研究者詳細 - 小松　克也

論文 - 小松　克也

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Recurrence Interval Within 1 Year Leads to Death in Patients with Grade 2 Meningioma.

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

World neurosurgery ( Elsevier {BV} ) 142 e58-e65 - e65 2020年10月 [査読有り] [国際誌]

OBJECTIVE: Grade 2 meningioma is more likely to recur than grade 1 meningioma. Recurrence decreases overall survival in patients with grade 2 meningioma. However, the clinical course of grade 2 meningioma with several repeated recurrences is poorly understood. The purpose of this study was to clarify the clinical characteristics of grade 2 meningioma with repeated recurrences. METHODS: This study included 28 patients with grade 2 meningioma treated at our institution from January 1994 to December 2017. The relationship between survival and factors including age, sex, number of recurrences, malignant transformation, radiation therapy, tumor location, MIB-1 labeling index, Simpson grade, Karnofsky Performance Status, and surgical interval were analyzed. RESULTS: The average age at the initial operation was 53.4 years. The number of recurrences was 3.7 times on average during the follow-up of 113.9 months after the initial operation. An increasing number of recurrences resulted in shortening of the surgical interval, increase in the MIB-1 labeling index, and decrease in Karnofsky Performance Status. In fatal cases, the average surgical interval before death was approximately 1 year. Three factors were related to poor prognosis: number of recurrences (odds ratio, 1.620; P = 0.030), malignant transformation (odds ratio, 10.625; P = 0.019), and high MIB-1 labeling index (odds ratio, 1.089; P = 0.044). CONCLUSIONS: Shortening of the surgical interval within 1 year because of multiple recurrences led to death in patients with grade 2 meningioma. Malignant transformation was the most potent among the poor prognostic factors.

Ischemic Tolerance Evaluated by Computed Tomography Perfusion during Balloon Test Occlusion.

Tomoyoshi Kuribara, Takeshi Mikami, Satoshi Iihoshi, Kei Miyata, Sangnyon Kim, Yuka Kawata, Katsuya Komatsu, Yusuke Kimura, Rei Enatsu, Yukinori Akiyama, Toru Hirano, Nobuhiro Mikuni

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association ( Elsevier {BV} ) 29 ( 6 ) 104807 - 104807 2020年06月 [査読有り] [国際誌]

OBJECTIVES: Balloon test occlusion (BTO) is performed to evaluate ischemic tolerance for large and giant cerebral aneurysms and head and neck tumors that may require parent artery occlusion. However, ischemic tolerance for the temporary test occlusion does not always guarantee a tolerance for permanent occlusion. In this study, we evaluated the utility of computed tomography (CT) perfusion during BTO to quantify ischemic tolerance for detecting delayed ischemic stroke. MATERIALS AND METHODS: Forty-one patients who underwent BTO for the internal carotid artery were included. The correlations between the parameters of CT perfusion and collateral angiographic appearance or stump pressure during BTO were evaluated. The cerebral blood flow (CBF), cerebral blood volume, mean transit time (MTT), and time to peak (TTP) were obtained through CT perfusion, and the asymmetry ratios were determined. Collateral angiographic appearances were categorized into 5 grades (0-4). RESULTS: The collateral angiographic appearance showed moderate correlations with CBF, MTT, and TTP that was significant. Of these, the absolute value of the correlation coefficient was the highest for MTT. MTT also showed a moderate correlation with stump pressure. CBF and MTT were significantly different between the poor collateral group (grades 2 and 3) and the good collateral group (grade 4). Based on the MTT, the good collateral group was identified with high sensitivity (75.0%) and specificity (81.2%). CONCLUSIONS: In BTO, the MTT obtained through CT perfusion showed a correlation with collateral angiographic appearance and stump pressure. Thus, the MTT might be useful to quantify ischemic tolerance for detecting delayed ischemic stroke.

Predictive factors for acute thrombogenesis occurring immediately after bypass procedure for moyamoya disease.

