研究者詳細 - 秋山　幸功

論文 - 秋山　幸功

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Pleomorphic Xanthoastrocytoma with Anaplastic Features in the Tectal Region in a Young Adult Patient: A Case Report.

Yuuto Suzuki, Yukinori Akiyama, Yuusuke Kimura, Shintaro Sugita, Tadashi Hasegawa, Nobuhiro Mikuni

World neurosurgery 94 580.e11-580.e15 2016年10月 [国際誌]

BACKGROUND: Pleomorphic xanthoastrocytomas (PXAs) in the tectal region are exceedingly rare and have distinctive clinicopathological features. CASE PRESENTATION: A 17-year-old man was admitted to our hospital owing to headache and diplopia. Magnetic resonance imaging showed a mass lesion in the tectal gland accompanied by obstructive hydrocephalus. A biopsy and third ventriculostomy were performed. Pathological examination revealed a PXA. Total excision of the lesion was achieved via an occipital transtentorial procedure performed 6 weeks after the biopsy. A pathological examination at that time showed a PXA with anaplastic features and a high mitotic index in surgical specimens. The patient's symptoms improved after the second operation, and radiation and temozolomide-based chemotherapy were administered. No recurrence was found at 24 months after the second operation. CONCLUSIONS: Maximum resections are recommended in cases with anaplastic features such as a high mitotic index in biopsy specimens because of the likelihood of recurrence and the low overall survival rate. We administered radiotherapy and temozolomide-based chemotherapy because of the high mitotic activity detected in surgical specimens. The postoperative course in this case is currently deemed acceptable.

DOI PubMed

ANCA-negative granulomatosis with polyangiitis presenting with orbital apex syndrome and recurrent pachymeningitis: A case report.

Shin Hisahara, Minoru Yamada, Yousuke Matsuura, Emiko Tsuda, Yukinori Akiyama, Masaki Saitoh, Jun Kawamata, Nobuhiro Mikuni, Shun Shimohama

Journal of the neurological sciences 368 175 - 7 2016年09月 [国際誌]

DOI PubMed

Quantitative Assessment of Flow Reduction After Feeder Embolization in Meningioma by Using Pseudocontinuous Arterial Spin Labeling.

Masahiko Wanibuchi, Katsuya Komatsu, Yukinori Akiyama, Takeshi Mikami, Satoshi Iihoshi, Kei Miyata, Nobuhiro Mikuni

World neurosurgery 93 237 - 45 2016年09月 [国際誌]

BACKGROUND: Meningioma is a hypervascular tumor of the central nervous system. Angiographic disappearance of tumor blush after preoperative feeder embolization allows qualitative, but not quantitative, assessment of flow reduction. Pseudocontinuous arterial spin labeling (PCASL), which has evolved from magnetic resonance imaging techniques, allows noninvasive measurement of cerebral blood flow (CBF) using water protons in the arterial blood flow. OBJECTIVE: We applied PCASL for assessment of blood flow in meningioma and its reduction on preoperative embolization. METHODS: Forty-one consecutive patients (11 males, 30 females) with histologically proven meningioma were evaluated by PCASL. Quantitative assessment by an absolute value of tumor blood flow (TBF) and a relative value of tumor vascular index (tVI; calculated as TBF divided by CBF) were calculated. In 8 cases, in which preoperative embolization was achieved, flow reduction rate was evaluated. RESULTS: TBF of meningiomas, 155.8 mL/100 g·min(-1) on average, was 2.6 times higher than CBF, 59.9 mL/100 g·min(-1) (P < 0.001). Patients who underwent feeder embolization showed statistically greater flow reduction rate, which was calculated as 42.7% (P < 0.05). Mean tVI before embolization was 4.1, which was reduced to 2.1 after embolization. CONCLUSION: PCASL could yield quantitative assessment of blood flow in meningioma including flow reduction rate in cases of feeder embolization.

DOI PubMed

[Extracranial metastases of the primary brain tumors].

Yukinori Akiyama

Nihon rinsho. Japanese journal of clinical medicine 74 Suppl 7 464 - 468 2016年09月 [国内誌]

PubMed

Training for Skull Base Surgery with a Colored Temporal Bone Model Created by Three-Dimensional Printing Technology.

