and 28.9 ms (range, 8.9-38.5) on the nondominant side. The latencies were not significantly different between the 2 sides (P = 0.604). CONCLUSIONS: The CCEP amplitudes were significantly larger in the dominant hemisphere. These findings can lead to better hypotheses regarding the relationship between language functions and the development of the network connecting the frontal and temporoparietal cortices.

DOI PubMed

A case of multiple infectious intracranial aneurysms concurrently presenting with intracerebral hemorrhage and epistaxis

Kyoya Sakashita, Kei Miyata, Ayumu Yamaoka, Takeshi Mikami, Yukinori Akiyama, Satoshi Iihoshi, Masahiko Wanibuchi, Nobuhiro Mikuni

INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT ( ELSEVIER SCIENCE BV ) 14 93 - 96 2018年12月

Infectious intracranial aneurysms (IIAs) have the specific features of rapid growth and multiplicity, which often show various pathologies and serious symptoms when ruptured. There are few previous reports of multiple IIAs that concurrently present with intracerebral hemorrhage (ICH) and epistaxis. A 62-year-old man with a history of tooth extraction 1.5 months before experienced an intracranial abscess in the left Sylvian fissure and insula cortex. The patient underwent a craniotomy to drain the abscess and he experienced a heavy epistaxis, which required intranasal gauze packing immediately after surgery. Subsequently, he had a massive ICH on the left temporal lobe resulting from a ruptured IIA in the left middle cerebral artery on day 8. Surgical trapping of the aneurysm contributed to a complete cure. Oral indigenous bacteria was obtained by culturing an aspirate of the abscess cavity. A follow-up radiological examination revealed that the right internal carotid artery (ICA) aneurysm in the cavernous segment concurrently grew and the aneurysmal rupture had caused the epistaxis. We performed stent-assisted coil embolization for the aneurysm on day 20 and achieved radiological resolution. Although right hemiparesis and some communication problems remained, the patient recovered but needed minimal assistance. Given multiple progressions and their destructive pathology, more attention needs to be paid to IIAs. Our multimodal strategy achieved clinical resolution, and IIAs should be treated immediately with appropriate radical intervention depending on the lesion location.

DOI

PHASE I/II STUDY OF TEMOZOLOMIDE PLUS NIMUSTINE CHEMOTHERAPY FOR RECURRENT MALIGNANT GLIOMAS: KYOTO NEURO-ONCOLOGY GROUP

Tomokazu Aoki, Yoshiki Arakawa, Tetsuya Ueba, Masashi Oda, Namiko Nishida, Yukinori Akiyama, Tetsuya Tukahara, Koichi Iwasaki, Nobuhiro Mikuni, Susumu Miyamoto

NEURO-ONCOLOGY ( OXFORD UNIV PRESS INC ) 20 25 - 25 2018年11月

もやもや病における脳表血管の幾何学的解析

小松克也, 三上毅, 秋山幸功, 江夏怜, 大川聡史, 鈴木比女, 鰐渕昌彦, 三國信啓

脳循環代謝 ( (一社)日本脳循環代謝学会 ) 30 ( 1 ) 107 - 107 2018年10月

Actin, alpha, cardiac muscle 1 (ACTC1) knockdown inhibits the migration of glioblastoma cells in vitro.

Masahiko Wanibuchi, Shunya Ohtaki, Satoshi Ookawa, Yuko Kataoka-Sasaki, Masanori Sasaki, Shinichi Oka, Yusuke Kimura, Yukinori Akiyama, Takeshi Mikami, Nobuhiro Mikuni, Jeffery D Kocsis, Osamu Honmou

Journal of the neurological sciences 392 117 - 121 2018年09月 [国際誌]

