記述言語：英語  

Using a Racz catheter (Brevi-XL™, Epimed Inc., NY, USA) to insert an epidural blood patch (EBP) may be an effective method of reaching the target epidural space in the cervical region. We would like to present a case, wherein a targeted EBP via Racz catheter was used in the management of spontaneous intracranial hypotension. When the leak point is clear via imaging, EBP should be performed exactly at that point. However, if the leak point is unclear, with only a contrast agent pool detected via imaging, EBP should be performed to mask the entire region of the pool. In both cases, EBP via Racz catheter is a convenient and effective method for the management of spontaneous intracranial hypotension. Further cases may be needed to verify our results.

DOI： 10.7759/cureus.23559

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 fluorescent dye, 5-aminolevulinic acid (5-ALA), is currently applied for fluorescence-guided resections of high-grade gliomas. Present limitations of this technique are qualitative and subjective analyses, which show little of the background structures. This paper describes the intraoperative quantitative analysis of fluorescence intensity, hot-spot enhancement by frame averaging, and observation of surrounding structures by using 1000-nm lighting in real time. PATIENTS AND METHODS: A sample of diluted protoporphyrin IX (PpIX) in a bottle and 37 samples from nine patients with brain lesions were involved in this study. In this preliminary study, we determined appropriate conditions for image averaging and filters and selected the most sensitive spectrometer. In addition, we utilized a 1000-nm lighting system to visualize surrounding structures with no interference from PpIX fluorescence. RESULTS: The novel system permitted the real-time quantitative analysis of PpIX fluorescence in operative fields by illuminating structures with 1000-nm-lighting. The real-time quantification provided subjective evaluations for surgical decision-making. We found good correlations between the fluorescence and PpIX contents in brain tissue. Furthermore, 1000-nm lighting visualized the anatomical structures and PpIX fluorescence simultaneously. CONCLUSION: The combination of spectroscopy and a 1000-nm lighting system could enable surgeons to create a spectrogram of targets of interest while observing background structures. The spectrometer that we selected is highly sensitive to PpIX fluorescence and enables us to perform intraoperative real-time tissue mapping. By using a real-time system, we can perform quantitative and objective evaluations to achieve maximal tumor resection.

DOI： 10.1016/j.clineuro.2019.04.005

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report a case of a primary malignant lymphoma of the trigeminal nerve that was associated with facial pain. A 65-year-old man was examined at another hospital for unilateral facial pain. Carbamazepine was prescribed, but his symptoms did not improve. Magnetic resonance imaging (MRI) revealed swelling of the trigeminal nerve and a mass lesion in Meckel's cave. The patient was referred to our hospital at this point. Gadolinium-enhanced MRI and F18-Fluorodeoxyglucose-position emission tomography suggested a likely malignant tumour and a biopsy was performed. Histopathological examination showed diffuse a large B cell lymphoma. The patient was treated with high-dose methotrexate (HD-MTX) and radiotherapy. Despite responding well to initial treatment, the patient relapsed, with lymphoma observed throughout the body. He died of pneumonia 18 months after the initial diagnosis. Facial pain is a symptom that is commonly managed in general practice. If symptoms do not improve, repeated imaging studies, including contrast MRI, is warranted. This is the first reported case of primary neurolymphomatosis (NL) of the trigeminal nerve associated with facial pain alone. Furthermore, HD-MTX and radiotherapy may be considered for the management of primary NL of a cranial nerve.

DOI： 10.1080/02688697.2019.1568391

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Arachnoid cysts are common anomalies in the intracranial region. However, an intraventricular arachnoid cyst is rare, and occurrence within the fourth ventricle is especially uncommon; only 16 cases have been described in the literature. Arachnoid cysts in the fourth ventricle may cause obstructive hydrocephalus or cerebellar ataxia or cranial nerve palsy. The treatment for a fourth ventricular arachnoid cyst is complete or partial resection via a midline suboccipital approach. Recently, endoscopic fenestration has become the procedure of choice in the treatment of arachnoid cysts in supratentorial locations, but as yet there has been no report of treating a fourth ventricle arachnoid cyst using a flexible endoscope. CASE DESCRIPTION: We present the case of a 43-year-old man, who suffered a recurrence of an arachnoid cyst in the fourth ventricle that had been partially excised 8 years previously using midline suboccipital craniectomy. Because of concerns of adhesions following the previous craniectomy, we decided to perform endoscopic treatment via the anterior horn of the lateral ventricle. CONCLUSIONS: As per our knowledge, this is the first case reporting the treatment of arachnoid cyst of the fourth ventricle using a flexible endoscope via the anterior horn of the lateral ventricle. This method can be one of the treatments of the arachnoid cysts of the fourth ventricle.