Masahiko Wanibuchi, Shouhei Noshiro, Toshiya Sugino, Yukinori Akiyama, Takeshi Mikami, Satoshi Iihoshi, Kei Miyata, Katsuya Komatsu, Nobuhiro Mikuni

World neurosurgery 91 66 - 72 2016年07月 [国際誌]

OBJECTIVE: A 3-dimensional temporal bone model for skull base surgical training was reconstructed via the use of a selective laser sintering technique, which is one of the 3-dimensional printing technologies. METHODS: The temporal bone model was created in 2 pieces to remove powder material in the mastoid air cells and to place dye into the semicircular canal and the Fallopian canal. RESULTS: The powder material was minimal, and the decisive structures were identified in color. CONCLUSIONS: This artificial model will pave the way to a "new era" in surgical training and medical education.

DOI PubMed

Intraoperative Mapping and Monitoring for Rootlets of the Lower Cranial Nerves Related to Vocal Cord Movement.

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

Neurosurgery 78 ( 6 ) 829 - 34 2016年06月 [国際誌]

BACKGROUND: Damage to the motor division of the lower cranial nerves that run into the jugular foramen leads to hoarseness, dysphagia, and the risk of aspiration pneumonia; therefore, its functional preservation during surgical procedures is important. Intraoperative mapping and monitoring of the motor rootlets at the cerebellomedullary cistern using endotracheal tube electrodes is a safe and effective procedure to prevent its injury. OBJECTIVE: To study the location of the somatic and autonomic motor fibers of the lower cranial nerves related to vocal cord movement. METHODS: Twenty-four patients with pathologies at the cerebellopontine lesion were studied. General anesthesia was maintained with fentanyl and propofol. A monopolar stimulator was used at amplitudes of 0.05 to 0.1 mA. Both acoustic and visual signals were displayed as vocalis muscle electromyographic activity using endotracheal tube surface electrodes. RESULTS: The average number of rootlets was 7.4 (range, 5-10); 75% of patients had 7 or 8 rootlets. As many as 6 rootlets (2-4 in most cases) were responsive in each patient. In 23 of the 24 patients, the responding rootlets congregated on the caudal side. The maximum electromyographic response was predominantly in the most caudal or second most caudal rootlet in 79%. CONCLUSION: The majority of motor fibers of the lower cranial nerves run through the caudal part of the rootlets at the cerebellomedullary cistern, and the maximal electromyographic response was elicited at the most caudal or second most caudal rootlet. ABBREVIATION: EMG, electromyographic.

DOI PubMed

Cortical and subcortical vascular hypointensity on T2* weighted imaging in moyamoya disease.

Shouhei Noshiro, Takeshi Mikami, Katsuya Komatsu, Kei Miyata, Yukinori Akiyama, Masahiko Wanibuchi, Nobuhiro Mikuni

Neurological research 38 ( 2 ) 110 - 6 2016年02月 [国際誌]

OBJECTIVES: Decreased cortical and subcortical vascular signals in gradient echo T2* weighted imaging have been reported in acute stroke due to major artery occlusion. The purpose of this study was to evaluate this cortical and subcortical vascular hypointensity (CSVH) in patients with moyamoya disease. METHODS: Subjects were 20 consecutive patients with moyamoya disease. The numbers of CSVH in each hemisphere were counted and the numbers were compared between patients with moyamoya disease and controls. The distribution of CSVH, clinical features of cases exhibiting large numbers of CSVH and post-operative changes were analysed. RESULTS: Patients with moyamoya disease had significantly more CSVH in the middle cerebral artery territory (p < 0.001) and the anterior cerebral artery territory (p < 0.001) compared with controls. The number of CSVH was correlated significantly with regional cerebral blood flow, as shown through simple regression analysis (R = 0.461, p = 0.006), and the numbers of CSVH were significantly higher in patients with higher magnetic resonance angiography scores (p = 0.017). A given patient's total number of CSVH per hemisphere was significantly decreased after surgery (p = 0.018). CONCLUSION: CSVH on T2* WI may be a useful tool for diagnosing and evaluating the extent of moyamoya disease. Our small series study shows that revascularization surgery can decrease the number of CSVH.

