記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: The use of anti-epileptic drugs (AEDs) in degenerative dementia (DD) remains uncertain. We aimed to evaluate the association of early AED administration with subsequent DD occurrence. METHODS: Using a large nationwide database, we enrolled patients newly diagnosed with epilepsy from 2014 to 2019 (n = 104,225), and using propensity score matching, we divided them into treatment (those prescribed AEDs in 2014) and control groups. The primary outcome was subsequent DD occurrence in 2019. RESULTS: Overall, 4489 pairs of patients (2156 women) were matched. The odds ratio (treatment/control) for DD occurrence was 0.533 (95% confidence interval: 0.459-0.617). The DD proportions significantly differed between the treatment (340/4489 = 0.076) and control (577/4489 = 0.129) groups. DISCUSSION: Among patients newly diagnosed with epilepsy, compared to non-use, early AED use was associated with a lower occurrence of subsequent DD. Further investigations into and optimization of early intervention for epilepsy in DD are warranted. HIGHLIGHTS: Anti-epileptic drug (AED) use before epilepsy diagnosis was linked with a lower subsequent degenerative dementia (DD) occurrence.Identifying the epileptic phenotype was crucial for justifying early AED use in DD.AED use with an epilepsy diagnosis did not pose an additional risk of DD.The potential contribution of combination drug therapy to the strategy was noted.

DOI： 10.1002/trc2.70001

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Vertebral artery (VA) stenosis can be caused by several factors, including arteriosclerosis, arterial dissection, and mechanical compression. Symptomatic vertebrobasilar insufficiency caused by VA stenosis due to mechanical compression associated with head rotation is well-known as Bow Hunter's syndrome. However, an accurate diagnosis of asymptomatic osteophyte compression-induced nonrotational VA stenosis is difficult. We report a case of left posterior inferior cerebellar artery aneurysm with severe left VA stenosis, treated with stent-assisted coil embolization following appropriate diagnosis. CASE DESCRIPTION: A 72-year-old female patient was found to have severe asymptomatic VA stenosis at the V2 segment (C4-5 level of the cervical spine) on cerebral angiography. Osteophyte compression-induced VA stenosis was suspected, which was confirmed by cone-beam computed tomography. The VA stenosis improved by flexing the neck and fixing the head position, following which the endovascular treatment was successfully completed. CONCLUSION: The site of the VA stenosis is critical in determining the etiology. Atherosclerotic VA stenosis often occurs at the origin of the artery or V4 segment, whereas bony compression-induced stenosis is more likely to occur at the V2 segment. Diagnosis and appropriate management of VA stenosis is based on determining the site.

DOI： 10.25259/SNI_772_2024

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: The superiority and usefulness of liquid material over particles for embolization have been a topic of debate due to differences in materials and techniques. This study aimed to identify the complications and outcomes associated with both embolization materials. METHODS: This retrospective multicenter cohort study included 93 patients from an endovascular treatment registry, treated from January 1, 2018 to May 31, 2022. It included patients who underwent preoperative embolization for meningioma, solitary fibrous tumor/hemangiopericytoma, and hemangioblastoma. Data for patient characteristics, procedural factors, complications, and outcomes were collected from medical records. RESULTS: A tortuous access route was the only factor independently associated with complications (p = 0.020). Although liquid material was more frequently used for embolization in relatively high-risk conditions, complication rates did not differ significantly between the groups (p = 0.999). In the liquid material group, the tip of the microcatheter could be guided closer to the tumor (p <0.001) using a distal access catheter and flow-guide microcatheters. The subgroup middle meningeal artery embolization had less operative bleeding in the liquid material group (p <0.001), whereas the particles group exhibited less intraoperative blood loss than the liquid material group (p = 0.006). CONCLUSION: The vascular tortuosity of the access route was only associated with complications in preoperative tumor embolization. Liquid material and particles showed no difference in complication rates. The use of particles in embolization may reduce intraoperative bleeding, but not in all cases can it be used safely. Therefore, a thorough understanding of the characteristics of both approaches and their relative advantages in clinical practice is essential to opt for the appropriate material according to the case.

DOI： 10.5797/jnet.oa.2023-0083

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Isolated abducens nerve palsy (IANP), caused by secondary communicating hydrocephalus, has been rarely documented; in addition, its mechanism and appropriate treatment are not understood well. This study presents a case of bilateral IANP with hydrocephalus in a 62-year-old man who was successfully treated with cerebrospinal fluid (CSF) diversion to correct an enlarged retroclival space during the follow-up of recurrent brain tumor in the right parieto-occipital lobe. The patient was treated with three resections, temozolomide, and irradiation before developing IANP. Magnetic resonance imaging (MRI) revealed a recurrent tumor and ventriculomegaly with an expanded retroclival cisternal space. The patient underwent subtotal tumor resection and external ventricular drain placement in the anterior horn of the lateral ventricle. His bilateral IANP persisted for 4 days after surgery but gradually improved and disappeared by Day 7. Four weeks later, the patient underwent ventriculoperitoneal (VP) shunt surgery to establish a permanent CSF diversion that continued to control the symptoms. Retrospective MRI review revealed the distance between the clivus and pontomedullary junction on the sagittal section (retroclival-pontomedullary distance; RPD) of 9.0, 12.8, 10.7, and 10.6 mm before IANP, on IANP onset, on postoperative Day 4, and post VP shunt surgery, respectively. In conclusion, VP shunt surgery was an appropriate approach for IANP with communicating hydrocephalus to correct the enlarged retroclival cisternal space. RPD thus may be used as one of possible evaluation methods for IANP with hydrocephalus, which can be caused by various factors.

DOI： 10.2176/jns-nmc.2024-0092

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND OBJECTIVES: Insulo-opercular surgery can cause ischemic motor complications. A source of this is the arteries around the superior limiting sulcus (SLS), which reach the corona radiata, but the detailed anatomy remains unclear. To characterize arteries around the SLS including the long insular arteries (LIAs) and long medullary arteries, we classified them and examined their distribution in relation to the SLS, which helps reduce the risk of ischemia. METHODS: Twenty adult cadaveric hemispheres were studied. Coronal brain slices were created perpendicular to the SLS representing insular gyri (anterior short, middle short, posterior short, anterior long, and posterior long). The arteries within 10-mm proximity of the SLS that reached the corona radiata were excavated and classified by the entry point. RESULTS: A total of 122 arteries were identified. Sixty-three (52%), 20 (16%), and 39 (32%) arteries penetrated the insula (LIAs), peak of the SLS, and operculum (long medullary arteries), respectively. 100 and six (87%) arteries penetrated within 5 mm of the peak of the SLS. The arteries were distributed in the anterior short gyrus (19%), middle short gyrus (17%), posterior short gyrus (20%), anterior long gyrus (19%), and posterior long gyrus (25%). Seven arteries (5.7%) had anastomoses after they penetrated the parenchyma. CONCLUSION: Approximately 90% of the arteries that entered the parenchyma and reached the corona radiata were within a 5-mm radius of the SLS in both the insula and operculum side. This suggests that using the SLS as a landmark during insulo-opercular surgery can decrease the chance of ischemia.