Takeshi Mikami, Hime Suzuki, Ryo Ukai, Katsuya Komatsu, Yukinori Akiyama, Masahiko Wanibuchi, Kiyohiro Houkin, Nobuhiro Mikuni

Neurosurgical review ( Springer Science and Business Media {LLC} ) 43 ( 2 ) 609 - 617 2020年04月 [査読有り] [国際誌]

Extracranial-to-intracranial (EC-IC) bypass surgery is an effective treatment for patients with moyamoya disease and other conditions. Some patients with moyamoya disease have a risk of acute thrombogenesis at the anastomotic site just after bypass surgery. The purpose of this study was to study risk factors of acute thrombogenesis and determine effective countermeasures. This study included 48 patients (66 EC-IC bypass procedures) with moyamoya disease and 52 controls (54 procedures) without moyamoya disease. The development of acute thrombogenesis was compared between the moyamoya disease and control groups. In the moyamoya disease group, clinical and radiological characteristics were assessed with respect to acute thrombogenesis. In the patients with acute thrombogenesis, causes of technical problems were retrospectively examined. The incidence of acute thrombogenesis was significantly higher in the moyamoya disease group than those in the control group. In the moyamoya disease group, acute thrombogenesis was observed in seven patients. In the moyamoya disease group, the magnetic resonance angiography (MRA) scores were significantly higher in patients with acute thrombogenesis than those in the patients without acute thrombogenesis. In the multivariate analysis, the predictive factor of acute thrombogenesis in moyamoya disease was a high MRA score (odds ratio, 2.336; p = 0.009). During EC-IC bypass surgery for moyamoya disease, acute thrombogenesis should be considered to obtain a high patency rate, particularly in patients with high MRA scores. Acute thrombogenesis will not influence morbidity if proper countermeasures are followed; therefore, the prediction and recognition of white thrombus are important for a successful bypass surgery.

Effectiveness of intraoperative visual evoked potential in avoiding visual deterioration during endonasal transsphenoidal surgery for pituitary tumors.

Kentaro Toyama, Masahiko Wanibuchi, Toshimi Honma, Katsuya Komatsu, Yukinori Akiyama, Takeshi Mikami, Nobuhiro Mikuni

Neurosurgical review 43 ( 1 ) 177 - 183 2020年02月 [査読有り] [国際誌]

Postoperative visual function is a major concern in transsphenoidal surgery (TSS). Although several reports have demonstrated the importance of visual evoked potential (VEP) monitoring during TSS, the usefulness of VEP monitoring have been controversial because of its reproducibility. Efficacy of VEP was analyzed in 20 consecutive cases of patients who underwent endoscopic endonasal TSS surgery. We adapted a high-power light-emitting diode stimulator with electroretinography using venous anesthesia. In addition, we used black shield patch and braided codes to obtain reproducible VEP amplitudes. Stable and reproducible VEP waveforms were obtained in 38 of 39 eyes (97.4%) before surgery. Fifteen eyes had deteriorated VEP amplitude during operation, and nine eyes had improved VEP amplitude at the end of surgery, and six eyes had not improved VEP amplitude. But no postoperative visual impairment was observed in all cases by temporary halting the surgical manipulation when the VEP was deteriorated. In conclusion, VEP monitoring could be a warning sign to avoid postoperative visual dysfunction. We recommend VEP as a routine monitoring in TSS.

Influence of Inflammatory Disease on the Pathophysiology of Moyamoya Disease and Quasi-moyamoya Disease.

Takeshi Mikami, Hime Suzuki, Katsuya Komatsu, Nobuhiro Mikuni

Neurologia medico-chirurgica ( Japan Neurosurgical Society ) 59 ( 10 ) 361 - 370 2019年10月 [査読有り] [国内誌]

Moyamoya disease is a unique cerebrovascular disease that is characterized by progressive bilateral stenotic alteration at the terminal portion of the internal carotid arteries. These changes induce the formation of an abnormal vascular network composed of collateral pathways known as moyamoya vessels. In quasi-moyamoya disease, a similar stenotic vascular abnormality is associated with an underlying disease, which is sometimes an inflammatory disease. Recent advances in moyamoya disease research implicate genetic background and immunological mediators, and postulate an association with inflammatory disease as a cause of, or progressive factor in, quasi-moyamoya disease. Although this disease has well-defined clinical and radiological characteristics, the role of inflammation has not been rigorously explored. Herein, we focused on reviewing two main themes: (1) molecular biology of inflammation in moyamoya disease, and (2) clinical significance of inflammation in quasi-moyamoya disease. We have summarized the findings of the former theme according to the following topics: (1) inflammatory biomarkers, (2) genetic background of inflammatory response, (3) endothelial progenitor cells, and (4) noncoding ribonucleic acids. Under the latter theme, we summarized the findings according to the following topics: (1) influence of inflammatory disease, (2) vascular remodeling, and (3) mechanisms gleaned from clinical cases. This review includes articles published up to February 2019 and provides novel insights for the treatment of the moyamoya disease and quasi-moyamoya disease.