DOI PubMed

Therapeutic temperature modulation in severe or moderate traumatic brain injury: a propensity score analysis of data from the Nationwide Japan Neurotrauma Data Bank.

Kei Miyata, Hirofumi Ohnishi, Kunihiko Maekawa, Takeshi Mikami, Yukinori Akiyama, Satoshi Iihoshi, Masahiko Wanibuchi, Nobuhiro Mikuni, Shuji Uemura, Katsutoshi Tanno, Eichi Narimatsu, Yasufumi Asai

Journal of neurosurgery 124 ( 2 ) 527 - 37 2016年02月 [国際誌]

OBJECTIVE: In patients with severe traumatic brain injury (TBI), a randomized controlled trial revealed that outcomes did not significantly improve after therapeutic hypothermia (TH) or normothermia (TN). However, avoiding pyrexia, which is often associated with intracranial disorders, might improve clinical outcomes. The objective of this study was to compare neurological outcomes among patients with moderate and severe TBI after therapeutic temperature modulation (TTM) in the absence of other interventions. METHODS: Data from 1091 patients were obtained from the Japan Neurotrauma Data Bank Project 2009, a cohort observational study. Patients with cardiac arrest, those with a Glasgow Coma Scale score of 3 and dilated fixed pupils, and those whose cause of death was injury to another area of the body were excluded, leaving 687 patients aged 16 years or older in this study. The patients were divided into 2 groups: the TTM group underwent TN (213 patients) or TH (82 patients), and the control group (392 patients) did not receive TTM. The primary end point for this study was the rate of poor outcome at hospital discharge, and the secondary end point was in-hospital death. Out of the 208 total items in the database, 29 variables that could potentially affect outcome were matched using the propensity score (PS) method in order to reduce selection bias and balance the baseline characteristics. RESULTS: From each group, 141 patients were extracted using the PS-matching process. Among the patients in the TTM group, 29 had undergone TH and 112 had undergone TN. In a log-rank test using Kaplan-Meier survival curves, no significant differences in patient outcome or death were observed between the 2 groups (poor outcome, p = 0.83; death, p = 0.18). A Cox proportional-hazards regression analysis established the HR for poor outcome and mortality at 1.03 (95% CI 0.78-1.36, p = 0.83) and 1.34 (95% CI 0.87-2.07, p = 0.18), respectively. CONCLUSIONS: There was no clear improvement in neurological outcomes after TTM in patients with moderate or severe TBI. To elucidate the role of TTM in patients with these injuries, a prospective study is needed with long-term follow-up using specific target temperatures.

DOI PubMed

Intraoperative Subcortical Fiber Mapping with Subcortico-Cortical Evoked Potentials.

Rei Enatsu, Aya Kanno, Shunya Ohtaki, Yukinori Akiyama, Satoko Ochi, Nobuhiro Mikuni

World neurosurgery 86 478 - 83 2016年02月 [国際誌]

OBJECTIVE: During brain surgery, there are difficulties associated with identifying subcortical fibers with no clear landmarks. We evaluated the usefulness of cortical evoked potentials with subcortical stimuli (subcortico-cortical evoked potential [SCEP]) in identifying subcortical fibers intraoperatively. METHODS: We used SCEP to identify the pyramidal tract in 4 patients, arcuate fasciculus in 1 patient, and both in 2 patients during surgical procedures. After resection, a 1 × 4-electrode plate was placed on the floor of the removal cavity and 1-Hz alternating electrical stimuli were delivered to this electrode. A 4 × 5 recording electrode plate was placed on the central cortical areas to map the pyramidal tract and temporoparietal cortical areas for the arcuate fasciculus. SCEPs were obtained by averaging electrocorticograms time locked to the stimulus onset. RESULTS: The subcortical stimulation within 15 mm of the target fiber induced cortical evoked potentials in the corresponding areas, whereas the stimulation apart from 20 mm did not. Five patients showed transient worsening of neurologic symptoms after surgery. However, all patients recovered. CONCLUSIONS: SCEP was useful for identifying subcortical fibers and confirmed the preservation of these fibers. This technique is expected to contribute to the effectiveness and safety of resective surgery in patients with lesions close to eloquent areas.