DOI： 10.1227/ons.0000000000000879

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Intraosseous clival arteriovenous fistulas (AVFs), in which the shunt drains extracranially from the posterior and anterior condylar veins rather than from the cavernous sinus (CS), are rare. Targeting embolization of an intraosseous clival AVF is challenging because of its complex venous and skull base anatomy; therefore, a therapeutic strategy based on detailed preoperative radiological findings is required to achieve a favorable outcome. Here, the authors report the successful targeted embolization of an intraosseous clival AVF using an ingenious access route. OBSERVATIONS: A 74-year-old woman presented with left-sided visual impairment, oculomotor nerve palsy, and right facial pain. A fusion image of three-dimensional rotational angiography and cone-beam computed tomography revealed a left CS dural AVF and a right intraosseous clival AVF. The shunt flow of the clival AVF drained extracranially from the posterior and anterior condylar veins via the intraosseous venous route. Transvenous embolization was performed by devising suboccipital, posterior condylar, and intraosseous access routes. The symptoms resolved after the bilateral AVFs were treated. LESSONS: Accurate diagnosis and proper transvenous access based on detailed intraosseous and craniocervical venous information obtained from advanced imaging modalities are key to resolving intraosseous clival AVF.

DOI： 10.3171/CASE23492

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The 2021 World Health Organization (WHO) classification of central nervous system (CNS) tumors uses an integrated approach involving histopathology and molecular profiling. Since majority of adult malignant brain tumors are gliomas and primary central nervous system lymphomas (PCNSL), rapid differentiation of these diseases is required for therapeutic decisions. Additionally, diffuse gliomas require molecular information on single nucleotide variants (SNV), such as IDH1/2. Here, we report an intraoperative integrated diagnostic (i-ID) system to classify CNS malignant tumors, which updates legacy frozen section (FS) diagnosis through incorporation of a quantitative polymerase chain reaction (qPCR)-based genotyping assay. EXPERIMENTAL DESIGN: FS evaluation, including GFAP and CD20 rapid immunohistochemistry, was performed on adult malignant CNS tumors. PCNSL was diagnosed through positive CD20 and negative GFAP immunostaining. For suspected glioma, genotyping for IDH1/2, TERT SNV, and CDKN2A copy number alteration was routinely performed, whereas H3F3A and BRAF SNV were assessed for selected cases. i-ID was determined based on the 2021 WHO classification and compared with the permanent integrated diagnosis (p-ID) to assess its reliability. RESULTS: After retrospectively analyzing 153 cases, 101 cases were prospectively examined using the i-ID system. Assessment of IDH1/2, TERT, H3F3AK27M, BRAFV600E, and CDKN2A alterations with i-ID and permanent genomic analysis was concordant in 100%, 100%, 100%, 100%, and 96.4%, respectively. Combination with FS and intraoperative genotyping assay improved diagnostic accuracy in gliomas. Overall, i-ID matched with p-ID in 80/82 (97.6%) patientswith glioma and 18/19 (94.7%) with PCNSL. CONCLUSIONS: The i-ID system provides reliable integrated diagnosis of adult malignant CNS tumors.

DOI： 10.1158/1078-0432.CCR-23-1660

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND OBJECTIVES: Insulo-opercular surgery can cause ischemic motor complications. A source of this is the arteries around the superior limiting sulcus (SLS), which reach the corona radiata, but the detailed anatomy remains unclear. To characterize arteries around the SLS including the long insular arteries (LIAs) and long medullary arteries, we classified them and examined their distribution in relation to the SLS, which helps reduce the risk of ischemia. METHODS: Twenty adult cadaveric hemispheres were studied. Coronal brain slices were created perpendicular to the SLS representing insular gyri (anterior short, middle short, posterior short, anterior long, and posterior long). The arteries within 10-mm proximity of the SLS that reached the corona radiata were excavated and classified by the entry point. RESULTS: A total of 122 arteries were identified. Sixty-three (52%), 20 (16%), and 39 (32%) arteries penetrated the insula (LIAs), peak of the SLS, and operculum (long medullary arteries), respectively. 100 and six (87%) arteries penetrated within 5 mm of the peak of the SLS. The arteries were distributed in the anterior short gyrus (19%), middle short gyrus (17%), posterior short gyrus (20%), anterior long gyrus (19%), and posterior long gyrus (25%). Seven arteries (5.7%) had anastomoses after they penetrated the parenchyma. CONCLUSION: Approximately 90% of the arteries that entered the parenchyma and reached the corona radiata were within a 5-mm radius of the SLS in both the insula and operculum side. This suggests that using the SLS as a landmark during insulo-opercular surgery can decrease the chance of ischemia.

DOI： 10.1227/ons.0000000000000879

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Carotid artery stenting is sometimes adapted for some at-risk cases; however, appropriate treatment timing with stroke onset is controversial. This study aims to identify factors that have an impact on complications and outcomes, especially in patients at high risk. MATERIALS AND METHODS: We examined the characteristics of 152 consecutive patients treated by carotid artery stenting between January 2018 and March 2022 and retrospectively analyzed the risk factors for complications and poor outcomes (modified-Rankin-Scale deterioration), such as patient background, carotid artery stenting risks (access route tortuosity, severe calcification, vulnerable plaque, estimated glomerular filtration rate <30 mL/min/1.73 m2, etc.), characteristics of the stenosis, details of treatment, and treatment timing. RESULTS: The average North American Symptomatic Carotid Endarterectomy Trial criteria score was 68.3% and the lesion length was 20.5±9.7mm. Among patients, 107 (70.4%) had a carotid artery stenting risk. In high-risk carotid artery stenting cases, symptomatic complications occurred in 32 (30.0%), and the 90-day modified Rankin scale score deteriorated in 15 cases (14.0%). Multivariate analysis showed that cases with triple antithrombotic therapy (p=0.003), stenting within 7 days (p=0.0032), and after 28+ days (p=0.0035) of stroke onset were independently associated factors for complications. CONCLUSIONS: This study showed that among risk factors, triple antithrombotic therapy in particular was a risk factor for perioperative complications. Carotid artery stenting for patients with stroke after 28 days of onset affects the prognosis. Therefore, although further study is warranted, waiting more than one month for treatment in patients requiring carotid artery stenting is a potential risk.

