研究者詳細 - 堀口　崇

論文 - 堀口　崇

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Anterior transpetrosal approach and the tumor removal rate, postoperative neurological changes, and complications: experience in 274 cases over 33 years

Tomio R., Horiguchi T., Shibao S., Tamura R., Yoshida K., Kawase T.

Journal of Neurosurgery 141 （ 1 ） 108 - 116 2024年07月

ISSN 00223085

OBJECTIVE The authors report on the anterior transpetrosal approach (ATPA) and the results of surgeries performed over a 33-year period for petroclival tumors, including meningioma, trigeminal schwannoma, chordoma, and epidermoid tumor. They analyze early postoperative neurological changes, surgical complications, and trends over the decades. METHODS A retrospective analysis of 274 surgical cases that had undergone the ATPA from January 1984 to March 2017 was conducted. Data were collected from charts, clinical summaries, operative records, and operative videos. The analyzed parameters included patient diagnosis, tumor size, disease location, operation date, tumor removal rate, pre- and postoperative neurological symptoms (consciousness level, motor and sensory deficits of the limbs, sensory aphasia, and cranial nerve III–VIII injuries), surgical deaths, and radiologically recognized brain injuries after the operation (contusion, infarction, hemorrhage). RESULTS Gross-total resection (GTR) was achieved in 53.5% of the 243 tumors with available data. The GTR rate for meningiomas (148 cases) was 54.1%. Trigeminal schwannomas had a high GTR rate of 87.1%, whereas chordomas had a low GTR rate of 14.3%. The rate of early neurological deterioration immediately after the ATPA, referred to as “early neurological change,” was as follows: consciousness disturbance in 1.9% of cases (5 cases), improvement of hemiparesis in 45.0% of cases but deterioration in 8.1% of cases, sensory aphasia in 2.3% of cases due to temporal lobe injury, improvement of cerebellar symptoms in 39.3% of cases with rare deterioration (1.9% of cases), worsening of preoperative diplopia in 49.4% of patients and rarely improving, improvement of trigeminal symptoms in 19.1% of cases (mostly trigeminal neuralgia) among the 43.7% of patients who had them preoperatively, and deterioration of facial hypesthesia and/or paresthesia in 27.4% of cases. Early neurological deterioration was monitored in 183 patients for 6 months to determine the surgical complications of ATPA. Consciousness disturbance recovered in half of the cases but persisted in 3 (1.5%). Hemiparesis fully recovered in 63.2% of cases, resulting in a complication rate of 3.0%. The most frequent complication was diplopia (36.4%), with a complete remission rate of 26.4%. The second most frequent complication was facial hypesthesia (24.0%), with a recovery rate of 16.1%. Facial nerve palsy improved in 63.0% of cases and had a complication rate of 4.9%. Cerebellar symptoms showed complete recovery in all cases. CONCLUSIONS The ATPA allows the removal of petroclival tumors extending into Meckel’s cave and the middle fossa, making it preferred for dumbbell trigeminal schwannomas and meningiomas. However, the ATPA’s aggressive tumor removal can risk a lower recovery of cranial nerve IV–VI deficits. For benign meningiomas, initial observation with regular follow-up is recommended. Surgery is appropriate for high-growth cases aiming for total removal, accompanied by a thorough explanation of the risks. If the risks are not accepted, subtotal removal can be considered, and radiosurgery is suggested for residual tumor.

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Interprofessional competency in clinical students: validating the Clinical student version of the Japanese Self-assessment Scale of Interprofessional Competency (C-JASSIC)

Haruta J., Tomizaki E., Horiguchi T., Nakamura T., Ishikawa S., Monkawa T.

