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Papers - ENATSU Rei

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新規迷走神経刺激療法装置VNS-aspire SRの治療成績長期VNS例のトラブルシューティングを含めて

越智さと子, 菅野彩, 鈴木悠斗, 江夏怜, 三國信啓

てんかん研究 ( (一社)日本てんかん学会 ) 36 ( 2 ) 434 - 434 2018.09

Meningioma mimicking an intraparenchymal cystic tumor.

Tomoaki Tamada, Rei Enatsu, Noriaki Kikuchi, Nobuhiro Mikuni

Nagoya journal of medical science 80 ( 3 ) 431 - 434 2018.08 [Domestic journal]

Meningiomas rarely exhibit cystic lesions with mural nodules, and may be misdiagnosed as intraparenchymal cystic tumors. We herein present a 64-year-old woman with a cystic lesion and enhancing mural nodule in the left temporal lobe accompanied by peritumoral brain edema. Differential diagnoses included low-grade gliomas, hemangioblastoma, and cystic meningioma. Gross total resection of the tumor was achieved through a temporal surgical approach. Intraoperative findings showed that the tumor was an extraparenchymal tumor. The cyst was covered by an extraparenchymal thin membrane and the cystic fluid was yellowish in color. The final result of the pathological examination was microcystic meningioma, WHO grade I. Although intraparenchymal tumors, such as hemangioblastoma, ganglioglioma, pilocytic astrocytoma, and pleomorphic xanthoastrocytoma, commonly display this MRI pattern, meningioma needs to be included in the differential diagnosis.

DOI PubMed

Gelastic attack in a child with moyamoya disease.

Hime Suzuki, Takeshi Mikami, Rei Enatsu, Aya Kanno, Yasuhiro Takahashi, Nobuhiro Mikuni

Neurology 91 ( 3 ) 141 - 142 2018.07 [International journal]

DOI PubMed

後背側視床下核、不確帯、prelemniscal radiationの微小電極記録による同定と刺激効果の比較

北川まゆみ, 江夏怜, 三上毅, 菅野彩, 古村翔一, 三國信啓

パーキンソン病・運動障害疾患コングレスプログラム・抄録集 ( Movement Disorder Society of Japan (MDSJ) ) 12回 82 - 82 2018.07

遺伝子解析によりPIK3CAの体細胞モザイク変異が明らかとなった片側巨脳症の1例

山本晃代, 川村健太郎, 福村忍, 菅野彩, 江夏怜, 越智さと子, 三國信啓, 藤田京志, 松本直通, 加藤光広

てんかん研究 ( (一社)日本てんかん学会 ) 36 ( 1 ) 80 - 80 2018.06

【次のリハビリテーションに活きる!私の脳疾患評価】疾患別評価と画像診断てんかん

江夏怜, 三國信啓

MEDICAL REHABILITATION ( (株)全日本病院出版会 ) ( 223 ) 119 - 129 2018.06

てんかんとは、てんかん発作を引き起こす持続性素因とそれによる神経生物学的、認知的、心理学的、社会的な帰結を特徴とする脳の障害と定義されている。国際抗てんかん連盟(ILAE)はより実用的なものとして、2014年にてんかんの新定義を、2017年に発作型とてんかんの新分類を発表している。てんかんの診断には、発作症状に加え、脳波、神経画像、神経心理検査などが行われる。脳波は発作間欠期脳波と発作時脳波がある。MRIは原因となる構造異常を検出することができる最重要の検査である。SPECT、PET検査で血流、代謝異常を検出することができ、また、中枢性ベンゾジアゼピン受容体を評価して焦点検索が行える。神経心理検査では術前・術後の高次脳機能障害を評価できる。これらの結果を組み合わせて、総合的にてんかんの診断を行う必要がある。(著者抄録)

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 2018.05 [International journal]