DOI： 10.1016/j.jstrokecerebrovasdis.2023.107329

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: There have been several reports of central nervous system impairments associated with severe coronavirus disease 2019 (COVID-19) infection on head magnetic resonance imaging and angiography (MRI/A). However, head MRI/A is rarely performed in mild cases, and there have been few reports on intracranial changes after COVID-19 infection in these cases. Here, we report a comparative examination of the findings seen in common head MRI/A sequences in mild cases of COVID-19. METHODS: Of the 15,376 patients who underwent head MRI/A examination called "Brain Dock" between June 2020 and June 2021, 746 patients who received a COVID-19 antibody test were evaluated. Positive and negative patients were comparatively examined for head MRI/A findings such as cerebral white matter lesions, ischemic changes, cerebral microbleeds, cerebral aneurysms, arterial stenosis, sinusitis, and other abnormal findings. RESULTS: Overall, 31 (4.2%) patients were COVID-19 positive, and all of them had mild infections not requiring hospitalization. There was no significant difference in patient characteristics and head MRI/A findings between positive and negative patients. All positive patients showed no particular abnormalities in the nasal findings such as olfactory bulb atrophy or thickening of the olfactory mucosa. CONCLUSION: Intracranial lesions in mild patients do not show a clear difference from those in negative patients. This indicates that findings seen in common MRI/A sequences of severe patients are not likely in mild patients, supporting that there is relatively no damage to the central nervous system in mild patients.

DOI： 10.7759/cureus.34229

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1227/neuopn.0000000000000019

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000525229

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The use of mechanical thrombectomy (MT) for treatment of acute large vessel occlusion has recently increased. Prompt and timely guiding catheter (GC) induction is necessary to improve prognosis of MT and reduce the time for recanalization. However, difficulties in GC induction are encountered in some patients. This GC induction depends mainly on the aortic arch structure. Therefore, this study focused on assessing presence of tracheal shift on chest X-ray images as pre-treatment evaluation method for GC induction due to its wide availability as an indicator for status of the mediastinum. METHODS: We retrospectively examined 33 patients who underwent MT at our facilities between April 2017 and March 2021. The patients were divided into two groups according to presence or absence of tracheal shift on chest X-ray images. Background characteristics and treatment courses in these two groups were compared. RESULTS: Among 33 patients, tracheal shift was observed on the chest X-ray images of 14 patients. Furthermore, tracheal shift was positively correlated with the time of GC induction (32.9 min vs. 11.6 min, [p < 0.05]) and the female sex (p = 0.03). Additionally, tracheal shift exhibited correlations with multiple risk factors of atherosclerosis (p = 0.04). CONCLUSIONS: In patients with tracheal shift, GC induction could be expectedly difficult. Therefore, advanced disinfection of the right upper arm and affected side of the neck during MT in preparation for changing an approach route is required.

DOI： 10.1177/19714009221084237

PubMed

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：英語  

Background: It is not well-known that contralateral vertebral artery dissecting aneurysms (VADA) may be newly revealed after parental artery occlusion for unilateral VADA. However, the optimal treatment strategies and perioperative management have not been established. In this report, we present the case of a patient who required reconstructive embolization in the subacute stage for contralateral VADA developed after endovascular internal trapping of the ruptured VADA. Case Description: A 61-year-old man developed subsequent disturbance of consciousness. Head CT showed a diffuse and symmetrical SAH. 3DCT revealed a fusiform aneurysm of the left intracranial vertebral artery with bleb formation. We performed emergency endovascular parent artery occlusion of the left vertebral artery. A digital subtraction angiography on postoperative day 16 showed continued occlusion of the left VA, and a fusiform aneurysm was noted at the right VA. We performed reconstructive embolization and the patient eventually recovered with minimal persistent symptoms. Conclusion: Since the outcomes of contralateral VAD complicated by infarction or hemorrhage are poor, and most cases develop within 7-14 days after endovascular internal trapping for unilateral VAD, performing bilateral radiographic reinspection within this time frame is recommended for early detection and preventive treatment of possible contralateral VADs.

DOI： 10.25259/SNI_19_2022

PubMed

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The occipital transtentorial approach (OTA) is a very useful but challenging approach to expose the pineal region because the deep-seated arachnoid membranes usually fold and extend over the great vein of Galen (GVG), leading to dense and poor visibility. In addition, the practical aspects of arachnoid anatomy are not well understood. We aimed to develop a safe surgical procedure for the OTA according to the practical aspects of arachnoid anatomy. METHODS: The procedure is shown through an illustrative video of surgery and cadaver. Five cadavers were analyzed for their arachnoid structures and the surgical procedures via the OTA, in strict compliance with legal and ethical requirements. RESULTS: All cadavers showed a 2-layered arachnoid structure-one belonging to the occipital lobe, and the other to the cerebellum. According to our cadaveric analysis, the arachnoid attachment of the tentorial apex can be peeled bluntly, with an average distance of 10.2 mm. For our clinical presentation, a pineal tumor with hydrocephalus was detected in a 14-year-old boy. While using the OTA and expanding the deep surgical field, we detached the membrane from the tentorial apex and bluntly peeled it to reveal the deep veins. Finally, gross total removal of the tumor was achieved. CONCLUSIONS: A 2-layered arachnoid structure interposes the GVG from above and below the tentorium. The arachnoid membrane below the tentorium can be peeled off bluntly from the GVG to the attachment bundle limited by the penetrating veins. This detachment technique is useful for safe enlargement of the surgical field for the OTA.

DOI： 10.1016/j.wneu.2021.04.041

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本てんかん学会  

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記述言語：日本語   出版者・発行元：(一社)日本てんかん学会  

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記述言語：日本語   出版者・発行元：(一社)日本てんかん学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床スポーツ医学会  

脳振盪の重症化や慢性化リスクが明らかになり、その予防や適切な対応の重要性は増加している。そのため、スポーツに伴う脳振盪ではスポーツ現場での迅速な判断や対応が求められる。特に若年での脳振盪は症状の遷延や認知機能への影響、長期の競技期間による慢性外傷性脳症のリスクが指摘されており、安全な競技環境のための脳振盪についての知識の普及が重要である。一方で、選手の脳振盪を予防する環境整備や選手及び保護者の脳振盪に対する知識の程度は未知である。今回、安全なボクシング競技環境の整備を目的とし、神奈川県で活動するボクシングアンダージュニア選手および保護者を対象に無記名方式のアンケート調査を実施したため報告する。選手の平均年齢は12.1歳で、ボクシング開始年齢は平均8.8歳だった。回答のあったアンダージュニア選手は過去に平均5.9試合を経験していた。臨床スポーツ医学会を中心に作成された「頭部外傷10か条の提言」を知らない割合は選手で77%、保護者で62%だった。また、脳振盪に対する「段階的復帰の必要性」を知らない割合は選手で58%、保護者で62%だった。このように、半数以上の選手及び保護者は脳振盪についての十分な知識を持たずに競技に臨んでいることが明らかとなった。本アンケートの結果から、選手のみならず保護者を対象とした頭部外傷の知識の啓発が不可欠と考えられる。(著者抄録)