Journal of Interprofessional Care 38 （ 5 ） 875 - 882 2024年

ISSN 13561820

In this study, we developed and validated the Clinical Student Version of the Japanese Interprofessional Competency Self-Assessment Scale (C-JASSIC) for healthcare students in their clinical practice phase. Data obtained from 331 students (medical, 98; nursing, 99; pharmacy, 134) during orientation for interprofessional education (pre-IPE) and from 319 students (medical, 94; nursing, 93; pharmacy, 132) within a week following IPE (post-IPE) were analyzed. Exploratory pre-IPE and Confirmatory post-IPE factor analyses revealed a consistent 6-factor structure aligning with the Japanese Interprofessional Competency domains. The scale exhibited strong internal consistency, with Cronbach’s α values exceeding 0.8 for all factors both pre- and post-IPE. Scores for overall competency and individual domains increased post-IPE in 234 matched cases. A notable significant pre vs post difference concerned “Understanding of Others,” indicating enhanced interprofessional comprehension after clinical practice. There was a weak but significant positive correlation between IPE satisfaction and difference in pre- and post-IPE scores. However, no significant differences were observed among medical, nursing, and pharmacy students. Despite its strengths, such as its competency-based design and cultural relevance to Japan, a limitation of the study may be potential self-reporting bias. Nonetheless, C-JASSIC represents a valuable tool for seamless competency evaluations from student to professional stages, with implications for broader Asian contexts.

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Executive summary: Japanese guidelines for adult asthma (JGL) 2021.

Niimi A, Fukunaga K, Taniguchi M, Nakamura Y, Tagaya E, Horiguchi T, Yokoyama A, Yamaguchi M, Nagata M

Allergology international : official journal of the Japanese Society of Allergology 72 （ 2 ） 207 - 226 2023年04月

ISSN 1323-8930

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A simple combined approach using anterior transpetrosal and retrosigmoid approach: A case report

Tamura R., Ueda R., Karatsu K., Sayanagi T., Takahara K., Hino U., Iwama T., Nogawa H., Nakaya M., Horiguchi T., Toda M.

Frontiers in Surgery 10 1094387 2023年

ISSN 2296-875X

Background: A combined transpetrosal approach (CTP) is often used for large lesions in the posterior cranial fossa (PCF). Although CTP provides a wide surgical corridor, it has complex and time-consuming bony work of mastoidectomy and cosmetic issues. Here, we describe a simple combined surgical technique to approach the supratentorial region, anterolateral surface of the brainstem, petroclival region, and foramen magnum by drilling only the petrous apex with a combination of retrosigmoid approach (RA). Clinical presentation: A 27-year-old female was referred with extra-axial left cerebellopontine angle space-occupying epidermoid cyst extending to the prepontine cistern, anterior to the basilar artery, superior to the chiasma, and caudally to the foramen magnum. A one-stage surgical procedure using the anterior transpetrosal approach (ATP) and RA was performed after one-piece temporal-suboccipital craniotomy. These two approaches complemented each other well. Near-total removal was achieved. Conclusion: A one-stage surgical procedure using ATP and RA provides the wider viewing and better visualization of the PCF with minimal technical difficulty.

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Odontogenic Pericarotid Abscess after Carotid Endarterectomy.

Takahara K, Takahashi S, Hino U, Horiguchi T, Toda M

NMC Case Report Journal （一般社団法人日本脳神経外科学会） 9 （ 0 ） 377 - 382 2022年12月

ISSN 2188-4226

Carotid endarterectomy (CEA) and carotid artery stenting (CAS) for internal carotid artery (ICA) stenosis have specific risks. Therefore, the accurate evaluation and management of each risk factor are important, especially for patients who are at high risk for both CEA and CAS.We report the case of a 77-year-old man with right ICA stenosis that progressed despite optimal medical treatment. In addition, he had several risk factors for both CEA and CAS, including previous cervical radiation therapy, contralateral ICA occlusion, chronic kidney insufficiency, and severe aortic valve stenosis. CEA was performed with priority given to aortic valve stenosis without complications, and the patient was discharged 10 days postoperatively, without neurological sequelae. However, a pericarotid cervical abscess was detected by carotid echo, computed tomography (CT), and magnetic resonance imaging (MRI) 1 month after CEA that required surgical drainage. The infection was thought to be odontogenic because the pathogen was identified as normal oral bacterial flora, and a wound infection was not apparent. Teeth extraction and abscess drainage, in combination with antibiotic therapy, successfully cured the infection without additional complications.Odontogenic cervical abscesses after CEA can occur, especially if the patient is at risk of infection. Therefore, both preoperative and postoperative dental evaluation and management are recommended. As in this case, a cervical abscess can occur without wound infection, and the abscess diagnosis is sometimes difficult from wound inspection alone. Cervical echocardiogram and CT were useful for detecting fluid collection, whereas MRI was useful for qualitatively evaluating the lesion.

