論文 - 秋山　武紀

Endoscopic endonasal removal of a pediatric paranasal ossifying fibroma using preoperative embolization

Saito S., Ozawa H., Ikari Y., Nakahara N., Ito F., Sekimizu M., Kameyama K., Akiyama T., Toda M., Ogawa K.

Otolaryngology Case Reports （Otolaryngology Case Reports）  14 2020年03月

共著

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© 2019 Elsevier Inc. Background: Ossifying fibroma arising in the sinonasal tract is rare. Its treatment includes complete resection; however, this can be challenging to perform due to the well-vascularized nature of the fibroma. Some surgical techniques can control intraoperative hemorrhage; however, to date, no reports have assessed the use of preoperative embolization. Methods: We report a case of a child with ossifying fibroma arising from the ethmoid sinus, which was resected by endoscopic surgery using preoperative transarterial embolization. Conclusions: Embolization was effective in decreasing intraoperative hemorrhage. No complications related to the procedure or operation were encountered. Preoperative embolization should be considered for better control of the bleeding that occurs in ossifying fibromas, similar to that in other well-vascularized tumors.

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Effectiveness of staged angioplasty for avoidance of cerebral hyperperfusion syndrome after carotid revascularization

Hayakawa Mikito, Sugiu Kenji, Yoshimura Shinichi, Hishikawa Tomohito, Yamagami Hiroshi, Fukuda-Doi Mayumi, Sakai Nobuyuki, Iihara Koji, Ogasawara Kuniaki, Oishi Hidenori, Ito Yasushi, Matsumaru Yuji, Ichihashi Toshikazu, Suzuki Kensuke, Tanaka Yoshihiro, Hyodo Akio, Hayase Makoto, Miyakoshi Akinori, Toda Hiroki, Enomoto Yukiko, Egashira Yusuke, Yamauchi Keita, Iwama Toru, Haraguchi Koichi, Yoshioka Tsutomu, Sambongi Yoshiki, Okata Takuya, Mizoue Tatsuya, Uchida Kazutaka, Shirakawa Manabu, Yamada Kiyofumi, Yoshimura Shinichi, Oishi Hidenori, Yamamoto Munetaka, Teranishi Kosuke, Yatomi Kenji, Okauchi Masanobu, Kawanishi Masahiko, Tamiya Takashi, Uchiyama Naoyuki, Mohri Masanao, Misaki Kouichi, Nakada Mitsutoshi, Takagaki Masatoshi, Nakagawa Yu, Akiyama Takenori, Yoshida Kazunari, Takemoto Hideki, Nishiyama Hirokazu, Tetsuo Yoshiaki, Matsumoto Hiroyuki, Arimura Koichi, Imamura Hirotoshi, Todo Kenichi, Sakai Nobuyuki, Sato Kenichi, Matsumoto Yasushi, Miyata Haruka, Ishii Akira, Matsumoto Shoji, Nakahara Ichiro, Kikuchi Takayuki, Ishii Akira, Takenobu Yohei, Toma Naoki, Yasuda Ryuta, Izumi Takashi, Ito Masashi, Maruyama Daisuke, Satow Tetsu, Kataoka Hiroharu, Takahashi Jun C., Shigeta Keigo, Yatsushige Hiroshi, Hayakawa Takanori, Koyanagi Masaomi, Narumi Osamu, Ezura Masayuki, Suma Takeshi, Yoshino Atsuo, Tanoue Shuichi, Kiyosue Hiro, Kubo Takeshi, Hishikawa Tomohito, Haruma Jun, Takasugi Yuji, Shinji Yukei, Nishihiro Shingo, Sugiu Kenji, Ohnishi Hiroyuki, Miyachi Shigeru, Kuroiwa Toshihiko, Asai Katsunori, Nishida Takeo, Kishima Haruhiko, Nakamura Hajime, Ogata Atsushi, Nakagaki Hideaki, Yamada Takeshi, Kojima Atsuhiro, Saga Isako, Nomura Tatsufumi, Onda Toshiyuki, Nonaka Tadashi, Tsuji Atsushi, Nakazawa Takuya, Nozaki Kazuhiko, Murata Takahiro, Nagashima Hisashi, Morioka Jun, Murao Kenichi, Suyama Yoshio, Ishii Yosuke, Imamura Eiji, Wakabayashi Shinichi, Srivatanakul Kittipong, Aoki Rie, Abe Hajime, Kanenaka Naosuke, Satou Hiroaki, Amano Tatsuo, Sato Masayuki, Matsumaru Yuji, Ikeda Norio, Shojima Masaaki, Ono Hideaki, Dofuku Shogo, Saito Nobuhito, Tsuruta Wataro, Marushima Aiki, Takigawa Tomoji, Ito Yoshiro, Hashimoto Koji, Kanemaru Kazuya, Yoshioka Hideyuki, Kinouchi Hiroyuki, Ishihara Hideyuki, Oku Takayuki, Oka Fumiaki, Suzuki Michiyasu, Hattori Itaro, Nemoto Akihiro, Hikita Chiyoe, Iwasaki Mitsuhiro, Morimoto Masafumi