J-GLOBAL

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J03582&link_issn=&doc_id=20210514370019&doc_link_id=%2Fdp2sport%2F2021%2F002902%2F019%2F0211-0219%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdp2sport%2F2021%2F002902%2F019%2F0211-0219%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Primary central nervous system lymphoma (PCNSL) is an isolated type of lymphoma of the central nervous system and has a dismal prognosis despite intensive chemotherapy. Recent genomic analyses have identified highly recurrent mutations of MYD88 and CD79B in immunocompetent PCNSL, whereas LMP1 activation is commonly observed in Epstein-Barr virus (EBV)-positive PCNSL. However, a lack of clinically representative preclinical models has hampered our understanding of the pathogenic mechanisms by which genetic aberrations drive PCNSL disease phenotypes. Here, we establish a panel of 12 orthotopic, patient-derived xenograft (PDX) models from both immunocompetent and EBV-positive PCNSL and secondary CNSL biopsy specimens. PDXs faithfully retained their phenotypic, metabolic, and genetic features, with 100% concordance of MYD88 and CD79B mutations present in PCNSL in immunocompetent patients. These models revealed a convergent functional dependency upon a deregulated RelA/p65-hexokinase 2 signaling axis, codriven by either mutated MYD88/CD79B or LMP1 with Pin1 overactivation in immunocompetent PCNSL and EBV-positive PCNSL, respectively. Notably, distinct molecular alterations used by immunocompetent and EBV-positive PCNSL converged to deregulate RelA/p65 expression and to drive glycolysis, which is critical for intracerebral tumor progression and FDG-PET imaging characteristics. Genetic and pharmacologic inhibition of this key signaling axis potently suppressed PCNSL growth in vitro and in vivo. These patient-derived models offer a platform for predicting clinical chemotherapeutics efficacy and provide critical insights into PCNSL pathogenic mechanisms, accelerating therapeutic discovery for this aggressive disease. SIGNIFICANCE: A set of clinically relevant CNSL xenografts identifies a hyperactive RelA/p65-hexokinase 2 signaling axis as a driver of progression and potential therapeutic target for treatment and provides a foundational preclinical platform. GRAPHICAL ABSTRACT: http://cancerres.aacrjournals.org/content/canres/80/23/5330/F1.large.jpg.

DOI： 10.1158/0008-5472.CAN-20-2425

PubMed

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

小児後頭蓋窩上衣腫で、播種を伴い多発に再発した場合の治療については一定の見解はない。本症例は第四脳室に発生した退形成性上衣腫の6歳女児で、3回の手術で全摘出後に後頭蓋窩照射するも、その後播種を伴い再発を繰返した。定位照射により各腫瘍は1年程度制御でき、合計14回の手術と11回の定位照射で発症から60ヵ月は良好なQOLを保つことができた。再発時の治療は再手術や追加照射を繰り返すことになり、患児の負担が大きい。定位照射は手術回数を減らしQOLを維持する目的で、治療オプションと成り得ると考えられた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00650&link_issn=&doc_id=20210115260006&doc_link_id=%2Fco2socie%2F2020%2F004504%2F006%2F0358-0364%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fco2socie%2F2020%2F004504%2F006%2F0358-0364%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Cerebral bypass surgery, such as the STA-MCA bypass, is one of the essential procedures for cerebral revascularization. However, very narrow or thin blood vessels increase the risk of anastomotic problems, as seen in Moyamoya disease. For such vessels, we have devised the "lifting method" in the recipient arteriotomy. Here, we introduce this novel optional technique and evaluate its effects. METHODS: The "lifting method" is a procedure of lifting the incision edge in a linear incision on the recipient vessel to widen the ostium. We attempted the "lifting method" in 23 consecutive cases (41 arteries) and, as a historical control, compared it with the conventional method of 25 consecutive cases (37 arteries) for the previous 3 years. We compared patient age, years of surgical experience, recipient vessel diameter, anastomotic events and final patency. As a sub-analysis, the same evaluations were done for Moyamoya disease cases. Furthermore, the time required for the lifting procedure was measured retrospectively. RESULTS: The incidence of anastomotic events in the conventional method was 13.5% overall and 19% in Moyamoya disease. No events occurred with the "lifting method" (P <0.05). There was no significant difference in other factors including final patency between the two groups. The time required for lifting procedure averaged at 1 minute 15 seconds. CONCLUSIONS: The "lifting method" widens and secures the ostium in a recipient vessel and greatly facilitates operability. This is a foolproof method enabling safe and reliable anastomosis even in conditions of narrow or thin vessels.

DOI： 10.1016/j.wneu.2020.06.077

PubMed

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記述言語：英語  

Thiel's embalming method provides natural coloration, flexibility, and tissue plasticity, and is used widely to prepare specimens for cadaver surgical training. However, this method causes brain softening, thereby restricting the cadaver surgical training of intra-cranial procedures. In this study, three cadavers were embalmed using formalin fixation, Thiel's embalming method, and Thiel's embalming method with additional intra-cerebral ventricular formalin injection, respectively. We also established rat models of the three embalming methods to develop and determine the best method for retaining adequate brain elasticity. The intra-ventricular formalin injection in the cadaver was performed through the Kocher's point, as in the classical external ventricular drain procedure. Both, the cadaver brains and rat models yielded consistent shear wave measurements and brain surface stiffness data. Notably, the Thiel's embalming method with additional intra-cerebral ventricular formalin injection yielded suitable elasticity for brain cadaver surgical training in terms of brain mobilization and surgical field deployment, and also discharged formaldehyde in undetectable quantities. To our knowledge, this is the first report in which a fixed quality, namely, brain elasticity for the performance of head and brain cadaver surgical training, has been evaluated in a cadaver subjected to the Thiel's embalming method with immersion fixation in the cerebrospinal fluid space. We conclude that the Thiel's embalming method with additional intra-cerebral ventricular formalin injection can maintain the brain elasticity, and may therefore improve the quality of head and brain cadaver surgical training safely and easily.