Prevention of neointimal hyperplasia induced by an endovascular stent via intravenous infusion of mesenchymal stem cells.

Masahito Nakazaki, Shinichi Oka, Masanori Sasaki, Yuko Kataoka-Sasaki, Rie Onodera, Katsuya Komatsu, Satoshi Iihoshi, Manabu Hiroura, Akira Kawaguchi, Jeffery D Kocsis, Osamu Honmou

Journal of neurosurgery ( Journal of Neurosurgery Publishing Group ({JNSPG}) ) 133 ( 6 ) 1 - 13 2019年10月 [査読有り] [国際誌]

OBJECTIVE: In-stent restenosis after percutaneous transluminal angioplasty and stenting (PTAS) due to neointimal hyperplasia is a potential cause of clinical complications, including repeated revascularization and ischemic events. Neointimal hyperplasia induced by an inflammatory response to the stent strut may be a possible mechanism of in-stent restenosis. Intravenous infusion of bone marrow-derived mesenchymal stem cells (MSCs) has been reported to show therapeutic efficacy for cerebral stroke, presumably by an antiinflammatory effect. This study aimed to determine whether MSCs can reduce or prevent neointimal hyperplasia induced by an endovascular stent. METHODS: In this study, two types of bare metal stents were deployed using a porcine (mini-pig) model. One stent was implanted in the common carotid artery (CCA), which is considered quite similar to the human CCA, and the other was inserted in the superficial cervical artery (SCA), which is similar in size to the human middle cerebral artery. Angiographic images, intravascular ultrasound (IVUS) imaging, and microscopic images were used for analysis. RESULTS: Angiographic images and IVUS studies revealed that intravenous infusion of MSCs immediately after deployment of stents prevented in-stent stenosis of the CCA and SCA. Histological analysis also confirmed that inflammatory responses around the stent struts were reduced in both the stented CCA and SCA in the mini-pig. CONCLUSIONS: Intravenous infusion of MSCs inhibited the inflammatory reaction to an implanted stent strut, and prevented progressive neointimal hyperplasia in the stented CCA and SCA in a porcine model. Thus, MSC treatment could attenuate the recurrence of cerebral ischemic events after stenting.

Rare Case of Concurrent Glossopharyngeal and Trigeminal Neuralgia, in Which Glossopharyngeal Neuralgia was Possibly Induced by Postoperative Changes Following Microvascular Decompression for Trigeminal Neuralgia.

Yoshinori Maki, Takayuki Kikuchi, Katsuya Komatsu, Yasushi Takagi, Susumu Miyamoto

World neurosurgery ( Elsevier {BV} ) 130 150 - 153 2019年10月 [査読有り] [国際誌]

BACKGROUND: Glossopharyngeal neuralgia (GPN) and trigeminal neuralgia (TN) can result from mechanical stimulation of the glossopharyngeal nerve (GPNv) and trigeminal nerve (TNv) by blood vessels. TN can cause severe pain in the orofacial region, whereas GPN manifests as pain in the tongue, throat, tonsil, and ear. Although these 2 neuralgias can occur concurrently, concurrence of recurrent TN and GPN that develops postoperatively has not been previously described. CASE DESCRIPTION: A 68-year-old male complained of right glossalgia and pain in the pharynx radiating to the right auricular area. The patient had previously undergone microvascular decompression (MVD) for right TN. Medication and intraoral xylocaine spray did not relieve the symptoms. An oral surgeon was unable to find any disease related to the glossalgia. The anesthesiologist pointed out that the symptoms could be from partial recurrence of the TN because the patient also complained of pain in the inferior alveolus. Magnetic resonance angiography indicated that the right GPNv seemed to be compressed by the right posterior inferior cerebellar artery (PICA); hence, MVD for both GPN and TN was performed. Intraoperatively, the right PICA was found to be adherent to the GPNv because of the thickened arachnoid membrane and was subsequently detached. The TNv was also examined, but only a Teflon ball was found, which was detached from the TNv. The GPN disappeared postoperatively, although TN persisted after the second operation. CONCLUSIONS: GPN can result from adhesions between the GPNv and arachnoid membrane following previous MVD.