JOURNAL OF NEUROSURGERY 132 （ 1 ） 51 - 61 2020年01月

ISSN  0022-3085

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A questionnaire-based survey to evaluate and improve the current HHT medical and social condition in Japan

Arai N., Akiyama T.

Surgical Neurology International （Surgical Neurology International）  11   323 2020年

共著,  ISSN  2229-5097

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Background: Hereditary hemorrhagic telangiectasia (HHT) is a genetic systemic vascular disease affecting multiple organs and shows recurrent intractable symptoms. This disease has not been widely recognized in Japan until recently. Both diagnosed HHT patients and potential ones have faced difficulties because of the unfamiliarity with the disease in Japan. To evaluate the effect and degree of such a Japanese situation, a questionnaire-based survey was executed in this study. Methods: This survey was carried out among the members of HHT Japan Association. The organization consisted of 102 members (as of 6/2019), mainly HHT patients and their family members. A questionnaire was used to gather demographic data, the effort to reach the diagnosis, and information regarding current patients' and their families' medical managements. Results: Of the 102 questionnaires distributed, we have got 56 responses. The participants were mostly female (30) with an average age of 55.4 ± 14.8 (mean ± standard deviation [SD]) years. The average age of males was 53.5 ± 16.4. Relatively many HHT patients were born in huge cities such as Tokyo, Osaka, and Fukuoka Prefecture (n = 4 to 8 patients). The duration between the initial symptoms and the definite diagnosis was 8.8 ± 10.9 years. The number of hospitals involved in the final diagnosis was 2.38 ± 1.83. More than 70% of patients now have to visit at least two departments and 24% of HHT patients did not want their family to screen for HHT. Conclusion: HHT medical practice in Japan should be further modified, for example, by establishing HHT centers and educating primary care physicians and HHT patients.

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骨内静脈路の観点からみたAnterior CondylarArteriovenous Fistula の病態について

水谷 克洋, 秋山 武紀, 吉田 一成

脳血管内治療 （特定非営利活動法人 日本脳神経血管内治療学会）  5 （ 1 ） 56 - 64 2020年

ISSN  2423-9119

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<p>Anterior condylar arteriovenous fistula（AVF）は舌下神経管周囲に形成される比較的稀なdural arteriovenous fistula（DAVF）の一型であり，一般的には舌下神経管内のanterior condylar vein にAVF が形成されると考えられてきた．最近の研究で，舌下神経管の周囲にはanterior condylar vein 以外にも豊富な骨内静脈路が存在していることが明らかとなった．また，改めて詳細にAVF のshunted venous pouch の位置を検討すると，骨内にshunted venous pouch が存在しているような症例が一定数以上あることがわかり，anterior condylar AVF はanterior condylar vein やその付近の骨内静脈路に形成される一群のAVF であることが明らかとなった．このAVF は通常の硬膜に形成されるDAVF と同様に，骨内静脈路の血栓化などが原因となって二次的に形成されると考えられる．本稿で述べる骨内静脈路の解剖やanterior condylar AVF の病態はこの疾患を理解するうえで非常に重要である．</p>

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Targeted embolisation for coexisting conus medullaris arteriovenous malformation and cauda equina arteriovenous fistulas with a varix on a shared drainer†

Yoshida K., Niimi Y., Kamamoto D., Fukumura M., Imai R., Nagoshi N., Akiyama T.