DOI： 10.1016/j.wneu.2018.12.226

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVERecent neuroimaging studies suggest that intractable epilepsy involves pathological functional networks as well as strong epileptogenic foci. Combining cortico-cortical evoked potential (CCEP) recording and tractography is a useful strategy for mapping functional connectivity in normal and pathological networks. In this study, the authors sought to demonstrate the efficacy of preoperative combined CCEP recording, high gamma activity (HGA) mapping, and tractography for surgical planning, and of intraoperative CCEP measures for confirmation of selective pathological network disconnection.METHODSThe authors treated 4 cases of intractable epilepsy. Diffusion tensor imaging-based tractography data were acquired before the first surgery for subdural grid implantation. HGA and CCEP investigations were done after the first surgery, before the second surgery was performed to resect epileptogenic foci, with continuous CCEP monitoring during resection.RESULTSAll 4 patients in this report had measurable pathological CCEPs. The mean negative peak-1 latency of normal CCEPs related to language functions was 22.2 ± 3.5 msec, whereas pathological CCEP latencies varied between 18.1 and 22.4 msec. Pathological CCEPs diminished after complete disconnection in all cases. At last follow-up, all of the patients were in long-term postoperative seizure-free status, although 1 patient still suffered from visual aura every other month.CONCLUSIONSCombined CCEP measurement, HGA mapping, and tractography greatly facilitated targeted disconnection of pathological networks in this study. Although CCEP recording requires technical expertise, it allows for assessment of pathological network involvement in intractable epilepsy and may improve seizure outcome.

DOI： 10.3171/2017.6.JNS17452

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Neuroscientists have long debated whether some regions of the human brain are exclusively engaged in a single specific mental process. Consistent with this view, fMRI has revealed cortical regions that respond selectively to certain stimulus classes such as faces. However, results from multivoxel pattern analyses (MVPA) challenge this view by demonstrating that category-selective regions often contain information about "nonpreferred" stimulus dimensions. But is this nonpreferred information causally relevant to behavior? Here we report a rare opportunity to test this question in a neurosurgical patient implanted for clinical reasons with strips of electrodes along his fusiform gyri. Broadband gamma electrocorticographic responses in multiple adjacent electrodes showed strong selectivity for faces in a region corresponding to the fusiform face area (FFA), and preferential responses to color in a nearby site, replicating earlier reports. To test the causal role of these regions in the perception of nonpreferred dimensions, we then electrically stimulated individual sites while the patient viewed various objects. When stimulated in the FFA, the patient reported seeing an illusory face (or "facephene"), independent of the object viewed. Similarly, stimulation of color-preferring sites produced illusory "rainbows." Crucially, the patient reported no change in the object viewed, apart from the facephenes and rainbows apparently superimposed on them. The functional and anatomical specificity of these effects indicate that some cortical regions are exclusively causally engaged in a single specific mental process, and prompt caution about the widespread assumption that any information scientists can decode from the brain is causally relevant to behavior.

