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  2010年

  札幌医科大学   大学院医学研究科   博士課程 情報伝達医学専攻 中枢神経機能治療学  

• 1998年

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  2004年

  札幌医科大学   医学部   医学科  

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• 2010年03月   札幌医科大学   博士

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• 2018年12月

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  継続中

  札幌医科大学 脳神経外科学講座 助教  

• 2017年04月

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  2018年03月

  京都大学 脳神経外科学講座  

• 2018年04月

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  2018年11月

  市立札幌病院 脳神経外科 副医長  

• 2014年01月

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  2017年03月

  札幌医科大学 脳神経外科学講座 助教  

• 2013年12月

  　

  　

  札幌医科大学 脳神経外科学講座 診療医  

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• ライフサイエンス   脳神経外科学  

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• 札幌医科大学   脳神経外科   助教  

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• Intracranial aneurysm

• moyamoya disease

• brain

• サイトカイン

• cytokine receptors

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• Deep learning from head CT scans to predict elevated intracranial pressure.

  Ryota Sato, Yukinori Akiyama, Takeshi Mikami, Ayumu Yamaoka, Chie Kamada, Kyoya Sakashita, Yasuhiro Takahashi, Yusuke Kimura, Katsuya Komatsu, Nobuhiro Mikuni

  Journal of neuroimaging : official journal of the American Society of Neuroimaging    2024年10月  [国際誌]

  　概要を見る

  BACKGROUND AND PURPOSE: Elevated intracranial pressure (ICP) resulting from severe head injury or stroke poses a risk of secondary brain injury that requires neurosurgical intervention. However, currently available noninvasive monitoring techniques for predicting ICP are not sufficiently advanced. We aimed to develop a minimally invasive ICP prediction model using simple CT images to prevent secondary brain injury caused by elevated ICP. METHODS: We used the following three methods to determine the presence or absence of elevated ICP using midbrain-level CT images: (1) a deep learning model created using the Python (PY) programming language; (2) a model based on cistern narrowing and scaling of brainstem deformities and presence of hydrocephalus, analyzed using the statistical tool Prediction One (PO); and (3) identification of ICP by senior residents (SRs). We compared the accuracy of the validation and test data using fivefold cross-validation and visualized or quantified the areas of interest in the models. RESULTS: The accuracy of the validation data for the PY, PO, and SR methods was 83.68% (83.42%-85.13%), 85.71% (73.81%-88.10%), and 66.67% (55.96%-72.62%), respectively. Significant differences in accuracy were observed between the PY and SR methods. Test data accuracy was 77.27% (70.45%-77.2%), 84.09% (75.00%-85.23%), and 61.36% (56.82%-68.18%), respectively. CONCLUSIONS: Overall, the outcomes suggest that these newly developed models may be valuable tools for the rapid and accurate detection of elevated ICP in clinical practice. These models can easily be applied to other sites, as a single CT image at the midbrain level can provide a highly accurate diagnosis.

  DOI PubMed

• An anatomo-functional study of the interactivity between the paracentral lobule and the primary motor cortex.

  Yusuke Kimura, Shoto Yamada, Katsuya Komatsu, Rei Enatsu, Ryota Sato, Chie Kamada, Ayaka Sasagawa, Tsukasa Hirano, Masayasu Arihara, Nobuhiro Mikuni

  Journal of neurosurgery     1 - 9  2024年05月  [国際誌]