British Journal of Neurosurgery （British Journal of Neurosurgery）     1 - 6 2020年

研究論文（学術雑誌）, 共著,  ISSN  02688697

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Background: The coexistence of vascular malformations in the conus medullaris and cauda equina has been rarely reported, and the complex angioarchitecture in multiple arteriovenous lesions remains poorly understood. Case description: A 17-year-old woman presented with a sudden-onset, stepwise worsening of weakness and pain in the bilateral legs. Angiography revealed conus medullaris arteriovenous malformation and cauda equina arteriovenous fistulas. One of the drainers was shared between the coexisting lesions and harboured a varix. Targeted embolisation of a fistulous point in the conus lesion was performed with precaution to prevent occluding the common drainage route, which led to symptom improvement with angiographical diminishment of the varix. Conclusions: Recognising that communications between drainers can be observed in multiple spinal arteriovenous lesions is important in facilitating a safe embolisation. Cautious assessment of angiogram with fusion images of cone-beam computed tomography and volumetric T2 magnetic resonance imaging can help in establishing the diagnosis and treatment strategy.

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Analysis of Temporobasal Vein with Short Subdural Segment for Anterior Transpetrosal Approach

Tamura R., Toda M., Morimoto Y., Sato M., Akiyama T., Yoshida K.

World Neurosurgery （World Neurosurgery）  132   e554 - e562 2019年12月

共著,  ISSN  18788750

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© 2019 Elsevier Inc. Background: The anterior transpetrosal approach (ATPA) is applied to petroclival and brainstem lesions. Although neurosurgeons need to minimize the risk of neurologic complications, brain retraction is necessary for procedures of ATPA. Bridging veins (BVs) limit mobility of the temporal lobe. In the present study, BVs around the petrous bone were analyzed, focusing on the dural entrance and termination points. Methods: The relationship between subdural and meningeal segments of temporobasal veins (TBVs) was analyzed by preoperative computed tomography venography in 102 patients who underwent ATPA. TBVs were classified by the dural entrance and termination points. Results: TBVs mainly entered the transverse sinus and rarely entered transverse-sigmoid sinus (T-S) junction and superior petrosal sinus (SPS). TBVs entered a dural sinus either directly or indirectly through a meningeal vein. The changes in vascular diameter of the lumen, shape, and course were identified between the subdural and meningeal segments. Generally, BVs with long subdural segment do not limit mobility of the temporal lobe. TBVs draining into the T-S junction and SPS tended to be shorter than those draining into the transverse sinus. Furthermore, a few TBVs indirectly entered the dural sinuses through the meningeal vein (early dural entrance). The subdural segment of these TBVs was much shorter. Conclusions: TBVs entering the T-S junction or SPS with short subdural segment may limit the mobility of the temporal lobe. Changes in vascular diameter, shape, and course were detected by computed tomography venography, which was helpful to detect the subdural-meningeal transition.

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A Novel Flow Dynamics Study of the Intracranial Veins Using Whole Brain Four-Dimensional Computed Tomography Angiography

Mizutani K., Arai N., Toda M., Akiyama T., Fujiwara H., Jinzaki M., Yoshida K.

World Neurosurgery （World Neurosurgery）  131   e176 - e185 2019年11月

共著,  ISSN  18788750

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© 2019 Elsevier Inc. Background: The flow dynamics of the intracranial venous channels are fundamentally important for understanding intracranial physiology and pathophysiology. However, the method clinically applicable to the evaluation of the flow dynamics of the intracranial venous system has not been well described in the reported data. We have developed a new method to evaluate intracranial venous flow direction and velocity using 4-dimensional (4D) computed tomography angiography (CTA). The aim of the present study was to verify the accuracy and validity of 4D-CTA in a clinical setting. Methods: We retrospectively analyzed 97 veins from 26 patients (16 cases of arteriovenous shunt disease, 9 intracranial tumor cases, and 1 cerebral aneurysm case) who had undergone both 4D-CTA and conventional digital subtraction angiography (DSA). Using 4D-CTA, we analyzed the time-density curve with gamma distribution extrapolation and obtained the direction of the flow and flow velocity of each vein. The direction of the flow in 4D-CTA was also collated with that obtained using conventional DSA to verify the experimental method. Results: The direction of the flow determined by 4D-CTA was consistent with that of conventional DSA in 94.8% of cases. The average venous flow velocity was 64.3 mm/second and 81.8 mm/second, respectively, in the antegrade and retrograde channels affected by arteriovenous shunts. Conclusions: The present flow analysis using 4D-CTA enabled us to evaluate the direction and velocity of intracranial venous flow. Other than some limitations, the presented method is reliable and its potential for application in clinical settings is promising.