DOI PubMed

Germinoma Mimicking Tumefactive Demyelinating Disease in Pediatric Patients.

Yukinori Akiyama, Hime Suzuki, Nobuhiro Mikuni

Pediatric neurosurgery 51 ( 3 ) 149 - 53 2016年 [国際誌]

Cases of intracranial germinoma with granulomatous reaction are rare, so a pathological diagnosis of this disease is difficult. In this report, we describe the case of a 13-year-old boy with a bilateral thalamic germinoma which initially mimicked tumefactive demyelinating disease with inflammation, based on the clinical symptoms, imaging results and histology of a biopsy specimen obtained endoscopically. Upon examination of the cerebrospinal fluid, oligoclonal bands were detected. Although his symptoms and radiological findings improved following steroid pulse treatment, they worsened dramatically almost 1 year after the first surgery and even after an additional steroid pulse treatment. Prompted by the clinical course, a second biopsy was performed, and a pathological examination of the specimen showed a two-cell pattern. The diagnosis was changed to intracranial germinoma. After chemotherapeutic treatment with etoposide and cisplatin, the patient's symptoms and radiological findings dramatically improved. We conclude that it is very challenging to distinguish germinomas with a granulomatous reaction due to other inflammatory diseases, especially when only small specimens can be obtained. Stereotactic or endoscopic biopsies should be performed using samples from several different points even if the lesions are associated with eloquent brain regions.

DOI PubMed

Evaluation of Posterior Hippocampal Epileptogenicity During Epilepsy Surgery For Temporal Lobe Cavernoma by the Occipital Approach.

Yukinori Akiyama, Kengo Suzuki, Satoko Ochi, Susumu Miyamoto, Nobuhiro Mikuni

World neurosurgery 84 ( 5 ) 1494.e1-6 2015年11月 [国際誌]

BACKGROUND: Cavernomas frequently are associated with intractable epilepsy. When cavernomas located in the temporal lobe are associated with intractable epilepsy, the hippocampus also may have an epileptic focus. The objective in the present study was to clarify the importance of evaluation of the posterior hippocampal epileptogenicity during epilepsy surgery for posteromedial temporal lobe cavernoma. CASE DESCRIPTIONS: In this study, we describe 2 rare cases of medically intractable epilepsy in patients with posteromedial temporal lobe cavernomas who underwent surgery via the occipital approach. Using longitudinal insertion of depth electrodes into the hippocampus, we evaluated epileptogenicity in both patients from the cavernoma cavity and its surrounding hemosiderin, as well as from the posterior hippocampus near the cavernoma. We show that the transoccipital approach to the posteromedial temporal lobe is compatible with depth electrode insertion and subdural electrode placement on the temporal lobe, enabling an accurate evaluation of potential epileptogenic zones in the posterior part of the hippocampus. Both patients did not experience any seizures and had no postoperative neurologic deficits, and their cognitive functions were intact. CONCLUSIONS: The transoccipital approach enables the optimization of the extent of posterior hippocampectomy while avoiding unnecessary resection for seizure control. We suggest resecting the posterior part of the hippocampus in addition to the cavernoma and surrounding areas in patients with medically refractory epilepsy due to a posteromedial temporal cavernoma. Tailored systematic resection guided by intraoperative electrocorticography and electroencephalography with a depth electrode was important and necessary in the present cases.

DOI PubMed

Vascular remodeling of the circle of Willis in moyamoya disease.