Imaging of the venous plexus of Rektorzik using CT-digital subtraction venography: a retrospective study

Imai R., Mizutani K., Akiyama T., Horiguchi T., Takatsume Y., Toda M.

Neuroradiology 64 （ 10 ） 1961 - 1968 2022年10月

ISSN 00283940

Purpose: The venous plexus of Rektorzik (VPR), first described by Rektorzik in 1858, is a venous plexus around the internal carotid artery in the carotid canal. However, the VPR has never been investigated using the recently developed imaging modalities. In this study, we analyzed the VPR using computed tomography-digital subtraction venography (CT-DSV). Methods: This study included 253 patients who had undergone head CT-DSV. The presence or absence of the right and left VPRs and their connecting veins were visually examined by two researchers. Results: The VPR was observed in 60 patients (24%), 39 of which showed VPR only on the right side, 10 only on the left side, and 11 on both sides. VPR was significantly more common on the right side (p = 0.0002) and was observed more frequently around the horizontal segment of the internal carotid artery than around the vertical segment. The most common veins identified as distal and proximal VPR connections were the cavernous sinus (63/71, 89%) and the anterior condylar confluence (27/71, 38%), respectively. The mean age was significantly lower in patients with the VPR than in those without (53 vs. 57 years, p = 0.02). Conclusion: The VPR was significantly more frequent on the right side and in younger patients but was not a radiographically constant structure. In most cases, the VPR connected the cavernous sinus and anterior condylar confluence. Preoperative evaluation of VPR may lead to refined surgical procedures.

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Anterior transpetrosal approach: experiences in 274 cases over 33 years. Technical variations, operated patients, and approach-related complications

Tomio R., Horiguchi T., Borghei-Razavi H., Tamura R., Yoshida K., Kawase T.

Journal of Neurosurgery 136 （ 2 ） 413 - 421 2022年02月

ISSN 00223085

OBJECTIVE The anterior transpetrosal approach (ATPA) was initially reported in 1985. The authors' institution has 274 case records of surgery performed with the ATPA during the period from 1984 to 2017. Although many technical advances and modifications in the ATPA have occurred over those 33 years, to the authors' knowledge no articles to date have reported a detailed analysis of variations and complications of the ATPA. In this study, the authors analyzed their patient series to elucidate improvements over time in ATPA methodology while highlighting unresolved problems and evaluating how to avoid surgical complications. METHODS All surgical cases (274 patients) using the ATPA at the authors' institution during the period from 1984 to 2017 were analyzed retrospectively using charts, clinical summaries, operative records, and operative videos. Obtained parameters were patient age and sex, diagnosis, size of tumors, location of disease, operative date, neurological symptoms before and after surgery, radiographically identified brain injury, and other surgical complications. The most common diagnosis was petroclival meningioma (n = 158), followed by trigeminal schwannoma (n = 32), chordoma (n = 25), epidermoid tumor (n = 21), other tumor (n = 27), aneurysm (n = 6), and other (n = 5). RESULTS The original ATPA was performed in 239 cases. In an additional 35 cases, a modified ATPA was performed. Zygomatic osteotomy with ATPA was a common modification that was used in 19 of the 35 cases to decrease retraction damage to the temporal lobe for high-positioned tumors. Brain injury by temporal lobe retraction without venous hemorrhage still occurred in 8 of the 19 cases (3.1%) with surgical death in 1 of these cases (0.4%) of reoperation with sacrifice of the petrosal vein. Symptomatic CSF leak was the most frequent complication noted and was observed in 35 cases (13.5%). In most of these cases the patients were cured by observation or lumbar drain, but in 6 cases (17.1%) reoperation was needed. Facial nerve damage related to surgical approach decreased from 6.2% to 3.5% after 2010; however, the incidence of CSF leaks (13.5%) has not improved. CONCLUSIONS There have been several modifications and advancements made in the ATPA to increase tumor removal and decrease surgical complications. However, complications related to surgical approach occurred, such as venous occlusion-related brain injury and facial nerve damage at pyramid resection. CSF leak remained an unsolved problem related to the ATPA procedures. Preoperative assessment of venous variation of the middle fossa, pneumatization of the temporal bone, and intraoperative monitoring of cranial nerves are important procedures to decrease these complications.