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Evaluation of cerebral arteriovenous malformations (AVMs) and detection of micro-AVMs in HHT with silent MRA; arterial spin labeling magnetic resonant angiography with ultra-short time echo comparing with TOF MRA

Arai N., Akiyama T., Fujiwara H., Jinzaki M., Yoshida K.

ANGIOGENESIS 22 （ 4 ） 603 - 604 2019年11月

共著,  ISSN  0969-6970

[Diagnosis and Treatment of Intracranial Dural Arteriovenous Fistulas in View of Pathophysiology].

Akiyama T

No shinkei geka. Neurological surgery （株式会社医学書院）  47 （ 9 ） 927 - 941 2019年09月

単著,  ISSN  0301-2603

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Factors that predicts poor outcome in patients with subarachnoid hemorrhage

Takahashi S., Akiyama T., Horiguchi T., Yoshida K.

JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM 39   180 - 180 2019年07月

共著,  ISSN  0271-678X

Altered expression of microRNAs in body fluids in after aneurysmal subarachnoid hemorrhage

Mihara K., Takahasi S., Yanagisawa K., Mizutani K., Akiyama T., Katayama M., Akaji K., Horiguchi T., Suga S., Yoshida K.

JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM 39   179 - 179 2019年07月

共著,  ISSN  0271-678X

A Case of Aggressive Recurrent Intracranial Subdural Hematoma Associated with Angiosarcoma Originating from the Skull

Kanazawa T., Miwa T., Akiyama T., Ohara K., Kosugi K., Nishimoto M., Yoshida K.

World Neurosurgery （World Neurosurgery）  126   120 - 123 2019年06月

共著,  ISSN  18788750

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© 2019 Elsevier Inc. Background: Angiosarcoma often arises as a cutaneous disease in the scalp and the face; however, subdural hematoma (SDH) associated with angiosarcoma is extremely rare. Case Description: A 72-year-old woman visited our hospital with gait disorder and progressive consciousness disturbance approximately 3 months after a minor head injury. Initially, on reviewing the results of imaging studies, she was diagnosed with traumatic chronic SDH. Despite repeated operations thereafter, including the embolization of the middle meningeal artery, her general condition progressively worsened, and computed tomography of head repeatedly showed the recurrence of SDH. Based on histopathologic and intraoperative findings, she was finally diagnosed with angiosarcoma originating from the skull. She died shortly thereafter because of aggressive recurrent intracranial SDH caused by leptomeningeal dissemination. Conclusions: In addition to cancers metastatic to the skull or dura mater, angiosarcoma should be included in the differential diagnosis for patients with repeated SDH and bone defect. An effective treatment for angiosarcoma with SDH that shows an unfavorable prognosis has not been established; however, an early diagnosis might be useful for a novel treatment.

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Hemodynamic stress distribution identified by SPECT reflects ischemic symptoms of Moyamoya disease patients

Arai N., Horiguchi T., Takahashi S., Nakahara T., Akiyama T., Jinzaki M., Yoshida K.