DOI： 10.1073/pnas.1713447114

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We developed a functional brain analysis system that enabled us to perform real-time task-related electrocorticography (ECoG) and evaluated its potential in clinical practice. We hypothesized that high gamma activity (HGA) mapping would provide better spatial and temporal resolution with high signal-to-noise ratios. METHODS: Seven awake craniotomy patients were evaluated. ECoG was recorded during language tasks using subdural grids, and HGA (60-170 Hz) maps were obtained in real time. The patients also underwent electrocortical stimulation (ECS) mapping to validate the suspected functional locations on HGA mapping. The results were compared and calculated to assess the sensitivity and specificity of HGA mapping. For reference, bedside HGA-ECS mapping was performed in 5 epilepsy patients. RESULTS: HGA mapping demonstrated functional brain areas in real time and was comparable with ECS mapping. Sensitivity and specificity for the language area were 90.1% ± 11.2% and 90.0% ± 4.2%, respectively. Most HGA-positive areas were consistent with ECS-positive regions in both groups, and there were no statistical between-group differences. CONCLUSIONS: Although this study included a small number of subjects, it showed real-time HGA mapping with the same setting and tasks under different conditions. This study demonstrates the clinical feasibility of real-time HGA mapping. Real-time HGA mapping enabled simple and rapid detection of language functional areas in awake craniotomy. The mapping results were highly accurate, although the mapping environment was noisy. Further studies of HGA mapping may provide the potential to elaborate complex brain functions and networks.

DOI： 10.1016/j.wneu.2016.09.071

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Congress of Neurological Surgeons  

Over the last four decades, neurosurgical operating techniques have greatly improved with the advent of the operation microscope and the drastic evolution of medical engineering technologies. In the field of epilepsy treatment where, even though electrophysiological monitoring through scalp EEG and/or chronic subdural electrodes is still considered the gold standard, various types of newly developed non-invasive monitoring apparatus, techniques and surgical intervention are enabling us to better understand the epilepsy phenomenon through a more detailed etiology while achieving better prognoses as well. In this article, we review the current status of surgical intervention for epilepsy syndromes with special reference to the ongoing evolution of medical engineering technologies.

DOI： 10.7887/JCNS.25.112

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記述言語：英語  

The authors report a rare case of right cerebellopontine angle cyst related to hemifacial spasm. The patient was a 66-year-old woman with a 3-year history of right hemifacial spasm. The cyst was diagnosed preoperatively by T2-weighted magnetic resonance imaging, which demonstrated a hyperintense area in the right cerebellopontine angle. A small artery was displaced by the cyst and compressed the root exit zone of the facial nerve. Decompression of the cyst and the vasculature using a microsurgical technique resulted in total recovery from hemifacial spasm.

DOI： 10.1055/s-0035-1564341

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Electrocortical stimulation (ECS) is the gold standard for functional brain mapping during an awake craniotomy. The critical issue is to set aside enough time to identify eloquent cortices by ECS. High gamma activity (HGA) ranging between 80 and 120 Hz on electrocorticogram is assumed to reflect localized cortical processing. In this report, we used real-time HGA mapping and functional neuronavigation integrated with functional magnetic resonance imaging (fMRI) for rapid and reliable identification of motor and language functions. METHODS: Four patients with intra-axial tumors in their dominant hemisphere underwent preoperative fMRI and lesion resection with an awake craniotomy. All patients showed significant fMRI activation evoked by motor and language tasks. During the craniotomy, we recorded electrocorticogram activity by placing subdural grids directly on the exposed brain surface. RESULTS: Each patient performed motor and language tasks and demonstrated real-time HGA dynamics in hand motor areas and parts of the inferior frontal gyrus. Sensitivity and specificity of HGA mapping were 100% compared with ECS mapping in the frontal lobe, which suggested HGA mapping precisely indicated eloquent cortices. We found different HGA dynamics of language tasks in frontal and temporal regions. Specificities of the motor and language-fMRI did not reach 85%. The results of HGA mapping was mostly consistent with those of ECS mapping, although fMRI tended to overestimate functional areas. CONCLUSIONS: This novel technique enables rapid and accurate identification of motor and frontal language areas. Furthermore, real-time HGA mapping sheds light on underlying physiological mechanisms related to human brain functions.

