Papers - Toda, Masahiro

Surgical treatment of cavernous sinus lesion in patients with non-functioning pituitary adenomas via the endoscopic endonasal approach.

Toda M, Kosugi K, Ozawa H, Ogawa K, Yoshida K

J Neurol Surg B Skull Base (Journal of Neurological Surgery, Part B: Skull Base)  in press ( 5 ) S311 - S315 2018

ISSN  2193634X

　View Summary

© 2018 Georg Thieme Verlag KG Stuttgart . New York. Objective The main purpose of this article is to assess the effectiveness and safety of surgery via the endoscopic endonasal approach (EEA) for cavernous sinus (CS) lesion in patients with nonfunctioning pituitary adenomas (NFPA). Design Retrospective study. Setting Keio University Hospital. Participants Thirty patients who underwent CS surgery via the EEA between 2009 and 2017 for Knosp grade 4 NFPA with pre- and postoperative magnetic resonance imaging available for volumetric analysis. Main Outcome Measures Clinical presentation, extent of resection, and surgical complications. Results Gross total and near total resection of CS tumors was achieved in 12/30 (40%) cases of Knosp grade 4 NFPA. The average resection rate of CS lesions in these 30 patients was 73.5%; 77.3% in primary cases and 70.1% in recurrent cases that did not vary significantly. Preoperative visual disturbance and oculomotor nerve palsy improved in 12/19 (63.1%) and - (60%) cases, respectively. Complications associated with CS via the EEA were postoperative cerebrospinal leakage (1/30, 3.3%), meningitis (1/30, 3.3%), and transient cranial nerve palsy (2/30, 6.7%). These complications except a case of mild transient abducens nerve palsy occurred in recurrent cases with subdural lesions. Conclusions Although the optimal management of CS lesions in NFPA is controversial, debulking via the EEA is an effective and safe option that improves neurological symptoms and enables effective adjuvant radiotherapy. Recurrent cases with subdural invasion are technically challenging, even using the EEA, and special care is required to avoid complications.

• Access to Document (DOI)

Preoperative prediction of solitary fibrous tumor/hemangiopericytoma and angiomatous　meningioma using magnetic resonance imaging texture analysis

Kanazawa　T,　Toda M

World Neurosurgery (World Neurosurgery)  in press   e1208 - e1216 2018

ISSN  18788750

　View Summary

© 2018 Elsevier Inc. Background: Solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is radiologically difficult to distinguish from meningioma, especially angiomatous meningioma. This study aimed to detect texture parameters to distinguish SFT/HPC from angiomatous meningioma using magnetic resonance imaging texture analysis with commercially available software. Methods: We retrospectively investigated textural parameters in 43 newly diagnosed SFTs/HPCs, angiomatous meningiomas, and other World Health Organization (WHO) grade I meningiomas treated at Keio University Hospital. For T1 contrast-enhanced, T2, and apparent diffusion coefficient (ADC) images, texture analyses were performed. Regions of interest were drawn manually with reference to the greater signal on contrast-enhanced T1-weighted images. ADC values and texture parameters, including kurtosis, skewness, and entropy, were evaluated and compared between these 3 groups. Results: The mean ADC value was significantly high in angiomatous meningioma, compared with SFT/HPC and other WHO grade I meningioma. ADC entropy was highest in SFT/HPC, followed by angiomatous and other WHO grade I meningioma. T2 skewness was significantly high in SFT/HPC, compared with angiomatous and other WHO grade I meningioma. T1 contrast-enhanced skewness was significantly low in angiomatous meningioma, compared with other WHO grade I meningioma. Mean ADC value distinguished SFT/HPC from angiomatous meningioma with a positive predictive value (PPV) of 62.5% and specificity of 62.5%. ADC entropy distinguished SFT/HPC from angiomatous meningioma with a PPV of 100% and specificity of 100%. ADC skewness distinguished SFT/HPC from angiomatous meningioma with a PPV of 66.7% and specificity of 71.4%. Conclusions: This study demonstrated that magnetic resonance imaging texture analysis was useful for distinguishing SFT/HPC from meningioma, especially angiomatous meningioma.

• Access to Document (DOI)

Treatment strategy for tuberculum sellae meningiomas based on a preoperative radiological assessment