Neurosurgical Review （Neurosurgical Review）  43 （ 5 ） 1323 - 1329 2019年

共著,  ISSN  03445607

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© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. This study aimed to validate the hypothesis that the ratio of cerebral blood flow (CBF) at rest in the lenticular nucleus (LN) territory to that in the middle cerebral artery (MCA) territory is higher in symptomatic Moyamoya disease (MMD) patients than in asymptomatic MMD patients. This was a retrospective observational study of adult patients with documented MMD who underwent single-photon emission computed tomography (SPECT) and had been examined at the Department of Neurosurgery of Keio University Hospital during a 10-year period (2006–2016). The diagnosis was made on the basis of typical imaging findings. We classified unoperated MMD patients into three groups: class I, no evidence of stenosis or occlusion hemispheres and without symptoms in unilateral MMD patients; class II, hemispheres with stenosis or occlusion but without ischemic symptoms; and class III, hemispheres with evidence of stenosis or occlusion associated with ischemic symptoms. Hemodynamic stress distribution (hdSD) was defined as the ratio of CBF in one LN to the CBF in the peripheral MCA; this was obtained by SPECT at rest. We compared the values of CBF and hdSD among the groups. A total of 173 adult patients were diagnosed with MMD from January 1, 2006, to January 1, 2016. Among them, 85 MMD patients underwent SPECT studies. After excluding inappropriate cases, 144 hemispheres were included in our analysis. hdSD was significantly higher (p < 0.001) in hemispheres with ischemic symptoms (class III, mean hdSD = 1.1; 36 sides) than in those without symptoms (class II, mean hdSD = 1.03; 82 sides). However, CBF at rest in the MCA or LN was not significantly associated with ischemic symptoms. The optimal threshold for hdSD to have ischemic symptoms was 1.040 (area under the curve; 74% sensitivity 91.7% and specificity 54.9%). We used SPECT to investigate cerebral blood from MMD patients and found that high hdSD values were predictive of ischemic symptom development in these patients.

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The Anterior Condylar Arteriovenous Fistula from the Viewpoint of the Osseous Venous Anatomy

Mizutani Katsuhiro, Akiyama Takenori, Yoshida Kazunari

脳神経血管内治療 （特定非営利活動法人 日本脳神経血管内治療学会）  13 （ 3 ） 97 - 104 2019年

ISSN  1882-4072

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<p>The anterior condylar arteriovenous fistula (AC-AVF) is a relatively rare AVF that affects the vasculatures adjacent to the hypoglossal canal. We aimed to discuss the etiology and definition of the AC-AVF from the viewpoint of the osseous venous anatomy. Our recent study, which used modern imaging technology (CT digital subtraction venography and cone beam CT reconstructed from 3D rotational angiography), elucidated the intraosseous venous anatomy in this region and the precise fistulous locations of AC-AVFs. Those findings suggest that the AC-AVF is a group of "osseous" AVF that involves the anterior condylar vein and jugular tubercle venous complex (JTVC), and the osseous veins connected to them. The AC-AVF develops in osseous veins adjacent to the hypoglossal canal, and it is one of the most common subtypes of osseous AVFs. The angioarchitectures and etiology of AC-AVFs discussed herein are essential to understand this clinical entity.</p>

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Traumatic Anterior Ethmoidal Artery Pseudoaneurysm with Repeated Epistaxis Treated by Transarterial Embolization: A Case Report

Kuranari Yuki, Akiyama Takenori, Yanagisawa Kaoru, Kamamoto Dai, Mizutani Katsuhiro, Takahashi Satoshi, Saito Shin, Ozawa Hiroyuki, Ogawa Kaoru, Yoshida Kazunari

脳神経血管内治療 （特定非営利活動法人 日本脳神経血管内治療学会）  13 （ 2 ） 72 - 76 2019年

共著,  ISSN  1882-4072

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<p><b>Objective:</b> Pseudoaneurysms of the internal carotid artery (ICA) and sphenopalatine artery (SPA) are recognized as sources of arterial epistaxis following head and face trauma. However, epistaxis involving pseudoaneurysm of the anterior ethmoidal artery (AEA) is extremely rare.</p><p><b>Case Presentation:</b> A 25-year-old man experienced massive epistaxis due to a ruptured traumatic pseudoaneurysm of the AEA. The patient had suffered head and face trauma in a car accident. CT showed fractures of the frontal, ethmoidal, and maxillary bones, and he was managed conservatively. Nine days after the injury, he had sudden, massive epistaxis. Angiography showed a right AEA aneurysm, which was treated successfully with transarterial embolization using n-butyl-2-cyanoacrylate (NBCA).</p><p><b>Conclusion:</b> Although pseudoaneurysm of the AEA is a rare cause of epistaxis, it is important to consider this diagnosis, in addition to pseudoaneurysm of the SPA and ICA, when a patient has massive arterial epistaxis following a traumatic skull base fracture, especially if the fracture is adjacent to the ethmoid sinus. Transarterial embolization using glue is a feasible therapeutic option for this condition.</p>

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Skull Base Venous Anatomy Associated with Endoscopic Skull Base Neurosurgery: A Literature Review

Mizutani K., Akiyama T., Yoshida K., Toda M.