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Suboccipital trans-horizontal fissure approach for cerebellar hemorrhage with rupture into the upper fourth and third ventricles: the first clinical experience. Illustrative cases

Tamura R., Katayama M., Kuranari Y., Horiguchi T.

Journal of Neurosurgery: Case Lessons 3 （ 7 ） 2022年

BACKGROUND The authors’ previous cadaveric study reported a new surgical approach that can expose the deep cerebellar hemisphere, cerebellopontine angle, and upper fourth ventricle through dissection of the horizontal fissure of the suboccipital cerebellar hemisphere. Here, the authors present their experience with the first clinical use of the suboccipital trans-horizontal fissure (SOTHF) approach requiring access to the third and upper fourth ventricle lesions, a challenging compartment to access by traditional approaches. OBSERVATIONS In cases 1 and 2, computed tomography demonstrated large hematomas in the left cerebellar hemisphere with extension into the third ventricle and/or the upper fourth ventricle, resulting in obstructive hydrocephalus. Large hematomas in both the cerebellar hemisphere and the upper fourth ventricle were successfully removed via an SOTHF approach alone without external ventricular drainage. Furthermore, the hematoma in the third ventricle was removed through the aqueduct in case 2. Access to the upper fourth ventricle and the third ventricle were intraoperatively verified using a neuronavigation system. The patients immediately regained consciousness, and the result of cerebellar function testing was almost normal after the operation. LESSONS An SOTHF approach can achieve the removal of cerebellar and intraventricular hematomas simultaneously, is a faster and potentially safer method than others, and subsequently allows rapid clinical improvement.

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Suboccipital Transhorizontal Fissure Approach for Posterior Cranial Fossa Lesions: A Cadaveric Study and First Clinical Experience

Tamura R., Katayama M., Yamamoto K., Horiguchi T.

Operative Neurosurgery 21 （ 6 ） E479 - E487 2021年12月

ISSN 23324252

BACKGROUND: Surgical treatment of pathological lesions in the deep cerebellar hemisphere, cerebellopontine angle (CPA), and fourth ventricle of the posterior cranial fossa (PCF) is challenging. Conventional neurosurgical approaches to these lesions are associated with risk of various complications. Mastery of efficient fissure dissection is imperative when approaching deep-seated lesions. The horizontal fissure (HF) is the largest and deepest fissure of the cerebellum. OBJECTIVE: To conduct an anatomical study and introduce a novel suboccipital trans-HF (SOTHF) approach to access lesions of the deep cerebellar hemispheres, CPA, and upper fourth ventricle of the PCF. METHODS: We performed a cadaveric dissection study focusing on anatomical landmarks and surgical feasibility of the SOTHF approach then implemented it in 2 patients with a deep cerebellar hemispheric tumor. RESULTS: Anatomical feasibility of the SOTHF approach was demonstrated and compared with conventional approaches in the cadaveric study. Opening the suboccipital surface of the HF to create medial, intermediate, and lateral surgical corridors provided optimal viewing angles and wide access to the deep cerebellar hemispheres, CPA, and upper fourth ventricle without heavy cerebellar retraction. Sacrificing cerebellar neural structures and complex skull base techniques were not required to obtain adequate exposure. The SOTHF approach was successfully applied without complication in 2 patients with a deep cerebellar hemispheric tumor. CONCLUSION: The HF is an important cerebellar fissure that provides a gateway to deep areas of the PCF. Further studies are needed to define and expand applications of the SOTHF approach.