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

小児難治性てんかん症例の画像診断と外科的治療戦略

越智さと子, 菅野彩, 江夏怜, 三國信啓, 長濱宏史, 平野透

CI研究 ( 日本脳神経CI学会 ) 39 ( 3-4 ) 131 - 137 2018.03

てんかん外科治療を行った18歳未満の小児19例(男児11名、女児8名)を対象とした。開頭焦点切除9例(男児5例、女児4例、2～17歳)、緩和外科治療12例(男児4例、女児8例、1～17歳)であった。19例中10例にMRI所見があり、6例が焦点切除適応となった。焦点切除9例の予後について検討し、初回治療後発作制御5/9(55.6%)、追加治療後を含めると7/9(77.8%)、MRI陽性で機能画像一致(P/C)5例では100%予後良好であった。機能画像がなにがしか一致しなかった(P/NC+N/NC)2例は制御不十分であった。制御群の中で不一致例は2/7(29%)に対し、非制御群では2/2(100%)と、有意に高かった。緩和治療VNSは、MRI陽性でも病変が多発、び漫性で焦点が絞れない4例とMRI陰性で機能画像で病変が明瞭化した1例が含まれた。感染抜去1例を除き、発作減少率50%以上は7例(63.6%)、MRI陽性中3/4(75%)、陰性中4/7(57.1%)であった。副次効果としての情動安定、意思疎通性、姿勢運動、社交性等QOL改善は有意でないもののMRI陽性で高かった。

[(2)Usefulness of Cortico-Cortical Evoked Potential in the Diagnosis of Epilepsy].

Rei Enatsu, Nobuhiro Mikuni

No shinkei geka. Neurological surgery 46 ( 2 ) 163 - 172 2018.02 [Domestic journal]

DOI PubMed

機能的脳神経外科最新の動向てんかん診断におけるCCEPの有用性

江夏怜, 三國信啓

Neurological Surgery ( (株)医学書院 ) 46 ( 2 ) 163 - 172 2018.02

【神経機能マッピング・モニタリング入門】神経機能マッピング・モニタリングの基本と応用を学ぼう術中脳神経機能モニタリング運動・感覚機能の基本モニタリング SEP、MEP

江夏怜, 鈴木脩斗, 山田奨人, 三國信啓

脳神経外科速報 ( (株)メディカ出版 ) 28 ( 1 ) 22 - 26 2018.01

【神経機能マッピング・モニタリング入門】神経機能マッピング・モニタリングの現状と未来展望

江夏怜, 佐久間潤, 前澤聡, 加藤天美

脳神経外科速報 ( (株)メディカ出版 ) 28 ( 1 ) 6 - 14 2018.01

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 45 199 - 204 2017.11 [International journal]

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.

DOI PubMed

Frontal Fibers Connecting the Superior Frontal Gyrus to Broca Area: A Corticocortical Evoked Potential Study.

Satoshi Ookawa, Rei Enatsu, Aya Kanno, Satoko Ochi, Yukinori Akiyama, Tamaki Kobayashi, Yukihiro Yamao, Takayuki Kikuchi, Riki Matsumoto, Takeharu Kunieda, Nobuhiro Mikuni

World neurosurgery 107 239 - 248 2017.11 [International journal]

BACKGROUND: The frontal aslant tract is a deep frontal pathway connecting the superior frontal gyrus (SFG) to Broca area. This fiber is assumed to be associated with language functions, especially speech initiation and spontaneity. The aim of this study was to electrophysiologically investigate this network using corticocortical evoked potentials (CCEPs). METHODS: This study enrolled 8 patients with brain tumors or medically intractable focal epilepsies who underwent frontal craniotomy over the language-dominant side. All patients underwent CCEP recordings during tumor resection or during invasive evaluation for epilepsy surgery. Alternating 1-Hz electrical stimuli were delivered to pars opercularis (pO) and pars triangularis (pT), corresponding to Broca area, and SFG via the subdural grid electrodes with intensity of 10 mA. Electrocorticograms from SFG and pO/pT time-locked to 50 stimuli were averaged in each trial to obtain CCEP responses. RESULTS: In all patients, stimulation of pO/pT induced CCEP responses in SFG. CCEP responses were recorded in lateral SFG in 5 patients and in supplementary motor areas in 4 patients. Reciprocality was observed in 7 patients in the stimulation of SFG. CCEP responses were significantly faster at SFG from pO/pT than at pO/pT from SFG (Wilcoxon signed rank test, P = 0.028). CONCLUSIONS: The present study demonstrated a corticocortical network connecting Broca areas and SFG in a reciprocal manner. Our findings might provide new insight into language and motor integration.