  　概要を見る

  OBJECTIVE: The purpose of this study was to understand the anatomical and functional connections between the paracentral lobule (PCL) and the primary motor cortex (M1) of the human brain. METHODS: This retrospective study included 16 patients who underwent resection of lesions located near M1. Nine patients had lesions in the dominant hemisphere. Tractography was performed to visualize the connectivity between two regions of interest (ROIs)-the convexity and the interhemispheric fissure-that were shown by functional MRI to be activated during a finger tapping task. The number, mean length, and fractional anisotropy (FA) of the fibers between the ROIs were estimated. During surgery, subdural electrodes were placed on the brain surface, including the ROIs, using a navigation system. Cortico-cortical evoked potentials (CCEPs) were evoked by applying electrical stimuli to the hand region of M1 using electrodes placed on the convexity and were measured with electrodes placed on the interhemispheric fissure. To verify CCEP bidirectionality, electrical stimuli were applied to electrodes on the interhemispheric fissure that showed CCEP responses. Correlations of CCEP amplitudes and latencies with the number, mean length, and mean FA value obtained from tractography were determined. The correlations between these parameters and perioperative motor functions were also analyzed. RESULTS: Fibers of 14 patients were visualized by diffusion tensor imaging (DTI). Unidirectional CCEPs between the PCL and M1 were measurable in all 16 patients, and bidirectional CCEPs between them were measurable in 14 patients. There was no significant difference between the two directions in the maximum CCEP amplitude or latency (amplitude, p = 0.391; latency, p = 0.583). Neither the amplitude nor latency showed any apparent correlation with the number, mean length, or mean FA value of the fibers obtained from tractography. Pre- and postoperative motor function of the hands was not significantly correlated with CCEP amplitude or latency. The number and mean FA value of fibers obtained by DTI, as well as the maximum CCEP amplitude, varied between patients. CONCLUSIONS: This study demonstrated an anatomical connection and a bidirectional functional connection between the PCL, including the supplementary motor area, and M1 of the human brain. The observed variability between patients suggests possible motor function plasticity. These findings may serve as a foundation for further studies.

  DOI PubMed

• [Usefulness of Preoperative Simulation: Skull Base Approach].

  Masahiko Wanibuchi, Toru Hirano, Toshihiro Takami, Shinji Kawabata, Motomasa Furuse, Naosuke Nonoguchi, Masahiro Kameda, Ryo Hiramatsu, Ryokichi Yagi, Gen Futamura, Masao Fukumura, Takuya Kosaka, Yusuke Fukuo, Katsuya Komatsu, Nobuhiro Mikuni

  No shinkei geka. Neurological surgery   52 ( 2 ) 320 - 326  2024年03月  [国内誌]

  　概要を見る

  Preoperative simulation images creates an accurate visualization of a surgical field. The anatomical relationship of the cranial nerves, arteries, brainstem, and related bony protrusions is important in skull base surgery. However, an operator's intention is unclear for a less experienced neurosurgeon. Three-dimensional(3D)fusion images of computed tomography and magnetic resonance imaging created using a workstation aids precise surgical planning and safety management. Since the simulation images allows to perform virtual surgery, a déjà vu effect for the surgeon can be obtained. Additionally, since 3D surgical images can be used for preoperative consideration and postoperative verification, discussion among the team members is effective from the perspective of surgical education for residents and medical students. Significance of preoperative simulation images will increase eventually.

  DOI PubMed

• Combined endoscopic endonasal and transcranial approach for internal carotid artery aneurysms: usefulness and safety of endonasal proximal control.

  Ryota Sato, Yukinori Akiyama, Takeshi Mikami, Yuka Kawata, Chie Kamada, Yusuke Kimura, Katsuya Komatsu, Nobuhiro Mikuni

  Neurosurgical review   46 ( 1 ) 283 - 283  2023年10月  [国際誌]

  　概要を見る

  It is necessary to secure both the proximal and distal sides of the parent artery to prevent premature rupture when clipping cerebral aneurysms. Herein, we describe four cases in which the proximal internal carotid artery (ICA), affected by a paraclinoid aneurysm, was secured using an endoscopic endonasal approach. We used various tools, including a surgical video, cadaver dissection picture, artist's illustration, and intraoperative photographs, to elucidate the process. No patient experienced postoperative complications at our institution. Compared to the cervical or cavernous ICA, the ICA adjacent to the clivus (paraclival ICA) can be anatomically safely and easily exposed using an endoscopic endonasal approach because there is no need to consider cerebrospinal fluid leakage or hemorrhage from the cavernous sinus. Securing the proximal side of the parent artery using an endoscopic endonasal approach may be a viable method for clipping selected ICA aneurysms, such as paraclinoid aneurysms especially for upward or outward aneurysms of the C2 portion.

  DOI PubMed

• Microbleeds Due to Reperfusion Enhance Early Seizures after Carotid Ligation in a Rat Ischemic Model.