Takeshi Mikami, Shouhei Noshiro, Katsuya Komatsu, Kei Miyata, Yukinori Akiyama, Masahiko Wanibuchi, Nobuhiro Mikuni

Neurological research 37 ( 10 ) 880 - 5 2015年10月 [国際誌]

OBJECTIVES: A positive (outward) remodelling pattern in patients with typical atherosclerotic disease was recognised using magnetic resonance imaging (MRI). In this report, the outer diameter of the circle of Willis was evaluated in patients with moyamoya disease, and its remodelling pattern was verified. METHODS: A total of 18 consecutive patients with moyamoya disease were included in this analysis. The diameter of the terminal portion of the internal carotid artery (ICA) (C1), proximal portion of the middle cerebral artery (MCA) (M1) and proximal portion of the anterior cerebral artery (A1) was evaluated using fast imaging employing steady-state acquisition (FIESTA) imaging. The outer diameter was estimated using these images, and compared with the control group, and the correlation with magnetic resonance angiography (MRA) scores was calculated for patients with moyamoya disease. RESULTS: The mean diameter of the moyamoya patient group on FIESTA was significantly lower than that of the control group in the C1, M1 and A1 (P < 0.0001). The M1 diameter on the FIESTA image showed a strong correlation with the moyamoya disease MRA score (y = (0.53x+2.31; R = 0.72), whereas the C1 diameter on the FIESTA image showed only a weak correlation (y = (0.16x+2.47; R = 0.21). CONCLUSION: We found that the outer diameter of all the vessels around the C1 was generally reduced in patients with moyamoya disease. Diameter of the MCA especially decreases as the disease progresses, similar to the negative (constrictive) remodelling pattern.

DOI PubMed

IgG4-related disease initially presented as an orbital mass lesion mimicking optic nerve sheath meningioma.

Shouhei Noshiro, Masahiko Wanibuchi, Yukinori Akiyama, Satoshi Okawa, Shunya Ohtaki, Toshiya Sugino, Satoshi Iihoshi, Takeshi Mikami, Shintaro Sugita, Tadashi Hasegawa, Nobuhiro Mikuni

Brain tumor pathology 32 ( 4 ) 286 - 90 2015年10月 [国内誌]

We report a case of an optic nerve mass lesion associated with IgG4-related disease. A 39-year-old man presented with right blurred vision and proptosis 8 years before admission. Magnetic resonance imaging showed a mass lesion in the center of the right orbit, which was diagnosed as optic nerve sheath meningioma by neuroradiologists and neurosurgeons. Irradiation was selected for treatment of the lesion on the basis of the radiological diagnosis; subsequently, the lesion gradually reduced in size. However, regrowth of an optic nerve mass lesion observed during the previous 2 years caused remarkable exophthalmos, and removal of the orbital mass lesion was performed via a transcranial orbital approach. Pathological examinations resulted in a diagnosis of IgG4-related disease, and hematological tests revealed an elevated level of serum IgG4. Additional radiological examinations showed mass lesions in the left maxillary nerve, bilateral inferior alveolar nerves, paravertebral tissue, and left kidney. Treatment with oral steroids has produced a reduction in the size of these lesions.

DOI PubMed

Association of a Subperiosteal Hematoma With Minor Injury.

Yukinori Akiyama, Masafumi Ohtaki, Sangnyon Kim, Yuusuke Kimura, Nobuhiro Mikuni

The Journal of craniofacial surgery 26 ( 6 ) e542-3 2015年09月 [国際誌]

An intraorbitalsubperiosteal hematoma is a rare clinical entity that is usually caused by head trauma. The authors experienced a patient involving an intraorbital hemorrhage that was associated with minor injury in the forehead and that required surgical decompression. The authors describe this rare case involving an intraorbitalsubperiosteal hematoma that occurred in a conscious young boy who had no remarkable head injury and who had sudden onset of proptosis. Three-dimensional computed tomography, which was conducted with a volume-rendering method, was very useful, and the transorbital approach that was used to remove the hematoma was very effective. The patient showed good recovery. The pathogenesis of the intraorbitalsubperiosteal hemorrhage could not be fully explained, and, thus, the authors suggest that a possible pathogenesis involved the migration of the hemorrhage from the forehead into the intraorbital region.

DOI PubMed

血中PRL値測定は、術後発作コントロールの指標となりうるか? 治療関与前後での対比

越智さと子, 菅野彩, 江夏怜, 秋山幸功, 三上毅, 三國信啓

てんかん研究 ( (一社)日本てんかん学会 ) 33 ( 2 ) 628 - 628 2015年09月

Radical removal of recurrent malignant meningeal tumors of the cavernous sinus in combination with high-flow bypass.