DOI： 10.1007/s12565-020-00545-z

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記述言語：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

症例は31歳男性で、発熱を主訴に外来を受診した。僧帽弁に疣贅を認め、血液培養からα-hemolytic Streptococcusが検出され、感染性心内膜炎と診断され入院となった。入院翌日に心臓血管外科で僧帽弁置換術を施行され、頭部MRIで左後大脳動脈末端に紡錘状の動脈瘤を認めた。抗生剤投与にもかかわらず動脈瘤が消退しないため血管内治療となった。全身麻酔下に視覚誘発電位(VEP)の術中モニタリングを行い、バルーンを拡張、造影を行うと後頭葉の造影欠損を認め、直後から左後頭葉のVEP振幅が低下し始めた。そこで、left parieto-occipital arteryを温存しつつleft calcarine arteryの起始拡張部をコイル塞栓することにした。術後はアスピリン100mg/日とクロピドグレル300mg/日の内服を開始し、クロピドグレルは75mg/日で維持を行った。MRAで動脈瘤は消失し、MRI拡散強調画像で新規梗塞はなかった。視野欠損なく独歩で退院した。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J02079&link_issn=&doc_id=20200527210009&doc_link_id=%2Fcp4strok%2F2020%2F004802%2F009%2F0134-0138%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2020%2F004802%2F009%2F0134-0138%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：横浜市立大学医学会  

横浜市立大学脳神経外科教室では、2009年より毎年頭頸部特別解剖講習を開催してきた。臨床医学の教育および研究を取り巻く環境はこの10年で変化してきている。その中にあって、本講習は一貫して頭頸部に関する専門的な微小解剖知識と手術技術の教育・習得を目的として11回にわたり継続してきた。講習参加者を対象としたアンケートからは、本講習が後期研修医にとって臨床に則した知識と技術を習得するための貴重な機会となっていることが明らかとなった。講習の充実を図るため、私たちは国内屈指のエキスパートに講師を依頼し、臨床に則した充実した手術機器を使用するなどの特徴的な講習を心がけている。本論文では、私たちの解剖講習に御協力頂いている有美会会員及び御遺族の皆さまへの感謝を再認識し、御意志や御期待に最大限応えるための解剖講習の歩みと将来への展望を概説する。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01499&link_issn=&doc_id=20200622220007&doc_link_id=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00001859%2F&url=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00001859%2F&type=%89%A1%95l%8Es%97%A7%91%E5%8Aw%81F%89%A1%95l%8Es%97%A7%91%E5%8Aw%8Aw%8Fp%8B%40%8A%D6%83%8A%83%7C%83W%83g%83%8A&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80205_3.gif

記述言語：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.expneurol.2019.113068

PubMed

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記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中の外科学会  

<p>Introduction: Magnetic resonance imaging (MRI) and spinal digital subtraction angiography (DSA) are considered the gold standard for the screening and diagnosis of spinal dural arteriovenous fistula (SPDAVF). However, the flow-void signals of abnormal vessels are not always reported, even when spinal cord edema is detected with the MRI, rendering the diagnosis in such cases difficult. Similarly, although selective spinal DSA is useful for the definite diagnosis of SPDAVF, it can be a lengthy procedure requiring technical proficiency. Here, we introduce an effective diagnostic procedure with MRI (3T MRI 3D T2 Cube), followed by reconstruction of the 3D-CTA (64 row multistring detector CT).</p><p>Material and Methods: A total of 15 consecutive cases of SPDAVF present in the departmental database from April 2006 to June 2017 were reviewed in this study. Of these, we enrolled 5 patients who conducted the 3T MRI 3D T2 Cube and/or 3D-CTA with the analysis application VINCENT®.</p><p>Result: Of the 5 SPDAVF cases analyzed, 4 showed flow-void signals around the spinal cord in the 1.5T MRI T2WI. In contrast, all cases showed engorged vessels around the spinal cord with the 3D-CTA reconstructed VINCENT® image. The entry point of the influx vessels can be easily identified, resulting in simple and efficient selective spinal DSA. Furthermore, the 3D-CTA reconstructed image was helpful as a surgical simulation tool.</p><p>Conclusion: The diagnostic procedure of the 3T MRI 3D T2 Cube followed by the reconstructed 3D-CTA image markedly contributes to the diagnosis of SPDAVF and the identification of the entry point of the influx vessels and is helpful for both efficient spinal DSA and surgical simulation.</p>

DOI： 10.2335/scs.48.42

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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DOI： 10.1038/s41598-019-50073-8

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DOI： 10.2176/nmc.tn.2018-0299

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

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DOI： 10.11477/mf.1436203773

PubMed

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DOI： 10.1080/02688697.2018.1485877

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

60歳女性。左顔面痙攣を主訴とした。頭部単純MRI/MRAにて左後下小脳動脈(左PICA)による左顔面神経の圧迫所見を認めたため、治療目的に入院となった。左顔面痙攣に対し、異常筋反応モニタリング(AMR)併用下に動脈刺激筋反応モニタリング(AWS-EMG)を行い、術中に異常波形を確認し、微小血管減圧術を施行した。術後AMR、AWS-EMGの異常波形は消失し、顔面痙攣も改善が得られた。

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1436203487

PubMed

CiNii Research

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その他リンク： https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-16K10765/

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ACADEMIC PRESS INC ELSEVIER SCIENCE  

Most of the successes in experimental models of stroke have not translated well to the clinic. One potential reason for this failure is that stroke mainly afflicts the elderly and the majority of experimental stroke studies rely on data gathered from young adult animals. Therefore, in the present study we established a reliable, reproducible model of stroke with low mortality in aged (18 month) male mice and contrasted their pathophysiological Changes with those in young (2 month) animals. To this end, mice were subjected to permanent tandem occlusion of the left distal middle cerebral artery (dMCAO) with ipsilateral common carotid artery occlusion (CCAO). Cerebral blood flow (CBF) was evaluated repeatedly during and after stroke. Reduction of CBF was more dramatic and sustained in aged mice. Aged mice exhibited more severe long-term sensorimotor deficits, as manifested by deterioration of performance in the Rotarod and hanging wire tests up to and after stroke. Aged mice also exhibited significantly worse long-term cognitive deficits after stroke, as measured by the Morris water maze test Consistent with these behavioral observations, brain infarct size and neuronal tissue loss after dMCAO were significantly larger in aged mice at 2 d and 14 d, respectively. The young versus aged difference in neuronal tissue loss, however, did not persist until 35 d after dMCAO. In contrast to the transient difference in neuronal tissue loss, we found significant and long lasting deterioration of white matter in aged animals, as revealed by the loss of myelin basic protein (MBP) staining in the striatum at 35 d after dMCAO. We further examined the expression of M1 (CD16/CD32) and M2 (CD206) markers in Iba-1(+) microglia by double immunofluorescent staining. In both young and aged mice, the expression of M2 markers peaked around 7 d after stroke whereas the expression of M1 markers peaked around 14 d after stroke, suggesting a progressive M2-to-M1 phenotype shift in both groups. However, aged mice exhibited significantly reduced M2 polarization compared to young adults. Remarkably, we discovered a strong positive correlation between favorable neurological outcomes after dMCAO and MBP levels or the number of M2 microglia/macrophages. In conclusion, our studies suggest that the distal MCAO stroke model consistently results in ischemic brain injury with long-term behavioral deficits, and is therefore suitable for the evaluation of long-term stroke outcomes. Furthermore, aged mice exhibit deterioration of functional outcomes after stroke and this deterioration is linked to white matter damage and reductions in M2 microglia/macrophage polarization. (C) 2015 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.expneurol.2015.03.021

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ACADEMIC PRESS INC ELSEVIER SCIENCE  