BACKGROUND: Recurrence is inevitable in glioblastomas (GBMs) and requires multifactorial processes. One of the factors that cause recurrence is the strong migratory capacity of GBM cells. We recently reported that actin, alpha, cardiac muscle 1 (ACTC1) could serve as a marker to detect GBM migration in clinical cases. OBJECTIVE: This study aimed to clarify whether the knockdown of highly expressed ACTC1 can inhibit the migratory capacity of cells in the GBM cell line. METHODS: ACTC1 expression was examined using immunocytochemistry and droplet digital polymerase chain reaction. The motility of GBM cells that were either treated with siRNA to knock down ACTC1 or untreated were investigated using a time-lapse study in vitro. RESULTS: The relatively high ACTC1 expression was confirmed in a GBM cell line, i.e., U87MG. The ACTC1 expression in U87MG cells was significantly inhibited by ACTC1-siRNA (p < 0.05). A cell movement tracking assay using time-lapse imaging demonstrated the inhibition of U87MG cell migration by ACTC1 knockdown. The quantitative cell migration analysis demonstrated that the distance traversed during 72 h was 3607 ± 458 (median ± SD) μm by untreated U87MG cells and 3570 ± 748 μm by negative control siRNA-treated cells. However, the distance migrated by ACTC1-siRNA-treated cells during 72 h was significantly shorter (1265 ± 457 μm, p < 0.01) than the controls. CONCLUSION: ACTC1 knockdown inhibits U87MG cell migration.

DOI PubMed

Rapidly progressive fatal idiopathic hypertrophic pachymeningitis with brainstem involvement in a child.

Kosuke Tsuchida, Shinobu Fukumura, Akiyo Yamamoto, Yukinori Akiyama, Hiroshi Hirano, Hiroyuki Tsutsumi

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 34 ( 9 ) 1795 - 1798 2018年09月 [国際誌]

BACKGROUND: Hypertrophic pachymeningitis (HP) is a rare disorder characterized by diffuse thickening of the dura mater with resultant neurologic deficits. HP develops secondary to various conditions or idiopathically usually in adults but rarely in children. CASE REPORT: We describe a 3-year-old female child with idiopathic HP. Her HP involved the entire central nervous system with progression into the brainstem. The lesion responded poorly to pulsed steroids or any immunosuppressants. The brainstem lesion grew rapidly and formed various nodules that ultimately resulted in brain death. This is the first fatal case of HP in a child.

DOI PubMed

低悪性度脳腫瘍における症候性てんかんの病理学的検討

鈴木比女, 三國信啓, 杉田真太朗, 長谷川匡, 横山林太郎, 鈴木脩斗, 江夏怜, 秋山幸功, 三上毅, 越智さと子, 鰐渕昌彦

てんかん研究 ( (一社)日本てんかん学会 ) 36 ( 2 ) 424 - 424 2018年09月

Traumatic Basilar Artery Entrapment without Longitudinal Clivus Fracture: A Case Report and Review of the Literature.

Ayumu Yamaoka, Kei Miyata, Naofumi Bunya, Hirotoshi Mizuno, Hideto Irifune, Naoya Yama, Yukinori Akiyama, Takeshi Mikami, Masahiko Wanibuchi, Nobuhiro Mikuni

Neurologia medico-chirurgica 58 ( 8 ) 362 - 367 2018年08月 [国内誌]

In blunt cerebrovascular injury, reported traumatic basilar artery occlusions have involved dissection of the basilar artery, distal embolization due to traumatic vertebral artery dissection, or entrapment of the basilar artery into the clivus fracture. To date, however, there are no reports of traumatic basilar artery entrapment without a clivus fracture. Here, we report the first case of traumatic basilar artery occlusion caused by entrapment into an originally existing bone defect. A 67-year-old man with a history of treatment for intracranial aneurysm suffered multiple traumatic injuries in a fall. On arrival at our hospital, he presented with neurogenic shock with quadriplegia. Computed tomography (CT) showed small epidural hematoma, C4-6 cervical spinous process fracture, and Th2-3 vertebral body fracture. CT angiography revealed occlusion of the basilar artery trunk. As vertebrobasilar artery dissections and clivus fracture were not observed; however, we could not elucidate the pathology of the basilar artery occlusion. On day 4, after surgery for the cervical and thoracic lesions, he exhibited consciousness disturbance. Diffusion-weighted imaging on day 5 showed hyperintensities in the brainstem and cerebellum. Basi-parallel anatomic scanning magnetic resonance imaging showed that the basilar artery, while lacking vascular wall injuries, was tethered into the clivus. Antithrombotic therapy was performed, but the patient progressed to a locked-in state. Previous head CT before the trauma revealed a bone defect already present in the clivus. We speculated basilar artery entrapment into this preexisting bone defect. We must look for basilar artery injury in trauma patients even in the absence of clivus fracture.