Masahiko Wanibuchi, Yukinori Akiyama, Takeshi Mikami, Satoshi Iihoshi, Kei Miyata, Yoshifumi Horita, Toshiya Sugino, Katsuya Komatsu, Kengo Suzuki, Ken Yamashita, Nobuhiro Mikuni

World neurosurgery 83 ( 4 ) 424 - 30 2015年04月 [国際誌]

BACKGROUND: Meningiomas or solitary fibrous tumors arising from the cavernous sinus (CS) are usually treated with radiosurgery to control growth. Surgical removal of cavernous tumors is indicated only for tumors extending outside the CS. However, even after adequate treatment, the tumor may exhibit recurrence or malignant transformation. We report a treatment option for recurrent meningeal tumors of the CS. METHODS: In 4 patients with CS tumors that exhibited regrowth after multiple operations and radiosurgery, radical removal in combination with high-flow bypass was performed, and a vascularized muscle flap was used for reconstruction. One patient had a radiation-induced atypical meningioma, 2 patients had transformed atypical meningiomas, and 1 patient had a frequently recurring solitary fibrous tumor. RESULTS: No local recurrence was observed in any patients during a follow-up period of 13-41 months. In all patients, a Karnofsky performance scale score of >80 on admission was maintained at >70 at the final follow-up evaluation. CONCLUSIONS: Radical removal in combination with high-flow bypass provides favorable results and maintains quality of life in patients with recurrent CS meningeal tumors.

DOI PubMed

Rigid endoscopic resection of deep-seated or intraventricular brain tumors.

Yukinori Akiyama, Masahiko Wanibuchi, Takeshi Mikami, Yoshifumi Horita, Katsuya Komatsu, Kengo Suzuki, Shunya Otaki, Nobuhiro Mikuni

Neurological research 37 ( 3 ) 278 - 82 2015年03月 [国際誌]

Rigid endoscopic resection using a thick sheath (ViewSite) may be a viable method for the resection or biopsy of selected deep-seated brain tumors, such as thalamic gliomas and malignant lymphomas. Neuroendoscopic biopsy is one technique used for the histological verification of suspected brain tumors. There are a number of advantages to using this technique. For example, under direct vision, it is possible to carefully observe the tumor surface and avoid vessels during tumor resections. It is also possible to collect enough specimens for a pathological diagnosis. Eighteen consecutive patients safely underwent rigid endoscopic resection or biopsy using a thick sheath (ViewSite). The two-handed endoscopic technique that utilized a mounted rigid endoscope proved very useful and safe, since it enabled easy stanching of hemorrhages. The aim of this study was to demonstrate how to use a thick sheath for deep-seated or intraventricular tumors. The rigid endoscopic approach with a thick sheath provides an alternative medial approach with improved visualization and a wider working space.

DOI PubMed

Chloroquine potentiates temozolomide cytotoxicity by inhibiting mitochondrial autophagy in glioma cells.

Yusuke S Hori, Ryusuke Hosoda, Yukinori Akiyama, Rio Sebori, Masahiro Wanibuchi, Takeshi Mikami, Toshiya Sugino, Kengo Suzuki, Mitsuhisa Maruyama, Miki Tsukamoto, Nobuhiro Mikuni, Yoshiyuki Horio, Atsushi Kuno

Journal of neuro-oncology 122 ( 1 ) 11 - 20 2015年03月 [国際誌]