World Neurosurgery （World Neurosurgery）  120   405 - 414 2018年12月

共著,  ISSN  18788750

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© 2018 Elsevier Inc. An understanding of the anatomy and function of the skull base venous channels is fundamentally important for safe performance of endoscopic surgery for skull base lesions. This review focuses on 4 skull base venous channels—namely, the intercavernous sinuses, basilar plexus, osseous veins, and inferior petroclival vein—because these have been less recognized by neurosurgeons than other major venous channels such as the inferior petrosal sinus. We reviewed the literature concerning these 4 venous channels and discussed their anatomy and function. The literature review was mainly based on an electronic search in PubMed using the following terms: “intercavernous sinus,” “basilar plexus,” “emissary veins,” “diploic vein,” “basilar plexus,” “intraosseous vein,” “inferior petroclival/petro-occipital vein,” and “transclival.” A total of 50 articles were included in this review. Detailed anatomic features of the 4 structures have been elucidated in the literature. All of these venous channels run along the skull base and have multiple connections with surrounding venous structures. Because of their location, they occasionally obstruct the surgical view and are sometimes implicated in intraoperative hemorrhage, air embolism during endoscopic skull base surgery, and postoperative hematoma. They usually function as a venous reservoir of cranial venous drainage; however, they are less often directly involved in normal brain perfusion. Knowledge about the functional and morphologic anatomy of the skull base venous channels is important for neurosurgeons to avoid unexpected complications during endoscopic skull base surgery.

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An analysis of the anatomic route of the hypoglossal nerve within the hypoglossal canal using dynamic computed tomography angiography in patients with anterior condylar arteriovenous fistulas

Oishi Y., Akiyama T., Mizutani K., Horiguchi T., Imanishi N., Yoshida K.

Clinical Neurology and Neurosurgery （Clinical Neurology and Neurosurgery）  174   207 - 213 2018年11月

共著,  ISSN  03038467

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© 2018 Elsevier B.V. Objective: The venous outlet of anterior condylar arteriovenous fistulas (AC-AVFs) often empties into the anterior condylar vein (ACV). Hypoglossal nerve palsy is one of the major complications after transvenous embolization (TVE) for the AC-AVF within the hypoglossal canal. However, no studies have investigated the route of the hypoglossal nerve within the hypoglossal canal in AC-AVF. The aim of the current study is to retrospectively verify the anatomical route of the hypoglossal nerve within its canal using dynamic computed tomography angiography (CTA) in order to facilitate the safe TVE for AC-AVF. Patients and methods: We included five patients with AC-AVF from 2011 to 2017. Dynamic CTA was performed on all patients. When the ACV was well-visualized by dynamic CTA, the hypoglossal nerve could be recognized as a less-intense structure within the surrounding enhanced vasculatures and the nerve route within the canal was analyzed. We also analyzed the location of the fistulas by digital subtraction angiography and cone-beam computed tomography. Results: In all five patients, the filling defect of the hypoglossal nerve ran through the most caudal portion of the hypoglossal canal. The fistulous pouches were located in the hypoglossal canal in three cases, and in the jugular tubercle venous complex in two cases. In all three cases with AC-AVF in the hypoglossal canal, the fistulous pouches were located in the superior wall of the hypoglossal canal, which means superior to the ACV. We performed TVE in four patients and none developed post-therapeutic hypoglossal nerve palsy. Conclusion: In the current study, dynamic CTA is useful for detecting the hypoglossal nerve within the hypoglossal canal. The hypoglossal nerve usually ran the bottom of its canal and the fistulous pouches were usually located at the superior aspect of the canal opposite side to the hypoglossal nerve. Accordingly, the selective embolization within the fistulous pouch located in the superior aspect of the ACV including jugular tubercle venous complex can reduce the risk of hypoglossal nerve palsy.

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Pros and cons of using ORBEYE™ for microneurosurgery

Takahashi S., Toda M., Nishimoto M., Ishihara E., Miwa T., Akiyama T., Horiguchi T., Sasaki H., Yoshida K.