DOI PubMed

Arterial Spin Labeling Method as a Supplemental Predictor to Distinguish Between High- and Low-Grade Gliomas.

Katsuya Komatsu, Masahiko Wanibuchi, Takeshi Mikami, Yukinori Akiyama, Satoshi Iihoshi, Kei Miyata, Toshiya Sugino, Kengo Suzuki, Aya Kanno, Shouhei Noshiro, Shunya Ohtaki, Nobuhiro Mikuni

World neurosurgery 114 e495-e500 2018年06月 [国際誌]

BACKGROUND: Preoperative evaluation of malignancy in gliomas is important for surgical planning, particularly to determine whether a 1,3-bis-2-chloroethyl-1-nitrosourea wafer should be placed into the tumor cavity. In some cases, the intraoperative pathologic diagnosis of World Health Organization grade differs from the final diagnosis. Supplemental methods in addition to the routine contrast tomography or magnetic resonance imaging sequences may provide a more accurate preoperative diagnosis. Because tumor vascularity has been useful in distinguishing between low- and high-grade gliomas, we evaluated the accuracy of the arterial spin labeling (ASL) method, which could measure the cerebral blood flow (CBF) without using contrast medium, to determine the malignancy of gliomas. METHODS: This study included 102 patients with glioma (grade II, n = 40; grade III, n = 18; grade IV, n = 44). All patients underwent ASL to determine the tumor blood flow (TBF) and CBF in the middle cerebral region. The relative tumor vascular index (tVI), which is calculated as TBF divided by CBF in the contralateral middle cerebral region, was used to avoid dispersion of the absolute TBF value. RESULTS: tVI was significantly greater (1.46 ± 0.751) in high-grade gliomas than in low-grade gliomas (1.05 ± 0.343) (P = 0.003). As for each grade, tVI was statistically higher in grade IV than in grade II (P = 0.03) gliomas. CONCLUSIONS: The noninvasive ASL method provides additional information to distinguish high-grade glioma from low-grade gliomas without using contrast medium.

DOI PubMed

Advantages and Disadvantages of Combined Chemotherapy with Carmustine Wafer and Bevacizumab in Patients with Newly Diagnosed Glioblastoma: A Single-Institutional Experience.

Yukinori Akiyama, Yuusuke Kimura, Rei Enatsu, Takeshi Mikami, Masahiko Wanibuchi, Nobuhiro Mikuni

World neurosurgery 113 e508-e514 2018年05月 [国際誌]

OBJECTIVE: To retrospectively determine the safety and efficacy of combined chemotherapy with carmustine (BCNU) wafer, bevacizumab, and temozolomide plus radiotherapy in patients with newly diagnosed glioblastoma (GBM). METHODS: A total of 54 consecutive newly diagnosed GBMs were resected at our institution between 2010 and 2016. Twenty-nine patients underwent BCNU wafer implantation into the resection cavity followed by standard radiochemotherapy with temozolomide (TMZ, Stupp regimen) plus additional bevacizumab treatment between 2013 and 2016. Twenty-five patients who underwent resection without BCNU implantation between 2010 and 2012 were enrolled as a control group; these patients were treated with the Stupp regimen and did not receive bevacizumab. This retrospective study included evaluation of progression-free survival and overall survival, plus comparisons between the combined therapy group and the control group. RESULTS: There were no significant differences in age, sex, Karnofsky Performance Status on admission, isocitrate dehydrogenase 1/2 mutation ratio, or resection rate between the combined and standard therapy groups. The median overall survival in the combined therapy group and control group was 24.2 months and 15.30, respectively (P = 0.027). The median progression-free survival was 16.8 months and 7.30 months, respectively (P = 0.009). Overall, the incidence of adverse events leading to discontinuation of the study drug was similar between the treatment groups, except for infection, which was more common in the combined treatment group and required repeat surgery. CONCLUSIONS: The combined therapy showed higher efficacy compared with standard therapy in patients with GBM. Therefore, combined therapy seems to be effective with an acceptable toxicity profile.