Toda M

World Neurosurgery (World Neurosurgery)  in press   e1279 - e1288 2018

Research paper (scientific journal),  ISSN  18788750

　View Summary

© 2018 Elsevier Inc. Background: Although there are several surgical approaches for the treatment of tuberculum sellae (TS) meningiomas, clear indications for non–large TS meningiomas are still lacking. Methods: Our case series included 20 patients with TS meningiomas (<3 cm). We classified the tumors into 3 groups based on their radiologic relationship with the optic chiasm: type I, tumor with intact optic chiasm; type II, tumor with superiorly deviated optic chiasm; and type III, tumor with posteriorly deviated optic chiasm. Clinical outcomes, radiologic findings, and surgical approaches for the removal of each tumor type were retrospectively reviewed. Results: Resections using a pterional approach, interhemispheric approach, and an endoscopic endonasal approach were performed in three groups of 6, 7, and 7 patients. The rate of total tumor resection was equivalent across approaches, whereas postoperative visual dysfunction was observed in 1 patient (7.69%) undergoing a transcranial approach. Our evaluation of the sphenoid sinus shape across radiographs revealed that the patterns of bony wall elongation attached to these tumors significantly differed among tumor types, indicating that tumor origin and growth direction might affect the patterns of optic chiasm deviation. In addition, selective elongation of the TS provided a favorable surgical corridor for an endoscopic endonasal approach, especially in type II tumors. These results indicate that this tumor classification influenced surgical approach selection for non–large TS meningiomas. Conclusions: The aim of surgery is maximal tumor resection without causing visual dysfunction. The classification proposed here may predict surgical risk associated with meningioma resection and further inform the selection of a surgical approach.

• Access to Document (DOI)

Skull base venous anatomy associated with endoscopic skull base neurosurgery: a literature review

Toda M

World Neurosurgery (World Neurosurgery)  in press   405 - 414 2018

ISSN  18788750

　View Summary

© 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.

• Access to Document (DOI)

Endoscopic endonasal approach combined with a simultaneous transcranial approach for giant pituitary tumors.

TODA MASAHIRO

World Neurosurgery (World Neurosurgery)  in press   173 - 179 2018

Research paper (scientific journal),  ISSN  18788750

　View Summary

© 2018 Elsevier Inc. Background: The endoscopic endonasal approach is widely used for treating giant pituitary adenomas. However, a small subset of tumors is still challenging to treat, and the risk of complications increases when an endoscopic endonasal approach alone is used. The simultaneous combined endoscopic endonasal and transcranial approach is a surgical option for such difficult adenomas; however, very few studies have described the technical nuances and benefits of this approach. Methods: We treated 3 patients with giant pituitary adenoma and 1 patient with pituicytoma. Radiologic findings and clinical outcomes were retrospectively reviewed. Results: All patients had preoperative visual disturbances. A pterional approach was combined with an endoscopic endonasal approach to treat all the patients. Near-total and subtotal tumor removal was accomplished in 3 patients; however, only partial tumor removal was possible in 1 patient. Postoperative visual function improved in 3 patients, but there were no changes in 1 patient. There were no major complications; however, each patient developed either adrenocorticotropic hormone (ACTH) and thyroid-stimulating hormone deficiency or ACTH deficiency and persistent diabetes. Importantly, no cerebrospinal fluid leakage was observed in the patients. Conclusions: Our simultaneous combined endoscopic and transcranial approach offers safe tumor resection and a low rate of complications. In this procedure, it is important that tumor debulking be performed by the main surgeon via a single surgical route and not by 2 surgeons using the simultaneous endonasal and transcranial approach, to avoid interference in the surgical field. This approach may be considered as a surgical option for carefully selected tumors in the sellar region.

• Access to Document (DOI)

Severe headache in a patient with meningioma showing extensive dural tail correlates with IgG4-positive plasma cells and eosinophils: A case report and review of literature

Kuranari Y., Tamura R., Mikami S., Ohara K., Toda M., Yoshida K.

Surgical Neurology International (Surgical Neurology International)  9 ( 1 ) 202 2018

Research paper (scientific journal)

　View Summary

© 2018 Surgical Neurology International | Published by Wolters Kluwer - Medknow. Background: Meningiomas originate from meningothelial cells of the arachnoid membrane. Few cases of meningioma with infiltration of inflammatory cells, such as lymphocytes and plasma cells, have been reported, and the mechanisms underlying meningioma-induced inflammatory reactions have not been fully elucidated. Case Description: In this study, we report an extremely rare case of meningioma with infiltration of both IgG4-positive plasma cells and eosinophils showing extensive dural tail and reactive inflammation of the surrounding arachnoid tissue. The main clinical manifestation was a severe headache, which was improved by surgical excision of the tumor. Conclusion: Only 8 cases of meningioma with IgG4-positive plasma cells have been reported, and only one case exhibited eosinophil infiltration. IgG4-related inflammatory response might mediate inflammation in surrounding tissue, resulting in thickening of the dura adjacent to a meningioma and severe headache. The mechanisms underlying inflammation by meningiomas require further investigation.

• Access to Document (DOI)

Subtemporal approach: Intra- and extradural approach, anterior petrosal approach, and endonasal approach

Toda M., Yoshida K.