Previous research on stroke and traumatic brain injury (TBI) heavily emphasized pathological alterations in neuronal cells within gray matter. However, recent studies have highlighted the equal importance of white matter integrity in long-term recovery from these conditions. Demyelination is a major component of white matter injury and is characterized by loss of the myelin sheath and oligodendrocyte cell death. Demyelination contributes significantly to long-term sensorimotor and cognitive deficits because the adult brain only has limited capacity for oligodendrocyte regeneration and axonal remyelination. In the current review, we will provide an overview of the major causes of demyelination and oligodendrocyte cell death following acute brain injuries, and discuss the crosstalk between myelin, axons, microglia, and astrocytes during the process of demyelination. Recent discoveries of molecules that regulate the processes of remyelination may provide novel therapeutic targets to restore white matter integrity and improve long-term neurological recovery in stroke or TBI patients. (C) 2015 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.expneurol.2015.03.017

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1038/nrneurol.2014.207

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記述言語：英語   出版者・発行元：PERGAMON-ELSEVIER SCIENCE LTD  

Microglia are the first line of immune defense against central nervous system (CNS) injuries and disorders. These highly plastic cells play dualistic roles in neuronal injury and recovery and are known for their ability to assume diverse phenotypes. A broad range of surface receptors are expressed on microglia and mediate microglial 'On' or 'Off' responses to signals from other host cells as well as invading microorganisms. The integrated actions of these receptors result in tightly regulated biological functions, including cell mobility, phagocytosis, the induction of acquired immunity, and trophic factor/inflammatory mediator release. Over the last few years, significant advances have been made toward deciphering the signaling mechanisms related to these receptors and their specific cellular functions. In this review, we describe the current state of knowledge of the surface receptors involved in microglial activation, with an emphasis on their engagement of distinct functional programs and their roles in CNS injuries. It will become evident from this review that microglial homeostasis is carefully maintained by multiple counterbalanced strategies, including, but not limited to, 'On' and 'Off' receptor signaling. Specific regulation of theses microglial receptors may be a promising therapeutic strategy against CNS injuries. (C) 2014 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.pneurobio.2014.06.002

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

A 65-year-old woman presented with basilar invagination manifesting as neck pain, dysesthesia around the lips, and truncal ataxia. The radiological findings demonstrated invagination of the odontoid process into the medulla oblongata and vertical atlantoaxial subluxation with C1 assimilation. The clivo-axial angle was 88A degrees and the cervicomedullary angle was 115A degrees, indicating severe basilar invagination. We planned occipitocervical fusion with atlantoaxial distraction using a cylindrical titanium cage. C2 pedicle screws were inserted, and the atlantoaxial joint was opened to translocate the odontoid process downward. A cylindrical titanium cage packed with local bone graft was inserted into the opened facet joint space. Occipital-C2 fusion was completed by fastening the occipital bone plates with pedicle screws using titanium rods. Postoperatively, the apex of the odontoid process descended by 7 mm, and the clivo-axial and cervicomedullary angles opened to 112A degrees and 125A degrees, respectively. Invagination of the odontoid process into the medulla oblongata was relieved. The preoperative symptoms improved, and she remained symptom-free without requiring anterior decompression over 2 years. Bone fusion of the atlantoaxial joints was completed with sustained facet distraction 12 months after the surgery, and adequate relief of the basilar invagination was maintained. The atlantoaxial distraction method using a cylindrical titanium cage can be a useful option in posterior fusion surgery for basilar invagination.

DOI： 10.1007/s10143-014-0531-0

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DOI： 10.3174/ajnr.A3679

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記述言語：英語  

添付ファイル： Austin J 論文ajns-v1-id1013 suenaga manuscript final version.pdf

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: The regulatory mechanisms of motor protein-dependent intracellular transport are still not fully understood. The kinesin-1-binding protein, JIP1, can function as an adaptor protein that links kinesin-1 and other JIP1-binding "cargo" proteins. However, it is unknown whether these "cargo" proteins influence the JIP1-kinesin-1 binding.
Results: We show here that JIP1-kinesin-1 binding in Neuro2a cells was dependent on conserved amino acid residues in the JIP1-phosphotyrosine binding (PTB) domain, including F687. In addition, mutation of F687 severely affected the neurite tip localization of JIP1. Proteomic analysis revealed another kinesin-1 binding protein, JIP3, as a major JIP1 binding protein. The association between JIP1 and JIP3 was dependent on the F687 residue in JIP1, and this association induced the formation of a stable ternary complex with kinesin-1. On the other hand, the binding of JIP1 and JIP3 was independent of kinesin-1 binding. We also show that other PTB binding proteins can interrupt the formation of the ternary complex.
Conclusions: The formation of the JIP1-kinesin-1 complex depends on the protein binding-status of the JIP1 PTB domain. This may imply a regulatory mechanism of kinesin-1-dependent intracellular transport.

DOI： 10.1186/1471-2121-14-12

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

A 53-year-old man suffered contralateral hearing disturbance one day after acoustic neuroma surgery. Hearing function gradually recovered after steroid and hyperbaric therapy. Contralateral hearing disturbance after acoustic neuroma surgery is an extremely rare complication that can also occur after other posterior fossa surgery. The mechanism of this rare phenomenon remains unclear, but the patent cochlear aqueduct may be involved.

DOI： 10.2176/nmc.51.434

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER ASSOC NEUROLOGICAL SURGEONS  

Object. The outcomes after Gamma Knife surgery (GKS) were retrospectively analyzed in patients with brain metastases from radioresistant primary colorectal cancer to evaluate the efficacy of GKS and the prognostic factors for local tumor control and overall survival.
Methods. The authors reviewed the medical records of 152 patients with 616 tumors. The group included 102 men and 50 women aged 35-85 years (mean age 64.4 years), who underwent GKS for metastatic brain tumors from colorectal cancer between April 1992 and September 2008 at Yokohama Rosai Hospital.
Results. The mean prescription dose to the tumor margin was 18.5 Gy (range 8-30 Gy). The mean tumor volume at GKS was 2.0 cm(3) (range 0.004-10.0 cm(3)). The primary tumors were located in the colon in 88 patients and the rectum in 64. The median interval between the diagnosis of primary lesions and the diagnosis of brain metastases was 27 months (ranee 0-180 months). The median neuroradiological follow-up period after GKS was 3 months (mean 6.4 months, range 1-93 months). The local tumor growth control rate, based on MR imaging, was 91.2%. The significant factors for unfavorable local tumor growth control, based on multivariate analysis, were larger tumor volume (p = 0.001) and lower margin dose (p = 0.016). The median overall survival time was 6 months. Lower Karnofsky Performance Scale (KPS) score (p = 0.026) and the presence of extracranial metastases (p = 0.004) at first GKS were significantly correlated with poor overall survival period in multivariate analysis. The cause of death was systemic disease in 112 patients and neurological disease in 13 patients. Leptomeningeal carcinomatosis was significantly correlated with a shorter duration of neurological survival in multivariate analysis (p&lt;0.0001).
Conclusions. Gamma Knife surgery is effective for suppression of local tumor growth in patients with brain metastases from radioresistant colorectal primary cancer. Therefore, clinical and radiological screening of intracranial metastases for patients with lower KPS scores and/or the presence of extracranial metastases as well as follow-up examinations after GKS for brain metastases should be performed periodically in patients with colorectal cancer, because the neurological prognosis is improved by initial and repeat GKS for newly diagnosed or recurrent tumors leading to a prolonged high-quality survival period. (DOI: 10.3171/2010.9.JNS10354)