DOI： 10.1016/j.wneu.2014.08.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The supplementary motor area (SMA) is a key structure involved in behavioral planning and execution. Although many reports have indicated that SMA is organized somatotopically, its exact organization remains still unclear. This study aimed to functionally map SMA using functional magnetic resonance imaging (fMRI) and validate the fMRI-SMA by electrocortical stimulation (ECS) and postsurgical symptoms. Total 32 healthy volunteers and 24 patients participated in this study. Motor tasks were right and left finger tapping and language tasks included simple reading, lexical decision for presented words, and verb generating tasks. SPM8 was used to conduct individual and group analyses. In all subjects, the lexical decision task induced the greatest number of active fMRI pixels in SMA. fMRI during the language tasks showed anterior part of SMA compared to finger tapping tasks. We found an overlap spot with all different tasks in posterior part of SMA, which we termed SMA core. Six patients underwent awake craniotomy for ECS mapping for primary regions and SMA. During awake craniotomy, ECS to posterior part of SMA, which might involve the possible SMA core consistently, evoked both speech arrest and flaccid hemiparesis. The SMA mapping suggested posterior part of SMA might play more important roles in any executions, which might involve the SMA core.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We compared electrocorticography (ECoG) with invasive intracranial noninvasive functional MRI using language-related tasks. Twenty patients underwent bilateral implantation of subdural electrodes (more than 80 channels) for diagnosing intractable epilepsy. Before implantation of the electrodes, language-related fMRI was performed, and the fMR images were superimposed on individual brain images. Brain mapping with electrocortical stimulation was performed on the basis of the fused fMR and brain MR images, and the specificity and sensitivity of language-related fMRI was calculated. For careful interpretation of spatial and temporal ECoG changes with semantic tasks, we developed a software to visualize semantic-ECoG dynamics in the brain. Semantic-ECoG was recorded during word, figure, and face recognition as well as memory tasks. The raw ECoG data were processed by averaging and time-frequency analysis, and the functional profiles were projected onto the individual brain surface. Acquired ECoG was classified using Support Vector Machine and Sparse Logistic Regression to decode brain signals. Because of variations in electrode locations, we normalized the ECoG electrodes by using SPM8. Although fMRI has 90% sensitivity, its specificity is only up to 50%. The basal temporal-occipital cortex was activated within 250 ms after visual object presentation. Compared to other stimuli, face stimulation evoked significantly higher ECoG amplitudes. Among different brain regions, the hippocampus was predominantly activated during the memory task. The prediction rate of ECoG classification was 90%, which was sufficient for clinical use. Semantic-ECoG is a powerful technique to detect and decode human brain functions.

PubMed

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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：ASEAN NEUROLOGICAL ASSOC  

A kainic acid microinjection into unilateral occipital cortex induced an experimental model of occipital lobe epilepsy in cats and rats. Elicited focal seizures in the occipital cortex promptly propagated to the bilateral cortices and also to the subcortical structures. Behavioral and EEG observations were well correlated to the human occipital lobe epilepsy. Metabolic study using 14C-deoxyglucose autoradiography in rats demonstrated a rapid propagation of the hypermetabolic area in the parietal, frontal, temporal and contralateral occipital cortices and also to the thalamus, basal ganglia, MRF and lateral geniculate body. The result shows that not only Meyer's loop but also subcortical fasciculus between occipital lobe and other lobules may have an important role in the mechanism of seizure evolution and propagation of the occipital lobe epilepsy.

Web of Science

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

An 8-month-old female presented with hydrocephalus caused by cerebrospinal fluid (CSF) overproduction due to bilateral choroid plexus enlargement, which was clinically diagnosed as diffuse villous hyperplasia of the choroid plexus, but differentiation from bilateral choroid plexus papilloma was difficult. She initially underwent ventriculoperitoneal shunt surgery, but developed marked retention of ascites. Therefore, the peritoneal end of the shunt was removed for external drainage, but excessive CSF (1,500 ml/day) was collected. Computed tomography and magnetic resonance imaging revealed marked symmetric enhancement of the choroid plexuses in the bilateral lateral ventricles. Thallium-201 chloride single-photon emission computed tomography showed pronounced uptake on both early and delayed images, and good washout. CSF examination revealed no abnormalities such as atypical cells, and a ventriculoatrial shunt was inserted, achieving good control of the hydrocephalus.