  Takuro Saito, Takeshi Mikami, Tsukasa Hirano, Hiroshi Nagahama, Rei Enatsu, Katsuya Komatsu, Satoshi Okawa, Yukinori Akiyama, Nobuhiro Mikuni

  Neurologia medico-chirurgica   63 ( 6 ) 228 - 235  2023年06月  [国内誌]

  　概要を見る

  Impaired reperfusion in ischemic brain disease is a condition that we are increasingly confronted with owing to recent advances in reperfusion therapy. In the present study, rat models of reperfusion were investigated to determine the causes of acute seizures using magnetic resonance imaging (MRI) and histopathological specimens. Rat models of bilateral common carotid artery ligation followed by reperfusion and complete occlusion were created. We compared the incidence of seizures, mortality within 24 h, MRI, and magnetic resonance spectroscopy (MRS) to evaluate ischemic or hemorrhagic changes and metabolites in the brain parenchyma. In addition, the histopathological specimens were compared with those observed on MRI. In multivariate analysis, the predictive factors of mortality were seizure (odds ratios (OR), 106.572), reperfusion or occlusion (OR, 0.056), and the apparent diffusion coefficient value of the striatum (OR, 0.396). The predictive factors of a convulsive seizure were reperfusion or occlusion (OR, 0.007) and the number of round-shaped hyposignals (RHS) on susceptibility-weighted imaging (SWI) (OR, 2.072). The incidence of convulsive seizures was significantly correlated with the number of RHS in the reperfusion model. RHS on SWI was confirmed pathologically as microbleeds in the extravasation of the brain parenchyma and was distributed around the hippocampus and cingulum bundle. MRS analysis showed that the N-acetyl aspartate level was significantly lower in the reperfusion group than in the occlusion group. In the reperfusion model, RHS on SWI was a risk factor for convulsive seizures. The location of the RHS also influenced the incidence of convulsive seizures.

  DOI PubMed

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• 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 ]

  　概要を見る

  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

• arterial spin labeling法による髄膜腫内血流の評価

  鰐渕 昌彦, 小松 克也, 秋山 幸功, 長濱 宏史, 三國 信啓

  脳循環代謝 ( 日本脳循環代謝学会 )  27 ( 1 ) 183 - 183  2015年10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 ]

  　概要を見る

  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

• 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 ( ELSEVIER SCIENCE INC )  83 ( 4 ) 424 - 30  2015年04月  [査読有り]   [ 国際誌 ]

  　概要を見る

  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

共同研究・競争的資金等の研究課題 【 表示 ／ 非表示 】

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• 線維芽細胞に着目したくも膜炎症の分子機構の解明と新たな脳保護薬の開発

  基盤研究(C)

  研究期間:

  2020年04月

  -

  2023年03月

   

  三上 毅, 鈴木 比女, 秋山 幸功, 三國 信啓, 小松 克也, 平野 司

  　研究概要を見る

  臨床データから得られた知見として、慢性脳虚血性疾患に対する開頭血行再建術で得られたくも膜と脳脊髄液を使用した。対象群として開頭による非虚血性疾患で得られた前頭葉皮質血管(M4)直上のくも膜を使用した。これまでの研究成果としては、くも膜の厚さは年齢や疾患が影響しており、厚いくも膜では内層に線維芽細胞やマクロファージが増勢し、VEGFαやTGFβなどの炎症マーカーが増加していた。また、くも膜内の線維化や慢性炎症が確認されていることを基に、免疫組織学的に線維化に関わる炎症マーカーや間葉系幹細胞の存在、血管新生の有無を確認した。虚血性疾患において、強い炎症反応が認められており、疾患による影響もみられることがわかった。 また、実験動物として両側総頸動脈閉塞による認知症モデルによる評価を行った。8週のWister kyotoラットにおいて、両側総頚動脈閉塞モデルを作成し、頚動脈閉塞後4週間目に実験用7.0TMRIで脳小血管病性変化を計測した。また、電気生理学的な影響を測定するため、Pinnacle Technology社の大脳皮質脳波測定システムで、てんかん波や高次脳機能を反映するβ波やγ波などの高周波帯域のパワースペクトラム解析を行った。虚血によるてんかん原生が非常に強く影響を及ぼしていることを見出すとともに、MRI及び電気生理学的な虚血の影響を推し量れるシステムを確立した。また、両側頚動脈閉塞と再灌流の電気生理学的変化や組織変化、MRI画像変化の違いを検討し、組織学的変化が及ぼす電気生理学的異常について検討中である。