DOI： 10.3171/2010.9.JNS10354

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Background: To establish the surgical indications and strategy for late complications following gamma knife surgery (GKS) for arteriovenous malformations (AVMs). Methods: Ten male and 7 female patients aged 17-52 years (mean 28.0 years) were retrospectively identified among 686 patients who underwent GKS for AVM at our hospital. Ten patients showed cyst formation (group A), 2 patients had expanding hematoma (group B), and 5 patients had both cyst and expanding hematoma (group C). Results: The mean nidus volume was 10.1 ml (range 0.1-36 ml), and the mean prescription dose at the nidus margin was 19.9 Gy (range 18-28 Gy). Complete obliteration of the nidus was obtained in 12 patients, partial obliteration in 4, and no change in 1. Cyst formation (group A) was asymptomatic in 5 patients, and symptomatic in 5 patients, manifesting as headache, hemianopia, aphasia, and motor weakness. Expanding hematoma (groups B and C) was associated with surrounding brain edema and was symptomatic in all 7 patients. Cyst opening in 1 patient and placement of an Ommaya reservoir in 2 patients were necessary in group A. Both patients in group B underwent craniotomy. Four of the 5 patients in group C required craniotomy. Another patient in group C was lost to follow-up and the final outcome was unknown. Conclusions: Cyst formation is one of the late complications of GKS for AVM. Some cysts show spontaneous regression but others gradually increase in size and become symptomatic, although relatively large asymptomatic cysts are also known. Predicting the future course of a cyst is difficult. Surgery such as placement of an Ommaya reservoir should be considered for symptomatic cases. Expanding hematoma always increases in size and becomes symptomatic, so removal by craniotomy is necessary. Surrounding brain edema decreases rapidly after surgery and neurological symptoms quickly resolve. Copyright (C) 2011 S. Karger AG, Basel

DOI： 10.1159/000323543

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記述言語：日本語   出版者・発行元：The Japanese Society on Surgery for Cerebral Stroke  

We retrospectively studied 15 patients, 9 men and 6 women aged 17 to 52 years (mean 28.1 years), who developed cyst formation following gamma knife radiosurgery (GKS) at our hospital for cerebral arteriovenous malformation (AVM). The mean nidus volume was 11 cm³ (0.1-26.7 cm³), and the mean prescription dose at the nidus margin was 20.0 Gy (18-28 Gy). Nidus obliteration was obtained in 9 patients, partial obliteration in 5, and no change in 1. Cyst formation was detected from 2.5 to 13.5 years (mean 6.4 years) after GKS. Three patients underwent craniotomy, and 2 received placement of an Ommaya reservoir. Spontaneous regression of cyst was observed in 2 patients. The outcome of the cyst was unknown in 2 patients, because of no response from the neurosurgeon the patients were referred to. Serial magnetic resonance imaging was performed in the other 6 patients because the cyst size was stable or asymptomatic. These findings suggest that cyst formation following GKS is not a "late complication." <br> Placement of an Ommaya reservoir or cyst-peritoneal shunt is recommended for cysts with obliterated nidus. Craniotomy should be considered if the nidus is not completely obliterated or the cyst is associated with an expanding hematoma. Serial follow-up imaging is recommended for asymptomatic patients.<br>

DOI： 10.2335/scs.38.228

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その他リンク： http://search.jamas.or.jp/link/ui/2010317891

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

JNK is one of the key molecules regulating cell differentiation and migration in a variety of cell types, including cerebral cortical neurons. MUK/DLK/ZPK belongs to the MAP kinase-kinase-kinase class of protein kinases for the JNK pathway and is expressed predominantly in neural tissue. We have determined the expression pattern of MUK/DLK/ZPK and active JNK in the cerebellum at different stages of postnatal development. Quantitative analysis by Western blotting has showed that high expression levels of MUK/DLK/ZPK and active JNK are maintained during the postnatal development of the cerebellum, and that these levels decrease in the adult cerebellum. Immunohistochemical staining has revealed, however, that their distribution in the developing cerebellum is considerably different. Although active JNK is highly concentrated in the premigratory zone of the external germinal layer (EGL), high expression of MUK/DLK/ZPK has been observed in the molecular layer and in the premigratory zone. Neither the active JNK nor MUK protein has been detected in the proliferative zone of the EGL. These observations suggest that during the postnatal development of the cerebellum, the MUK-JNK signaling pathway contributes to the regulation of granule cell differentiation and migration; further, the activity of MUK/DLK/ZPK is tightly regulated by posttranslational mechanisms and by its expression level.

DOI： 10.1007/s00441-006-0164-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

C-Jun N-terminal kinase (JNK) is implicated in regulating the various cellular events during neural development that include differentiation, apoptosis and migration. MUK/DLK/ZPK is a MAP kinase kinase kinase (MAPKKK) enzyme that activates JNK via MAP kinase kinases (MAPKK) such as MKK7. We show here that the expression of MUK/DLK/ZPK protein in the developing mouse embryo is almost totally specific for the neural tissues, including central, peripheral, and autonomic nervous systems. The only obvious exception is the liver, in which the protein is temporally expressed at around E11. The expression becomes obvious in the neurons of the brain and neural crest tissues at embryonic day 10 (E10) after neuron production is initiated. By E14, MUK/DLK/ZPK proteins are found in various neural tissues including the brain, spinal cord, sensory ganglia (such as trigeminal and dorsal root ganglia), and the sympathetic and visceral nerves. The localization of MUK/DLK/ZPK protein in neural cells almost consistently overlapped that of beta III-tubulin, a neuron specific tubulin isoform, and both proteins were more concentrated in axons than in cell bodies and dendrites. The intensely overlapping localization of beta III-tubulin and MUK/DLK/ZPK indicated that this protein kinase is tightly associated with the microtubules of neurons. (c) 2005 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.modgep.2004.12.002