DOI PubMed

Heat generation by ultrasonic bone curette comparing with high-speed drill.

Kengo Suzuki, Masahiko Wanibuchi, Yoshihiro Minamida, Yukinori Akiyama, Takeshi Mikami, Masahito Fujishige, Akinori Yamamura, Toshio Nakagawa, Nobuhiro Mikuni

Acta neurochirurgica 160 ( 4 ) 721 - 725 2018年04月 [国際誌]

BACKGROUND: Ultrasonic bone curettes have been used as with high-speed drills. However, the amount of heat generated by the ultrasonic bone curette is not well known. This study quantitatively assessed the heat generated by an ultrasonic bone curette and compared it to that by a high-speed drill. METHODS: The thermal change in a swine skull during bone curetting using an ultrasonic device and a high-speed drill were assessed. The investigation focused on the type of surgical manipulation (brush-like strokes vs. pushing motion) and irrigation (room temperature vs. cold water; low-volume irrigation vs. high-volume irrigation). RESULTS: The thermal elevation during drill use was suppressed when using brush-like strokes compared to pushing motion (brush-like strokes, 44.7 °C; pushing motion, 69.2 °C; p < 0.01). Cold-water irrigation while drilling had a small effect compared to room temperature (RT) water (RT, 44.7 °C; cold, 35.2 °C; p = 0.12). The temperature generated by the curette was higher than that generated by the drill (curette, 72.5 °C; drill, 44.7 °C; p < 0.01). High-volume irrigation was required to reduce the heat generated by the curette (no irrigation, 88.6 °C; low-volume, 72.5 °C; high-volume, 60.5 °C; p < 0.01). CONCLUSIONS: The ultrasonic bone curate generated more heat than the high-speed drill. During surgical manipulation, the use of brush-like strokes by both the high-speed drill and the ultrasonic bone curette is necessary to avoid excess thermal elevation. Irrigation with RT water is sufficient to avoid heat generation. High-volume irrigation is required to reduce the heat generated by the curette.

DOI PubMed

Occipital Artery to Middle Cerebral Artery Bypass in Cases of Unavailable Superficial Temporal Artery.

Tsukasa Hirano, Takeshi Mikami, Hime Suzuki, Toru Hirano, Yusuke Kimura, Katusya Komatsu, Yukinori Akiyama, Masahiko Wanibuchi, Nobuhiro Mikuni

World neurosurgery 112 101 - 108 2018年04月 [国際誌]

In neurosurgery, extracranial-to-intracranial (EC-IC) bypass surgery is necessary for patients who have undergone surgery in which the superficial temporal artery (STA) was already used for a different bypass procedure or was damaged. Here we report our experience with EC-IC bypass using the occipital artery (OA) in patients in whom the STA was unavailable, and discuss the technical considerations and pitfalls. Five patients with ischemic-onset moyamoya disease and atherosclerotic disease were included. Two patterns of skin incisions were planned according to the OA pathway and recipient artery location. In one of these methods, a skin incision is made above the OA, and a craniotomy is performed under this incision after OA dissection. In the other method, a skin incision is made above the OA to enable its dissection, and a craniotomy is performed via a separate skin incision. No major perioperative complications developed in any of the 5 cases, and bypass patency was confirmed in all patients. There was a significant difference between the preoperative and postoperative asymmetry ratios of the mean transit time values. Our findings suggest that OA-to-middle cerebral artery (MCA) bypass is a simple and effective technique in patients in whom the STA was already used or was damaged by previous intracranial revascularization or craniotomy. This procedure could be an alternative to STA-MCA bypass in patients without an available STA.

DOI PubMed

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