Mitochondrial autophagy eliminates damaged mitochondria and decreases reactive oxygen species (ROS). The autophagy inhibitor chloroquine (CQ) potentiates temozolomide (TMZ) cytotoxicity in glioma cells, but it is not known whether CQ does this by inhibiting mitochondrial autophagy. The effects of CQ and TMZ on MitoSOX Red fluorescence, a mitochondrial ROS indicator, and cell death were examined in rat C6 glioma cells. Mitochondrial autophagy was monitored by the colocalization of MitoTracker Red fluorescence and EGFP-LC3 dots. Mitochondrial content was measured by MitoTracker Green fluorescence and immunoblotting for a mitochondrial protein. Finally, CQ's effects on tumor cells derived from a glioblastoma patient and human U87-MG glioblastoma cells were assessed. TMZ (100-1,000 μM) alone did not affect mitochondrial ROS or cell death in C6 cells, but when administered with CQ (10 μM), it increased mitochondrial ROS and cell death. Antioxidants significantly suppressed the CQ-augmented cell death in TMZ-treated cells, indicating that mitochondrial ROS were involved in this cell death. TMZ treatment reduced MitoTracker Green fluorescence and mitochondrial protein levels, and these effects were inhibited by CQ. TMZ also increased the colocalization of EGFP-LC3 dots with mitochondria, and CQ enhanced this effect. CQ potentiated TMZ-induced cytotoxicity in patient-derived glioblastoma cells as well as human U87-MG glioblastoma cells. These results suggest that CQ increases cellular ROS and augments TMZ cytotoxicity in glioma cells by inhibiting mitochondrial autophagy.

DOI PubMed

Predictive factors for epilepsy in moyamoya disease.

Takeshi Mikami, Satoko Ochi, Kiyohiro Houkin, Yukinori Akiyama, Masahiko Wanibuchi, Nobuhiro Mikuni

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 24 ( 1 ) 17 - 23 2015年01月 [国際誌]

BACKGROUND: Epilepsy cannot always be recognized in patients with moyamoya disease. In this report, the clinical features of patients with epilepsy were evaluated for assessing the predictive factors of epilepsy in moyamoya disease. METHODS: A total of 64 consecutive patients with moyamoya disease were included in this study. During their follow-up periods, 7 patients were diagnosed with epilepsy. Then, the patients with epilepsy were compared with the patients without epilepsy regarding their clinical features. RESULTS: Analysis of patient background characteristics revealed a significantly higher incidence of epilepsy in patients with high modified Rankin Scale (mRS) scores, high cerebrovascular attack scores, onset age of 3 years or less, early seizures, cortical involvement, stroke subtype, and diffuse brain atrophy. A logistic analysis of epilepsy data revealed significant differences between the 2 groups in mRS score, cerebrovascular attack score, onset age 3 years or less, early seizure, cortical involvement, stroke subtype, and diffuse brain atrophy. Of these, significant differences were noted in 3 items (mRS score, early seizure, and diffuse brain atrophy) on multivariate analysis. These 3 items were selected as the basis of our new moyamoya disease epilepsy risk scale (MDERS), which we then evaluated. The cutoff value estimated by the receiver operating characteristic curve was set at 1 (sensitivity, .857; specificity, .825) or 2 (sensitivity, .571; specificity, 1.000). CONCLUSIONS: Epilepsy in moyamoya disease is associated with clinical factors and is not an independent category. For prediction of epilepsy in moyamoya disease, MDERS is a simple and convenient assessment scale.

DOI PubMed

Fusion images for endonasal transsphenoidal surgery

Masahiko Wanibuchi, Toru Hirano, Yukinori Akiyama, Nobuhiro Mikuni

Japanese Journal of Neurosurgery ( Japanese Congress of Neurological Surgeons ) 24 ( 2 ) 92 - 98 2015年 [査読有り]

In endoscopic endonasal transsphenoidal surgery, it is essential to determine the precise anatomical relationship of the sellar or parasellar tumor with the internal carotid artery and the optic nerve prior to surgery in order to preserve the important structures and to avoid surgical complications. Computed tomography (CT) using a 64-detector row scanner and magnetic resonance imaging (MRI) using a 3.0 tesla system were used to create CT/MRI fusion images. Three orthogonal multiplanar reconstruction images including volume rendering (VR) and virtual endoscopy (VE) were created using a work station by radiological technologists in a 3-dimensional laboratory established in our hospital. The fusion images were then uploaded to a picture archiving communication system (PACS). When using system, the anatomical relationship between tumors and adjacent structures was clearly demonstrated. Additionally, the VR and VE images allow surgeons to make precise presurgical plans and conduct virtual operations. Furthermore, because the images can be observed anytime on PACS in the hospital, CT/MRI fusion images in endonasal transsphenoidal surgery contribute as very useful tools not only for the education of trainees and medical students but also for obtaining informed consent from patients and their families.

DOI

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