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

【目的】脳底動脈閉塞を呈した急性期脳梗塞に対して、左橈骨動脈穿刺で機械的血栓回収療法を行い良好な結果を得たため、文献的考察を加えて報告する。【症例】73歳男性。意識障害で発見され、救急搬送。National Institutes of Health Stroke Scale(NIHSS)25点。頭部CTで脳底動脈先端部にhyper dense signを認め、機械的血栓回収術を施行。右椎骨動脈は閉塞し、左椎骨動脈は起始部に高度狭窄を認めた。左椎骨動脈は起始部で屈曲しており、左橈骨動脈穿刺に変更し、まず狭窄部に対して経皮的血管形成術を施行した後に、脳底動脈閉塞部の血栓回収し、完全再開通を得た。【結語】脳底動脈閉塞に対する機械的血栓回収療法において、完全再開通までの時間はできるだけ短くすべきである。左橈骨動脈穿刺に変更したことで、狭窄の通過が容易となった。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J06751&link_issn=&doc_id=20190513310006&doc_link_id=%2Fcf5nokec%2F2019%2F000402%2F006%2F0090-0094%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf5nokec%2F2019%2F000402%2F006%2F0090-0094%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

診断・治療を行った中枢神経系原発悪性リンパ腫(PCNSL)は78例で、大量シタラビン、シスプラチン、エトポシド、メチルプレドニゾロンを用いた化学療法(ESHAP療法)を施行したものは35例であった。そのなかで大量メトトレキサート(HD-MTX)療法を行ったが進行・再発し、二次化学療法としてESHAP療法を施行した18例(28〜77歳)を対象とした。全生存期間は3.9〜124.9ヵ月、PCNSL発症時のKarnofsky Performance Statusは30〜100に対して、ESHAP療法施行時は50〜100であった。ESHAP療法1クール目終了時のRRは77.8%で、CRを6例に認めた。ESHAP療法は1〜8クール施行し、最終クール後のRRは61.1%で、CRを4例に認めた。HD-MTX療法においてPDであった早期進行症例についても、ESHAP療法の最終クールにおけるRRは77.8%で、CRを3例に認めた。ESHAP療法における、Grade 3以上の副作用は66.7%に認め、全症例が骨髄抑制による好中球減少、あるいは血小板減少であった。

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記述言語：日本語   出版者・発行元：(株)医学書院  

診断・治療を行った中枢神経系原発悪性リンパ腫(PCNSL)は78例で、大量シタラビン、シスプラチン、エトポシド、メチルプレドニゾロンを用いた化学療法(ESHAP療法)を施行したものは35例であった。そのなかで大量メトトレキサート(HD-MTX)療法を行ったが進行・再発し、二次化学療法としてESHAP療法を施行した18例(28〜77歳)を対象とした。全生存期間は3.9〜124.9ヵ月、PCNSL発症時のKarnofsky Performance Statusは30〜100に対して、ESHAP療法施行時は50〜100であった。ESHAP療法1クール目終了時のRRは77.8%で、CRを6例に認めた。ESHAP療法は1〜8クール施行し、最終クール後のRRは61.1%で、CRを4例に認めた。HD-MTX療法においてPDであった早期進行症例についても、ESHAP療法の最終クールにおけるRRは77.8%で、CRを3例に認めた。ESHAP療法における、Grade 3以上の副作用は66.7%に認め、全症例が骨髄抑制による好中球減少、あるいは血小板減少であった。

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記述言語：日本語   出版者・発行元：一般社団法人 日本脳卒中の外科学会  

We report herein five cases of symptomatic brainstem cavernous malformations (CM). Specific surgical approaches were designed to directly access each lesion. Neuronavigation and intraoperative monitoring were used. Four lesions underwent gross total resection, and one was subtotally partially removed. None of the patients developed new neurological deficits and all cases showed an improvement based on the modified Rankin Scale and the Karnofsky Performance Status. Although brainstem CM have a relatively high rate of re-bleeding, thus adversely affecting the neurological status of the patient, recent reports have demonstrated favorable outcomes after their resection. Hence, surgical removal can be recommended for cases of symptomatic brainstem CM, particularly those with re-bleeding. An optimal surgical approach, providing direct access to the lesion, is critical for successfully resecting brainstem CM.

DOI： 10.2335/scs.46.58

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記述言語：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

手術を施行した脳幹海綿状血管腫5例(男性2例、女性3例、32〜67歳)を対象とした。部位は、中脳1例、中脳-橋1例、橋2例、橋-延髄1例で、腹側病変2例、背側病変3例であった。全例出血発症で、発症から手術までの期間は2〜156ヵ月、再出血回数は1〜5回、最終出血から手術までの期間は6〜60週であった。手術時の最大径は19〜43mmであった。手術アプローチは原則として脳幹表面から病変までの距離が最短となるものを選択した。全摘出4例、部分摘出1例であった。腹側病変に対してはtemporopolar approach、anterior transpetrosal approach、背側病変に対しては、trans 4th ventricle approach、infratentorial supracerebellar approachで摘出した。術後入院期間は平均36.2日で、4例が自宅退院した。mRSは手術により4.0±0.70から2.0±0.78と改善傾向がみられ、全例において術後の新たな神経学的後遺症は生じなかった。

DOI： 10.2335/scs.46.58

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記述言語：日本語   掲載種別：記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

症例1(52歳女性)。右後頭葉AVMに対するガンマナイフ(GKS)10年後に左下肢の筋力低下が出現し、血管腫様病変の診断に至った。頭部造影MRIでは右後頭葉に強い周辺脳浮腫を伴う増強効果の著しい腫瘤が認められた。そこで、右後頭開頭による全摘出術を行ったところ、術後、神経症状、脳浮腫は速やかに改善した。症例2(20歳女性)。脳室内出血で発症した左後頭葉AVMに対するGKS後11年経過で頭痛が出現し、診断に至った。頭部造影MRIでは左後頭葉に強い周辺脳浮腫を伴う増強効果の著しい腫瘤、ならびに脳室内嚢胞性病変が認められ、腹臥位にて後頭葉半球間裂経由で摘出し、術後、頭痛と脳浮腫は速やかに改善した。症例3(31歳女性)。AVMに対するGKS後9年経過で右上下肢の筋力低下が出現し、診断に至った。頭部MRIでは左半球間裂に腫瘤が認められ、T2では強い周辺脳浮腫がみられた。そこで、経半球裂アプローチにて全摘出したところ、術後に一過性の右片麻痺が生じたが、運動麻痺は1週間後にはほぼ回復し、脳浮腫も術後1ヵ月以内に消失した。

DOI： 10.2335/scs.39.347

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

穿頭血腫ドレナージ術を施行した109例のうち再発した11例(男8例、女3例、年齢51〜91歳)を対象に、再発に影響を及ぼす因子について多変量解析を用いて検討した。11例中6例に先行する頭部打撲があり、抗血栓・凝固薬使用では抗凝固薬1例、高血圧あり2例、糖尿病あり2例であった。その結果、「手術翌日の残存空気が1/4(25%)以上」と「1週間後の脳の膨張率が悪い」のみが有意な因子であった。年齢、性別、先行する頭部打撲、抗血栓・凝固療法の有無、高血圧・糖尿病の既往については再発因子としては有意ではなかった。また、手術翌日に残存空気が25%以上ある群は、残存空気が少ない群と比較して優位に1週間後の脳の膨張率が悪い結果となった。

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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