• 悪性神経膠腫に対する浸潤能の分子メカニズムの解明と制御による革新的治療法の開発

  基盤研究(C)

  研究期間:

  2017年04月

  -

  2020年03月

   

  鰐渕 昌彦, 佐々木 祐典, 三上 毅, 三國 信啓, 小松 克也, 中崎 公仁, 本望 修

  　研究概要を見る

  悪性神経膠腫が予後不良である理由として、増殖能のみならず、強い浸潤能が挙げられる。現在まで浸潤に関与する分子は未同定で、それを制御する方法もない。我々は世界で初めて悪性脳腫瘍の浸潤能に深く関わる因子としてACTC1（actin alpha cardiac muscle 1）を同定し、予後と極めて強く相関することを見出した(Ohtaki et al. J Neurosurg 2016)。ACTC1陽性群は陰性群に比較し年単位で予後が悪い、という事実より、本因子の制御が神経膠腫の浸潤抑制と予後改善につながる可能性がある、と考えられた。つまり、ACTC1の発現の有無で、HGGの予後に約5年の差が認められたが、これは、既知の予後規定因子による生存期間をはるかに凌駕しており、本因子は浸潤能の鋭敏な指標となり、HGGの予後に与える影響は非常に強いと考えられる。従って、本因子の有無による新たな神経膠腫分類の提唱や、HGGにおけるACTC1発現の程度によっては、摘出範囲を限定する、逆に拡大するなどの個別化医療(molecular based microsurgery)の提供につながると考えられ、臨床的意義も極めて高い。また、神経膠腫の浸潤抑制という新たな切り口から革新的な治療法を開発することは、年単位での治療効果発現が期待でき、臨床的意義が極めて高い。我々はすでに予備実験により、ACTC1を直接的に阻害することが可能であることを明らかにしており、神経膠腫の細胞内におけるACTC1の信号伝達機構を解明し、浸潤抑制という新たな観点から革新的な治療法開発を目指す予定である。 本年度は、本研究費によって、ACTC1の発現の程度が異なる神経膠腫のcell line に対して、ACTC1の発現を抑制することによる治療効果の検討をin vitroで行い、良好な結果を得た。以上のように、補助金は補助条件に従って、有効に使用されている。

• 脳局所電場電位に着目した脳虚血の病態解析と新治療の開発

  基盤研究(C)

  研究期間:

  2016年04月

  -

  2019年03月

   

  三上 毅, 三國 信啓, 小松 克也

  　研究概要を見る

  慢性脳虚血性疾患の血行再建術の際に、皮質脳波をモニターして血流増加による脳機能ネットワークを解析した。もやもや病の手術の際に得られた脳表脳波からパワースペクトラムを解析した。ここで得られたデータは、β帯域(13-30 Hz)やγ帯域（30-80 Hz）の変化、特徴的なオシレーションである。すなわち、もやもや病ではコントロール例と比較し、β帯域のパワースペクトラムが低く、血行再建術後にパワースペクトラムが上昇するという結果であった。また、脳梗塞モデルラットにおいて、皮質刺激によるβ帯域やγ帯域の変化の解析モデルを作成しており、ニューロモデュレーションによる脳梗塞の縮小効果を解析中である。

• ステント留置後血管に対する骨髄幹細胞移植による内膜新生メカニズムの解析

  基盤研究(C)

  研究期間:

  2016年04月

  -

  2019年03月

   

  小松 克也, 佐々木 祐典, 鰐渕 昌彦, 三上 毅, 飯星 智史, 三國 信啓, 中崎 公仁, 本望 修

  　研究概要を見る

  ステント留置(carotid artery stenting:CAS)後の再狭窄はステントstrutにおける炎症反応により惹起される内皮の過形成が原因と考えられ、脳梗塞再発の原因となる。一方、我々はこれまでに脳梗塞などの動物実験モデルに対する骨髄間葉系幹細胞の静脈内投与の治療効果を報告してきた。本研究では、実験動物にステント留置術を行い、内膜損傷モデルを作製した後に、骨髄間葉系幹細胞を経静脈的に投与し、血管内膜の状態を種々の方法で解析した結果、骨髄間葉系幹細胞の投与により、ステントstrutに対する炎症反応を抑制されることにより内膜の過形成が抑制されることが明らかになった。