DOI PubMed

難治性てんかんに対して迷走神経刺激療法を導入した3例

木村修平, 信田大喜子, 辻岡孝郎, 内田雅也, 上野倫彦, 白石秀明, 笹森徹, 寳金清博, 江夏怜, 越智さと子, 三國信啓, 佐野仁美

日本小児科学会雑誌 ( (公社)日本小児科学会 ) 121 ( 11 ) 1890 - 1890 2017.11

皮質形成異常由来の症候性局在関連てんかん2乳児例の初期病像

高橋美智, 小川泰弘, 小野暁, 信太知, 梶井直文, 河野修, 伊藤智城, 江川潔, 白石秀明, 山本晃代, 福村忍, 管野彩, 江夏怜, 越智さと子, 三國信啓

日本小児科学会雑誌 ( (公社)日本小児科学会 ) 121 ( 11 ) 1890 - 1890 2017.11

Geometrical Complexity of Cortical Microvascularization in Moyamoya Disease.

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

World neurosurgery 106 51 - 59 2017.10 [International journal]

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.

DOI PubMed

Distribution and Network of Basal Temporal Language Areas: A Study of the Combination of Electric Cortical Stimulation and Diffusion Tensor Imaging.

Rei Enatsu, Aya Kanno, Satoshi Ookawa, Satoko Ochi, Sumio Ishiai, Takashi Nagamine, Nobuhiro Mikuni

World neurosurgery 106 1 - 8 2017.10 [International journal]

OBJECTIVE: The basal temporal language area (BTLA) is considered to have several functions in language processing; however, its brain network is still unknown. This study investigated the distribution and networks of the BTLA using a combination of electric cortical stimulation and diffusion tensor imaging (DTI). METHOD: 10 patients with intractable focal epilepsy who underwent presurgical evaluation with subdural electrodes were enrolled in this study (language dominant side: 6 patients, language nondominant side: 4 patients). Electric stimulation at 50 Hz was applied to the electrodes during Japanese sentence reading, morphograms (kanji) reading, and syllabograms (kana) reading tasks to identify the BTLA. DTI was used to identify the subcortical fibers originating from the BTLA found by electric stimulation. RESULTS: The BTLA was found in 6 patients who underwent implantation of the subdural electrodes in the dominant hemisphere. The BTLA was located anywhere between 20 mm and 56 mm posterior to the temporal tips. In 3 patients, electric stimulation of some or all areas within the BTLA induced disturbance in reading of kanji words only. DTI detected the inferior longitudinal fasciculus (ILF) in all patients and the uncinate fasciculus (UF) in 1 patient, originating from the BTLA. ILF was detected from both kanji-specific areas and kanji-nonspecific areas. CONCLUSION: This study indicates that the network of the BTLA is a part of a ventral stream and is mainly composed of the ILF, which acts as a critical structure for lexical retrieval. ILF is also associated with the specific processing of kanji words.

DOI PubMed

運動野双極刺激による運動誘発電位に対する刺激極性の及ぼす影響

山田奨人, 江夏怜, 山本恭輔, 大村慶太, 加藤理加, 田村秀朗, 長谷川武生, 橋本修一, 橋本佳苗, 千原伸也, 室橋高男

臨床神経生理学 ( (一社)日本臨床神経生理学会 ) 45 ( 5 ) 420 - 420 2017.10

脳機能マッピングにおける症候とafterdischarge誘発の皮質電気刺激閾値

江夏怜, 菅野彩, 大川聡史, 越智さと子, 三國信啓

臨床神経生理学 ( (一社)日本臨床神経生理学会 ) 45 ( 5 ) 395 - 395 2017.10

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Papers - ENATSU Rei