Vascular assessment after clipping surgery using four-dimensional CT angiography.

Yusuke Kimura, Takeshi Mikami, Kei Miyata, Hime Suzuki, Toru Hirano, Katsuya Komatsu, Nobuhiro Mikuni

Neurosurgical review ( Springer Verlag ) 42 ( 1 ) 107 - 114 2019年03月 [査読有り] [国際誌]

Recent advances in computed tomography angiography (CTA) enable repeated imaging follow up for post-clipping surgery. The purpose of this study was to clarify the critical volume and configuration of the aneurysmal clip in the postoperative evaluation using volume rendering (VR) imaging, and present four-dimensional (4D)-CTA for these larger metal artifacts. A total of 44 patients with cerebral aneurysm, treated using clipping surgery, were included in this study. The metal artifact volume was assessed using CTA and the association between the type of clips and its metal artifact volume was analyzed. A VR image and a 4D-CTA were then produced, and the diagnostic accuracy of arteries around the clip or residual aneurysm on these images was evaluated. In the receiver operating characteristic (ROC) curve analysis, the cutoff value for metal artifacts was 2.32 mm3 as determined through a VR image. Patients were divided into two groups. Group 1 included patients with a simple and small clip, and group 2 included patients with multiple, large or fenestrated clips. The metal artifact volume was significantly larger in group 2, and the group incorporated the cutoff value. Post-clipping status on the VR image was significantly superior in group 1 compared with group 2. In group 2, the imaging quality of post-clipping status on 4D-CTA was superior in 92.9% of patients. The metal artifact volume was dependent on the number, size, or configuration of the clip used. In group 2, evaluation using a 4D-CTA eliminated the effect of the metal artifacts.

[Possible Segmental Arterial Mediolysis Associated with Intraperitoneal Hemorrhage in the Acute Stage of Subarachnoid Hemorrhage:A Case Report].

Jiro Ohara, Yukihiro Yamao, Akira Ishii, Hironori Shimizu, Takayuki Kikuchi, Yohei Takenobu, Katsuya Komatsu, Hiroyuki Ikeda, Taku Inada, Hidehisa Nishi, Yu Abekura, Susumu Miyamoto

No shinkei geka. Neurological surgery 47 ( 1 ) 97 - 103 2019年01月 [査読有り] [国内誌]

Segmental arterial mediolysis(SAM)is a rare non-inflammatory and non-atherosclerotic arteriopathy associated with the occurrence of multiple aneurysms such as intracranial and intraperitoneal aneurysms. We report a case of intraperitoneal hemorrhage that occurred during the acute stage of subarachnoid hemorrhage(SAH). An 82-year-old woman presented with a sudden onset of loss of consciousness with a diagnosis of SAH. Digital subtraction angiography demonstrated two consecutive vertebral artery-posterior inferior cerebellar artery aneurysms. The larger aneurysm, which seemed to be ruptured, was successfully treated by coil embolization. On the 9th day after the onset of SAH, she developed aphasia secondary to the cerebral vasospasm. After selective intra-arterial infusion of fasudil hydrochloride, she was observed to maintain elevated systolic blood pressure. Her aphasia improved; however, on the 14th day, she suddenly developed hemorrhagic shock. An abdominal computed tomography scan demonstrated intraperitoneal hemorrhage secondary to a ruptured fusiform aneurysm of the right gastroepiploic artery. The lesion was successfully treated by coil embolization, although she became bedridden. Although a histopathological examination was not performed, her clinical, radiological, and serological presentation met the criteria of the clinical diagnosis of SAM. Elevated systolic blood pressure and excessive release of catecholamines in the acute stage of SAH might have caused the intraperitoneal hemorrhage. Non-saccular ruptured intracranial aneurysms should be considered among the differential diagnoses of SAM. In such cases, identifying and monitoring intraperitoneal aneurysms might be useful for earlier diagnosis and treatment of SAM, especially in the acute stage after SAH.