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Cone-Beam Computed Tomography Fusion Technique for Vascular Assessment of Skull Base Meningiomas

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

World Neurosurgery 151 61 - 69 2021年07月

ISSN 18788750

Objective: Cone-beam computed tomography (CBCT) images for skull base tumors provide detailed vascular information and localization in regard to surrounding bony structures. We report use of the CBCT fusion technique for skull base meningiomas. Methods: Six patients with petroclival or petrotentorial meningiomas supplied by multiple arterial systems were preoperatively evaluated using CBCT fusion imaging. Fusion images were reconstructed from three-dimensional rotational angiography with contrast agent injections from the internal carotid artery (ICA) and external carotid artery in 4 cases, vertebral artery and external carotid artery in 1 case, and ICA and vertebral artery in 1 case. Results: The feeding pedicles and tumor stains from 2 arterial systems were differentiated by separate colors. The courses and territories of the ICA dural feeders or ICA/vertebral artery pial feeders were easily distinguished from the external carotid artery dural feeders. Anastomoses between thin feeders from different arterial systems could be detected. Mixed stain (stain with both colors) was observed in some tumor compartments, suggesting dual supply from 2 arterial systems and the presence of peritumoral anastomoses. All patients underwent preoperative embolization without complications. Conclusions: CBCT fusion images clearly visualized the feeders from each arterial system, the vascular compartments within the tumor, and possible peritumoral anastomoses. This technique provides a substantial contribution to both preoperative embolization and surgical resection of skull base meningiomas.

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当院における頸部頸動脈瘤に対する治療戦略

堀口崇, 淺田英穂, 寺尾聡, 秋山武紀, 大石裕美子, 吉田一成

脳卒中の外科（(一社)日本脳卒中の外科学会） 49 （ 4 ） 259 - 264 2021年07月

ISSN 0914-5508

当院で頸部頸動脈瘤に対し直達術を行った6例(男性1例、女性5例、平均年齢56.7歳)について検討した。その結果、全例が症候性内頸動脈瘤であり、瘤径は平均35.8mm、動脈瘤内血栓化を2例に認められた。手術法は3例で動脈瘤の切除と内頸動脈の端々吻合による血行再建が行われ、残る3例で母血管閉塞が行われていた。動脈瘤を切除した3例の病理所見はいずれも動脈硬化性動脈瘤であった。5例が転帰良好であったが、1例は内頸動脈閉塞から中大脳動脈塞栓を生じ、広範な脳梗塞により死亡していた。

特集脳卒中:内科医が知っておくべき最新診療脳卒中急性期治療　高血圧性脳出血

堀口崇

診断と治療（(株)診断と治療社） 109 （ 5 ） 651 - 654 2021年05月

ISSN 0370999X

Adult Langerhans Cell Histiocytosis Diagnosed by Biopsy of the Skull Tumor Generated after Craniotomy.