Japanese Journal of Neurosurgery (Japanese Journal of Neurosurgery)  27 ( 11 ) 818 - 827 2018

ISSN  0917950X

　View Summary

The subtemporal approach is applied to the middle cranial fossa and infratemporal fossa in addition to the tentorial incisura, petroclivus, and brain stem lesions. To minimize compression damage to the temporal lobe, it is essential to perform the craniotomy along the middle cranial fossa, to remove the zygomatic arch for supratentorial lesions, and to remove the petrous pyramid for infratentorial lesions. To avoid venous damage, the drainage pathways of the superficial sylvian vein and bridging veins, including Labbé’s vein, should be preoperatively evaluated. Furthermore, with the recent advances in endoscopic surgery, it has become possible to approach the middle cranial fossa and infratemporal fossa endonasally. In the endonasal approach, surgical simulation is important because of the variations in the nasal cavity and paranasal sinus structures. In this article, we outline the surgical anatomy of the middle cranial fossa required for the subtemporal approach, including the endonasal approach, and variations in the venous drainage of the superficial sylvian vein and petrosal vein. Moreover, we describe the treatment of pontine lesions by the subdural subtemporal approach, Meckel cave lesions by the epidural subtemporal approach, petroclival lesions by the anterior transpetrosal approach, and infratemporal lesions by the endonasal approach.

• Access to Document (DOI)

Clinical and molecular prognostic factors for long-term survival of the patients with glioblastomas in a single institutional consecutive cohort.

Nakagawa Y, Sasaki H, Ohara K, Ezaki T, Toda M, Ohira T, Kawase T, Yoshida K.

World Neurosurg. 106   165 - 173 2017.10

• Access to Document (DOI)

The impact of several craniotomies on transcranial motor evoked potential monitoring during neurosurgery.

Tomio R, Akiyama T, Toda M, Ohira T, Yoshida K

J Neurosurg.  127 ( 3 ) 543 - 552 2017.09

• Access to Document (DOI)

Functional analysis of the DEPDC1 oncoantigen in malignant glioma and brain tumor initiating cells.

Kikuchi R, Sampetrean O, Saya H, Yoshida K, Toda M

J Neurooncol. 133 ( 2 ) 297 - 307 2017.06

• Access to Document (DOI)

Functional analysis of KIF20A, a potential immunotherapeutic target for glioma

Saito K, Ohta S, Kawakami Y, Yoshida K, Toda M

J Neurooncol 132 ( 1 ) 63 - 74 2017.03

• Access to Document (DOI)

Analysis of the venous channel within the clivus using multidetector computed tomography digital subtraction venography.

Mizutani K, Toda M, Kurasawa J, Akiyama T, Fujiwara H, Jinzaki M, Yoshida K

Neuroradiology 59 ( 3 ) 213 - 219 2017.03

• Access to Document (DOI)

Delayed and isolated oculomotor nerve palsy following minor head trauma.

Nakagawa Y, Toda M, Shibao S, Yoshida K.

Surg Neurol Int. 8 ( 20 )  2017.02

• Access to Document (DOI)

Transvenous Embolization of the Basilar Plexus Before Endoscopic Transsphenoidal Transclival Surgery.

Mizutani K, Akiyama T, Toda M, Kanazawa T, Kamamoto D, Yoshida K

World Neurosurg. 97   756 - 756 2017.01

• Access to Document (DOI)

Surgical Outcome of Endoscopic Endonasal Surgery for Non-Functional Pituitary Adenoma by a Team of Neurosurgeons and Otolaryngologists Adenoma by a Team of Neurosurgeons and Otolaryngologists.

Kikuchi R, Toda M, Tomita T, Ogawa K, Yoshida K

Turkish Neurosurg 27 ( 1 ) 1 - 7 2017.01

• Access to Document (DOI)

Endonasal endoscopic approach for a giant cavernous sinus meningioma that extended to the middle cranial fossa with preoperative embolization

Tamura R, Toda M, Kohno M, Ozawa H, Tomita T, Akiyama T, Ogawa K, Yoshida K

Interdisciplinary Neurosurgery 6   20 - 22 2016.12

• Access to Document (DOI)

Analysis of the medial opticocarotid recess in patients with pituitary macroadenoma using three-dimensional images.

Kikuchi R, Toda M, Wakahara S, Fujiwara H, Jinzaki M, Yoshida K

World Neurosurg. 93   139 - 143 2016.09

• Access to Document (DOI)

The analysis of the petrosal vein to prevent venous complications during the anterior transpetrosal approach in the resection of petroclival meningioma

Mizutani K, Toda M, Yoshida K

World Neurosurg. 93   175 - 182 2016.09

• Access to Document (DOI)

Vascularized middle turbinate flap for the endoscopic endonasal reconstruction of the anterior olfactory groove

Tamura R, Toda M, Kohno M, Watanabe Y, Ozawa H, Tomita T, Ogawa K, Yoshida K

Neurosurg Rev 39 ( 2 ) 297 - 302 2016.04

• Access to Document (DOI)

MIF maintains the tumorigenic capacity of brain tumor-initiating cells by directly inhibiting p53

Fukaya R, Ohta S, Yaguchi T, Matsuzaki Y, Sugihara E, Okano H, Saya H, Kawakami Y, Kawase T, Yoshida K, Toda M

Cancer Res 76 ( 9 ) 2813 - 2823 2016.03

• Access to Document (DOI)