Ruptured intranidal aneurysm of an arteriovenous malformation diagnosed by delay alternating with nutation for tailored excitation (DANTE)–prepared contrast-enhanced magnetic resonance imaging

Katsuya Komatsu, Yasushi Takagi, Akira Ishii, Takayuki Kikuchi, Yukihiro Yamao, Yasutaka Fushimi, John Grinstead, Sinyeob Ahn, Susumu Miyamoto

Acta Neurochirurgica ( Springer Nature ) 160 ( 12 ) 2435 - 2438 2018年12月 [査読有り] [国際誌]

This case report describes the usefulness of delay alternating with nutation for tailored excitation (DANTE)-prepared, contrast-enhanced magnetic resonance imaging (CE-MRI) for detecting the rupture site of an arteriovenous malformation (AVM). A ruptured intranidal aneurysm was confirmed histopathologically. Accurate non-invasive information about the possible rupture site of an AVM is critical for optimal treatment and evaluation. Vessel wall enhancement visualized by DANTE-prepared CE-MRI may be a useful tool for providing information about changes in inflammatory status and vulnerability to further developments.

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 ( Elsevier {BV} ) 120 e1310-e1318 - e1318 2018年12月 [査読有り] [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.

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

Interdisciplinary Prevention and Management of Wound-Related Complications in Extracranial-to-Intracranial Bypass Surgery.

Rintaro Yokoyama, Takeshi Mikami, Ryo Ukai, Katsuya Komatsu, Yusuke Kimura, Hime Suzuki, Toshimi Honma, Toru Hirano, Tamotsu Saito, Ken Yamashita, Takatoshi Yotsuyanagi, Kiyohiro Houkin, Nobuhiro Mikuni

World neurosurgery 115 247 - 253 2018年07月 [査読有り] [国際誌]

Extracranial-to-intracranial (EC-IC) bypass surgery may be necessary in patients with moyamoya disease and other ischemic conditions. However, there is a potential risk of wound-related complications in some cases. In this study, we report our approach to the prevention of wound-related complications in EC-IC bypass. Technical considerations and pitfalls of surgery are also discussed. This study included 89 patients with ischemic-onset moyamoya disease and atherosclerotic disease who underwent 108 superficial temporal artery (STA)-to-middle cerebral artery bypass procedures. Our study emphasized 3 major features. First, 3-dimensional simulation imaging was used to confirm STA anatomy. Second, the STA was meticulously dissected on the epigaleal layer to protect the galeal layer. Third, scalp skin ischemia was taken into consideration at each step until skin closure. There was no neurologic morbidity or mortality in this series. There were 2 cases of major wound-related complications requiring plastic surgical intervention, and 4 cases of minor complications that were treated conservatively. In major complication cases, the scalp defect was treated with pedicle flap reconstruction. In EC-IC bypass surgery, interdisciplinary management involving neurosurgery, plastic surgery, and radiology should reduce wound-related complications and achieve safe surgery.

Development of moyamoya disease after non-herpetic acute limbic encephalitis: A case report.

Yasuhiro Takahashi, Takeshi Mikami, Hime Suzuki, Katsuya Komatsu, Daisuke Yamamoto, Shun Shimohama, Kiyohiro Houkin, Shintaro Sugita, Tadashi Hasegawa, Nobuhiro Mikuni

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 53 250 - 253 2018年07月 [査読有り] [国際誌]

We report a case of moyamoya disease (MMD), which developed after non-herpetic acute limbic encephalitis (NHALE) associated with anti-leucine-rich glioma-inactivated 1 (LGI1) antibody. The patient's mother had a history of MMD. No vascular lesions were identified at the time of the NHALE. Nine years later, the patient visited our hospital due to memory disturbances and repeated transient ischemic attacks affecting the right limb. Diffusion-weighted magnetic resonance imaging revealed scattered areas of signal hyperintensity, and the patient was ultimately diagnosed with MMD based on angiography. Revascularization surgery was performed on the left side, where cerebral blood flow was impaired on 123I-N-isopropyl-p-iodoamphetamine single photon emission computed tomography. Postoperatively, the patient was discharged with a normal neurological examination. NHALE associated with LGI1 antibodies is an autoimmune disease. Although autoimmune disease is the most frequent finding other than atherosclerosis in quasi-MMD, this is the first report of NHALE associated with anti-LGI1 antibodies mimicking quasi-MMD. Inflammation and angiogenesis may contribute to the development of MMD, in addition to genetic background.