Kono M, Inomoto C, Horiguchi T, Sugiyama I, Nakamura N, Saito R

NMC Case Report Journal （一般社団法人日本脳神経外科学会） 8 （ 1 ） 101 - 105 2021年

ISSN 2188-4226

Langerhans cell histiocytosis (LCH) is a disease characterized by the proliferation of Langerhans cells. Most cases of LCH occur in children, although it can be seen in adults as well. We encountered an adult case of LCH. A 44-year-old woman who was diagnosed as diabetes insipidus underwent a magnetic resonance imaging (MRI) of the head which revealed sellar and suprasellar gadolinium-enhanced mass. Prolactin level was high and cabergoline was prescribed. The size of this mass had reduced, so we supposed the tumor was prolactinoma. However, after 4 years of observation, it had increased once again. The biopsy of pituitary stalk lesion was performed via transcranial approach. The histological diagnosis was initially gangliocytoma. The patient complained of back pain after surgery. Three months after the biopsy, a computed tomography (CT) scan revealed multiple osteolytic lesions throughout the entire body. One of the osteolytic lesions of the skull was removed to determine the diagnosis. The pathological examination of the skull led to a diagnosis of LCH. We concluded retrospectively that the lesion of the pituitary stalk was LCH mimicking gangliocytoma though classical pathological findings were not obtained. In conclusion, LCH should be considered as a differential diagnosis in adult cases of diabetes insipidus with hypothalamic–pituitary lesion.

当院における頚部頚動脈瘤に対する治療戦略

堀口崇, 淺田英穂, 寺尾聡, 秋山武紀, 大石裕美子, 吉田一成

脳卒中の外科（一般社団法人日本脳卒中の外科学会） 49 （ 4 ） 259 - 264 2021年

ISSN 09145508

We report the clinical features of six patients who underwent direct surgery at our hospital for large or giant cervical internal carotid artery aneurysms (CICAAs). Three patients underwent aneurysm resection with end-to-end anastomosis of the internal carotid artery (ICA), and three patients underwent proximal occlusion of the ICA. Five patients had good outcomes, including one case with transient dysphagia. In one case, a middle cerebral artery embolization occurred due to ICA occlusion, and the patient died due to extensive cerebral infarction. To avoid ischemic complications in direct surgery for CICAA, preoperative cerebral blood flow assessment and perioperative antithrombotic therapy are indispensable. In addition, to avoid lower cranial nerve palsy during dissection of the aneurysm from surrounding structures, a bloodless surgical field; safe, reliable internal shunt insertion and vascular suture techniques; and an accurate understanding of the anatomy of the neck are also necessary.

Surgical education using cadaver dissection for modern practical skull base surgical techniques

Horiguchi T.

Japanese Journal of Neurosurgery （日本脳神経外科コングレス） 30 （ 9 ） 665 - 672 2021年

ISSN 0917950X

We have outlined the modern cadaver surgical training to facilitate safe complex and advanced skull base surgeries. The normal formalin‒fixed cadaver head was useful for learning detailed skull base anatomy and histological research by removing the brain. Our fixation method, with the addition of phenol, ethanol, and methanol, was suitable for surgical simulation. To utilize the dissection performed by doctors for the development of surgical skills, it is essential to create an organization within the university.

硬膜動静脈瘻治療における外科治療の役割

秋山武紀, 堀口崇, 高橋里史, 大平貴之, 秋山武和, 吉田一成

脳卒中の外科（(一社)日本脳卒中の外科学会） 48 （ 6 ） 420 - 426 2020年11月

ISSN 0914-5508

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INVESTIGATION OF SERUM MICRORNAS AND THEIR TARGET GENES IN CEREBRAL VASCULAR ENDOTHELIAL CELLS THAT CAN REFLECT THE EXTENT OF EARLY BRAIN INJURY AFTER SUBARACHNOID HEMORRHAGE

Takahashi, S; Arai, N; Nakagawa, S; Koike, K; Yanagisawa, K; Mihara, K; Akiyama, T; Horiguchi, T; Yoshida, K

INTERNATIONAL JOURNAL OF STROKE 15 （ 1_SUPPL ） 581 - 581 2020年11月

ISSN 1747-4930

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 43 （ 5 ） 1323 - 1329 2020年10月

ISSN 03445607

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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Relationship between ischaemic symptoms during the early postoperative period in patients with moyamoya disease and changes in the cerebellar asymmetry index

Takahashi S., Horiguchi T.