Clinical Neurology and Neurosurgery （Clinical Neurology and Neurosurgery）  174   57 - 62 2018年11月

共著,  ISSN  03038467

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© 2018 Elsevier B.V. Objective: To evaluate the pros and cons of using a newly developed microscope, ORBEYE™, during microneurosurgery. Patients and methods: ORBEYE™ use in 14 microneurosurgical procedures was retrospectively assessed by nine neurosurgeons after the procedure. A questionnaire comprising 20 questions was designed and used for evaluation. Results: Compared with the current gold standard, the binocular microscope, ease of setting up the equipment was scored the highest, whereas ease of conducting surgery in a position of an assistant was scored the lowest. Among characteristics of ORBEYE™ itself, the space-saving feature was scored the highest and was followed by the ability to perform procedures in a comfortable position. The only characteristic that was rated below average was ease of operation in a position of an assistant. Neurosurgeons with greater experience (more than five procedures using ORBEYE™) provided significantly higher scores (p = 0.0196) for characteristics of ORBEYE™ itself compared with neurosurgeon with fewer ORBEYE™ experience. Conclusions: The main benefits of the ORBEYETM are its compact size and freedom from focusing through the eye lens of a conventional binocular microscope. However, it appears to be disadvantageous for operating in a position of an assistant because the surgical field has a rotated view on the monitor from a position of an assistant. Nonetheless, because of certain advantages, we believe the ORBEYE™ could be of additional help to use of conventional binocular microscope at the moment and will facilitate microneurosurgery in the future.

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Combined Endoscopic Endonasal and Video-microscopic Transcranial Approach with Preoperative Embolization for a Posterior Pituitary Tumor

Yoshida K., Toda M., Akiyama T., Takahashi S., Nishimoto M., Ozawa H., Ikari Y., Yoshida K.

World Neurosurgery （World Neurosurgery）  119   201 - 208 2018年11月

共著,  ISSN  18788750

　概要を見る

© 2018 Elsevier Inc. Background: Posterior pituitary tumor is rare, and its optimal surgical strategy is undetermined. Surgical removal of posterior pituitary tumors is often complicated by their hypervascularity. Prevention and preparation for excessive hemorrhage is crucial for safe resection. Case Description: A 69-year-old woman presented with bitemporal hemianopsia and was found to have a sellar tumor with suprasellar extension, resembling a pituitary adenoma. Microscopic transsphenoidal resection was attempted but was interrupted by a massive intraoperative hemorrhage. Pathologic diagnosis was a spindle cell oncocytoma, and she was referred to our institution. She underwent preoperative embolization to decrease tumor vascularity, and resection was performed using a combined endoscopic endonasal and video-microscopic transcranial approach, using a 4K three-dimensional (3D) video microscope. The final diagnosis was a posterior pituitary tumor with immunopositivity for thyroid transcription factor-1, with preferred interpretation as a pituicytoma. Conclusions: A combined endonasal and transcranial approach with preoperative embolization is a useful strategy for hypervascular posterior pituitary tumors. A 4K 3D video microscope is compact, and it provides high-resolution images, contributing larger surgical space and facilitating a multi-team surgery.

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Primary Intracranial Rhabdomyosarcoma in the Cerebellopontine Angle Resected After Preoperative Embolization

Yoshida K., Miwa T., Akiyama T., Nishimoto M., Kamamoto D., Yoshida K.

World Neurosurgery （World Neurosurgery）  116   110 - 115 2018年08月

研究論文（学術雑誌）, 共著,  ISSN  18788750

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© 2018 Elsevier Inc. Background: Primary intracranial rhabdomyosarcoma is a very rare malignant tumor. Owing to moderately vascular and firm characteristics of the tumor, complete removal without complications is often difficult. In pediatric patients, the volume of total blood is less than in adults, and minimal intraoperative hemorrhage is desirable. Case Description: A 6-year-old boy presented with ataxia and was found to have a large cerebellopontine angle tumor and hydrocephalus. The patient underwent preoperative coil embolization of the anterior inferior cerebellar artery to decrease tumor vascularity, and gross total removal was achieved on the same day via a suboccipital approach. Pathologic diagnosis was rhabdomyosarcoma. Conclusions: Successfully resection of primary intracranial rhabdomyosarcoma was achieved after preoperative embolization. Tumor vascularity was significantly reduced, and gross total removal was achieved safely with less hemorrhage.

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