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 [査読有り] [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.

Digital Polymerase Chain Reaction Quantification of SERPINA1 Predicts Prognosis in High-Grade Glioma.

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

World neurosurgery ( Elsevier Inc. ) 111 e783-e789 - e789 2018年03月 [査読有り] [国際誌]

BACKGROUND: SERPINA1 plays an anti-inflammatory role in protecting tissues from proteolytic mechanisms. SERPINA1 is positive in gliomas by immunohistochemical analysis; however, the role of SERPINA1, including the relationship with prognosis, has been uncertain. In recent years, digital polymerase chain reaction (PCR) has provided ultra-sensitive assessment of messenger RNA expression from formalin-fixed paraffin-embedded (FFPE) tissues. OBJECTIVE: In this study, we quantitatively determined the expression of SERPINA1 in high-grade gliomas (HGGs) using digital PCR, and we analyzed its relationship with prognosis. METHODS: Twenty-nine FFPE surgical samples from patients with HGGs (7 of World Health Organization [WHO] grade III and 22 of WHO grade IV), and human glioblastoma cell lines, U87 and U118, were used for analysis. A qualitative assessment using immunostaining and quantitative assessment using digital PCR were performed to assess the expression of SERPINA1. RESULTS: The expression of SERPINA1 was demonstrated in glioma tissues and glioblastoma multiforme cell lines by immunostaining. Digital PCR analysis showed that SERPINA1 was expressed in 14.3% and 63.6% of the tissues from patients with grade III and grade IV HGG, respectively (P = 0.035). The median overall survival of 38.8 months in the low SERPINA1 expression group was longer than that of 15.3 months in the high expression group (P = 0.030). CONCLUSIONS: The frequency and the amount of SERPINA1 expression were higher in grade IV than in grade III HGGs. The high expression of SERPINA1 indicates a poor prognosis of HGGs.

Effectiveness of the 3D Monitor System for Medical Education During Neurosurgical Operation.

Masahiko Wanibuchi, Katsuya Komatsu, Yukinori Akiyama, Takeshi Mikami, Nobuhiro Mikuni

World neurosurgery ( Elsevier {BV} ) 109 e105-e109 - e109 2018年01月 [査読有り] [国際誌]

BACKGROUND: Three-dimensional (3D) graphics are used in the medical field, especially during surgery. Although 3D monitoring is useful for medical education, its effectiveness needs to be objectively evaluated. The aim of this study was to investigate the efficacy of 3D monitoring in the surgical education of medical students. METHODS: A questionnaire on high-definition 3D monitoring was given to fifth-year medical students in a 6-year program. Sixty-four students wore polarized glasses and observed a microsurgical operation through a 3D monitor. The questionnaire contained questions on stereopsis, neurosurgical interest, visual impact, comprehension of surgical anatomy and procedures, optical sharpness, active learning enhancement, and eye exhaustion. These parameters were evaluated on a 5-point scale that spanned negative and positive scores. RESULTS: The average score of each parameter ranged from 3.13 to 3.78, except for eye exhaustion, which was 0.88. The items for which the students reported positive perceptions (scores of 4 or 5) were stereopsis (67.2% of students), neurosurgical interest (62.5%), visual impact and optical sharpness (60.9% for both), active learning enhancement (57.8%), and comprehension of surgical anatomy (50.0%) and procedures (42.2%). By contrast, only eye exhaustion was evaluated negatively (26.6%). CONCLUSION: The use of 3D monitoring systems in medical education offers the advantage of stereopsis and contributes to surgical training. However, improvements are required to decrease eye exhaustion.

Electrophysiological influence of temporal occlusion of the parent artery during aneurysm surgery.