Clinical Neurology and Neurosurgery 197 106090 2020年10月

ISSN 03038467

Objective: The aim of this study was to clarify the relationship between ischaemic symptoms during the early postoperative period in patients with moyamoya disease and changes in the cerebellar asymmetry index (AI), a parameter used to quantitatively identify crossed cerebellar diaschisis (CCD). Patients and methods: We analysed the data of 18 patients with moyamoya disease who underwent quantitative IMP-cerebral blood flow SPECT at least once during the follow-up period. Cerebellar AI scores were calculated using the CBF of the cerebellum calculated automatically from multiple slices of SPECT images with automated ROI setup software and categorized and statistically examined according to the presence or absence of ischaemic symptoms. Results: The cerebellar AI calculated from SPECT performed in the patients who presented with ischaemic symptoms was 0.094 ± 0.023 (mean ± SD), which was significantly elevated compared to the value of 0.013 ± 0.025 (mean ± SD) calculated from SPECT performed when the patients did not present with ischaemic symptoms (p < 0.0001). Limiting the time of SPECT to calculate the cerebellar AI to be compared to the acute phase within 2 weeks after surgery did not change this trend, and again, the cerebellar AI was statistically significantly elevated in the presence of ischaemic symptoms (0.094 ± 0.023 (mean ± SD)) compared to the AI in the absence of ischaemic symptoms (0.000081 ± 0.026 (mean ± SD)) (p = 0.0003). In patients who underwent quantitative SPECT in the acute phase during the first postoperative week, the cerebellar AI values calculated from the results of SPECT performed during the preoperative period as well as multiple times during postoperative period were followed over time in each case. The cerebellar AI increased in patients who presented with symptoms of ischaemia postoperatively but then tended to decrease reversibly and approach zero with the disappearance of symptoms of ischaemia. Conclusions: Since the cerebellar AI reflects the symptom of ischaemia in patients with moyamoya disease, especially in the early stage after revascularization surgery, and is a parameter that improves with symptom improvement, it seems to be useful for understanding the state of cerebral blood flow after bypass surgery in patients with moyamoya disease.

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Novel method to evaluate the risk of tumor adhesions and post-operative hemorrhage of meningiomas using 320 row CT-DSA: A clinical research study

Arai N., Mizutani K., Horiguchi T., Akiyama T., Takahashi S., Yanagisawa K., Koike K., Yoshida K.

Acta Neurochirurgica 162 （ 9 ） 2145 - 2153 2020年09月

ISSN 00016268

Objective: Meningioma is an extra-axial tumor that forms adhesions toward the brain surface in the course of its growth. Predicting adhesions between the tumor and the brain surface leads to better predictions of surgical results. There are few studies on brain–tumor adhesions or postoperative hemorrhage. This study aimed to assess tumor vascularity of the dura and cerebral surface, and predict surgical outcomes using four-dimensional computed tomography angiography (4D CTA). Patients and methods: Using a dynamic contrast CT, we conducted a retrospective study of 27 patients with convexity (n = 15), falx (n = 6), and parasagittal (n = 6) meningiomas treated in our hospital from January 2016 to September 2018. We set the region of interest on the dural layer and cerebral surface side of meningiomas and calculated the mean CT value in each region. Distribution of blood flow in the tumor was classified into two groups: A, which has a higher CT value of the dural side than that of the brain surface side at every timing, and B, which meets the criteria other than those in group A. Demographic data, preoperative characteristic images, and postoperative complications were compared between the groups. Results: Twelve and 15 patients were classified into groups A and B, respectively. The extent of adhesions against the cerebral cortex in group A was significantly less severe compared with that in group B (p = 0.038). The rate of postoperative hemorrhage occurrence in group B (53%) was significantly higher than that in group A (8%) (p = 0.04). There were no significant differences in the other preoperative characteristic images or perioperative parameters between groups A and B. Conclusion: A 320-row dynamic contrast CT scanner can detect meningiomas with a high probability of severe adhesion toward the brain surface and postoperative intraparenchymal hematoma.

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