PubMed

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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

In the experimental models of limbic seizures, seizure propagation mechanisms from the epilepsy foci have been extensively studied. However, influences of subcortical structures such as basal ganglia, thalamus, hypothalamus or mesencephalic reticular formation (MRF) upon focal seizure propagation were not well studied until now. Using two models of experimental epilepsies, amygdala kindling and kainic acid-induced amygala seizures, we investigated the characteristics of epilepsy focus and the mode of propagation from the epileptic seizures. Behavioral changes, EEG evolutions and ictal autoradiograms were compared and analysed. Influences of the thalamic nucleus, basal ganglia or MRF upon different limbic seizures were also analyzed. In each injection to the subcortical structures, seizure-like activities were elicited. These clinical observation, EEG analysis and autoradiograms were well correlated to each others. The present results suggested that seizure evolution from focal limbic seizure to secondarily generalized seizure seemed to require extensive seizure excitation of basal ganglia, thalamus and MRF.

Scopus

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科コングレス  

ペンフィールドのhomunculusが報告されてから機能的脳局在を重視した脳神経外科手術が進歩してきた。てんかん外科においては発作の減少と術後神経機能脱落の回避を目的に、従来の脳表電極・硬膜下電極によるてんかん原生域同定に加え、医用技術進歩により種々の非侵襲的・補助的診断機器、覚醒下手術などが積極的に導入されてきたが、これらは単にてんかんに留まらず、glioma手術を含めた脳神経外科手術の根幹をなすものと思われる。同時にてんかん関連・皮質機能関連ネットワークの解明にも利用され、新たな大脳皮質機能地図が明らかになりつつある。この稿では医用技術進歩に伴う検査と侵襲的・非侵襲的治療法に焦点をあて、概説を試みた。(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=2016&ichushi_jid=J02632&link_issn=&doc_id=20160208310001&doc_link_id=10.7887%2Fjcns.25.112&url=https%3A%2F%2Fdoi.org%2F10.7887%2Fjcns.25.112&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(株)中外医学社  

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記述言語：日本語   出版者・発行元：(株)中外医学社  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科コングレス  

症例は21歳男性で、周産期に異常なく、6歳8ヵ月頃から睡眠中に右上肢から始まる強直間代痙攣が出現し、小児科で局在関連性癲癇と診断され、フェニトインを内服した。フェニトインの効果がなく中止し、ゾニサミド、カルバマゼピンを開始した。さらにレベチラセタム内服を開始するも著効は認められず、その他の抗癲癇薬も無効であった。発作様式は右上肢屈曲と右下肢伸展から始まり、頸部が右に回旋し、眼球も右に偏位する単純部分発作で、その後に強直間代性発作へ二次性全般化した。右麻痺は進行性で、受診時、右上肢MMT3-、右下肢MMT3+であった。IQは50で重度知的障害と判定されていた。その他特記すべき神経症状は認めなかった。左中心前回にMRI(T1W1、T2W1)で約30cmの低輝度域を認めた。MRI(FLAIR)冠状断で海馬効果は認めなかった。その他、特記すべき器質的異常所見は認めなかった。術後10日目に退院し、6ヵ月経過現在も症状なく、抗癲癇薬を漸減しながら外来通院を継続している。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J02632&link_issn=&doc_id=20150715140007&doc_link_id=1390282679383128064&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390282679383128064&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

記述言語：日本語   出版者・発行元：(株)メディカ出版  

＜Check Point＞音の伝わる経路が重要です。感覚中枢が単独で障害されることは少ないです。聴覚中枢は、感覚性言語野と位置や機能的に密接な関係があります。(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=2015&ichushi_jid=J01883&link_issn=&doc_id=20150327130010&doc_link_id=%2Fao7brnui%2F2015%2F003104%2F012%2F0376-0378%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fao7brnui%2F2015%2F003104%2F012%2F0376-0378%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：日本てんかん学会-北海道地方会  

Arterial Spin Labeling(ASL)による運動・言語機能評価について検討した。健常人6例(男性4例、女性2例)を対象とし、fMRIとpulsed-continuous ASL(pCASL)を施行した。課題は運動課題として右指タッピング課題、言語課題として語彙決定課題を行った。fMRIは運動課題と言語課題において全例でBOLD信号の変化を検出し、有意な領域を同定することが可能であった。pCASLでは運動課題は全例、言語課題は4例で血流上昇の変化を検出した。fMRIとpCASLの血流上昇領域の分布に僅かなズレを検出した。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J02553&link_issn=&doc_id=20151228020005&doc_link_id=%2Fen4tenka%2F2014%2F003300%2F006%2F0043-0048%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fen4tenka%2F2014%2F003300%2F006%2F0043-0048%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)日本脳神経外科コングレス  