Katsuya Komatsu, Takeshi Mikami, Rintaro Yokoyama, Yuto Suzuki, Shoichi Komura, Rei Enatsu, Shouhei Noshiro, Kei Miyata, Yukinori Akiyama, Nobuhiro Mikuni

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia ( ELSEVIER SCI LTD ) 45 199 - 204 2017年11月 [査読有り] [国際誌]

Intraoperative monitoring of the motor evoked potential (MEP) during cerebral aneurysm surgery has been widely used to confirm surgical safety. In this study, we retrospectively analyzed the influence of the MEP amplitude resulting from temporal occlusion of the parent artery, and appropriate judgement in the surgery was discussed. Ten patients underwent temporal occlusion of the parent artery during aneurysm surgery, and five of these patients showed a decrease in the MEP amplitude following temporal arterial occlusion. Clinical factors in patients with and without MEP decrease were compared. The time gap between the surgical procedure and the MEP change and recovery was then investigated. A decrease in the MEP amplitude caused by temporal occlusion had a significantly higher occurrence compared with permanent clip failure. The time from the release procedure to MEP amplitude recovery was relatively longer than the time from the occlusion procedure to the decrease in MEP amplitude. The time from release procedure to MEP amplitude recovery showed a weak correlation with the parent artery occlusion time. There is a time gap between releasing the temporal arterial occlusion and MEP recovery that is similar to temporal parent arterial occlusion and the MEP decrease. The cause of MEP amplitude should be judged carefully, and influence of parent artery temporal occlusion should be taken into consideration during aneurysm clipping.

Geometrical Complexity of Cortical Microvascularization in Moyamoya Disease.

Katsuya Komatsu, Takeshi Mikami, Hime Suzuki, Yukinori Akiyama, Rei Enatsu, Masahiko Wanibuchi, Nobuhiro Mikuni

World neurosurgery ( Elsevier {BV} ) 106 51 - 59 2017年10月 [査読有り] [国際誌]

BACKGROUND: Dilatation of the microvascular diameter is recognized in moyamoya disease and referred to as microvascularization. The purpose of this study was to characterize the cortical microvascularization in moyamoya disease using imaging analysis, and to explore the developmental mechanism of the collateral network around the cortical surface. METHODS: A total of 20 hemispheric sides of 14 patients with moyamoya disease were included in this study. From the intraoperative images, cortical surface images were extracted, and binary images were subsequently created. Then the ratio of the microvessels of the brain surface (vascular fraction; VF) and the box-counting fractal dimension (Db) values were calculated. The VF and Db values in the moyamoya disease group were then compared with those in atherosclerotic disease and nonischemic disease groups, and assessed in terms of clinical and radiologic factors. RESULTS: VF was significantly higher in the moyamoya disease group compared with the atherosclerotic disease group, and Db was significantly higher in the moyamoya disease group compared with the atherosclerotic disease and nonischemic disease groups. In the moyamoya disease group, VF showed a moderate correlation with magnetic resonance angiography (MRA) score. Moreover, Db was significantly higher in the pediatric patients, in the presence of ischemic symptoms, and in the presence of ivy sign, and Db showed a moderate correlation with MRA score and cerebral blood flow in moyamoya disease. CONCLUSIONS: In the patients with moyamoya disease, the cortical microvascularization exhibited increased Db and dilatation of the pial arteries. In moyamoya disease, cortical microvascularization is associated with clinical and radiologic factors. This microvascularization might be a compensatory mechanism in the ischemic condition in moyamoya disease.

Intraoperative Mapping and Monitoring of the Pyramidal Tract Using Endoscopic Depth Electrodes.

Yukinori Akiyama, Shunya Ohtaki, Katsuya Komatsu, Kentaro Toyama, Rei Enatsu, Takeshi Mikami, Masahiko Wanibuchi, Nobuhiro Mikuni

World neurosurgery ( ELSEVIER SCIENCE INC ) 105 14 - 19 2017年09月 [査読有り] [国際誌]

OBJECTIVE: To evaluate motor function during neuroendoscopic resectioning of deep-seated brain tumors using endoscopically guided depth electrodes. METHODS: For 12 cases of thalamic tumors, including high-grade gliomas, germinomas, and malignant lymphomas, depth electrodes were inserted using endoscopic guides between the tumor and the pyramidal tract in the thalamus. Motor-evoked potentials (MEPs) were continuously recorded during neuroendoscopic resectioning of the tumors. RESULTS: Monitoring of MEP responses using depth electrodes in all 12 cases was successful. The minimum stimulus intensity threshold required to induce MEP responses was 3 mA. Gross total or subtotal resections were successful with this technique for all patients with glioma. No additional neurologic impairments were found after surgery in any of the cases. CONCLUSIONS: Continuous MEP measurement using depth electrodes can serve as a new monitoring technique for endoscopic resectioning of deep-seated brain tumors.

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