脳皮質電位(ECoG)計測による脳機能マッピング法が近年注目を集めている。そのなかでも高周波脳律動(high frequency oscillation:HFO)は脳機能局在に有用であると期待を集めている。本稿ではECoGをベッドサイド、手術室における覚醒下手術の際の脳機能マッピングとして応用した。さらに計測結果をリアルタイムに表示することで、新たな術中モニタリング法としての可能性を提示した。リアルタイムHFOマッピングの結果は脳皮質電気刺激の結果と比較して、きわめて信頼性が高く、検査時間が短いため、今後脳神経外科領域での新たなマッピング手法として確立することが期待される。(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=2014&ichushi_jid=J02632&link_issn=&doc_id=20141107370002&doc_link_id=10.7887%2Fjcns.23.862&url=https%3A%2F%2Fdoi.org%2F10.7887%2Fjcns.23.862&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本脳神経外科コングレス  

本稿では脳腫瘍摘出手術に役立つ術前機能マッピングと術中機能モニタリングの具体的方法と臨床現場における評価、信頼性について述べた。現在術前機能マッピングによる運動野/中心溝局在、および優位半球の同定は現場で十分応用できる。しかし、言語関連機能MRIの活動部の脳皮質電気刺激による検証では感度は80%、特異度は60%程度でさらなる改良が必要である。一方、tractographyは機能している皮質脊髄路と弓状束を正確に反映しているため、手術計画に有用である。術中脳機能モニタリング方法としては、感覚誘発電位、運動野、皮質脊髄路電気刺激による運動誘発電位、および覚醒下手術がある。感覚誘発電位、皮質刺激運動誘発電位により確実な運動野/中心溝局在の同定が行える。また、白質刺激運動誘発電位では刺激強度と切除腔と皮質脊髄路tractography間距離に強い相関関係があり、刺激強度から皮質下構造までの距離を推測することもできる。覚醒下手術では図形名称課題を用いることで、効率的に言語皮質、弓状束を同定・温存できる。蛍光画像マッピングは悪性腫瘍浸潤領域の同定に有用であるが、さらなる定量的な検討方法の確立が必要である。(著者抄録)

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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)日本脳神経外科コングレス  

脳腫瘍摘出では機能の温存が重要であり、その機能マッピングには覚醒下手術、頭蓋内電極による脳皮質電気刺激(ECS)がある。しかし、ECSは痙攣誘発のリスクや痛みなどを伴う。近年は脳皮質電位(ECoG)による機能マッピングの報告があり、特に高周波律動に注目が集まっている。今回われわれは、言語野近傍の脳腫瘍患者において、頭蓋内電極によりECSマッピングとECoG計測を行った。ECoGは60〜120Hzの高周波律動であるhigh Gamma activity(HGA)に着目した。文字読み課題で約600msec付近に誘発されたHGAはECSマッピングの側頭葉言語野と一致していた。また、HGAは後頭葉から側頭葉-前頭葉言語関連機能ダイナミクスを表していた。本症例で施行した認知課題ECoGはECSに代わる脳機能マッピング法となる。(著者抄録)

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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：(株)医学書院  

頭蓋内電極留置下の患者20例に様々な認知反応課題を行い、運動、言語関連、記憶関連機能の画像化を試みた。具体的には、個々の患者に行った課題・提示刺激で誘発された脳皮質電位(ECoG)の時間的・空間的広がりをパターン化し、記憶関連ECoGの有無と、手術による記憶障害出現程度との関係について検討した。また、電極留置前に行った認知関連課題fMRIと脳皮質電気刺激の結果との比較により、その精度・信頼性に関する検討も行った。さらに、複数の自動判別関数を用いて課題別ECoG反応のクラス分けを行い、より効率的な脳信号抽出を試みた。また、患者間で留置電極位置にバラツキがあるため、標準脳にECoG電極位置座標を変換・重畳し、これにより標準脳上に高解像度ECoGの時間的変化過程を描出した。これらを組み合わせることにより、言語・記憶機能野の同定、および典型的な認知ECoG反応ダイナミクスを解析する方法を開発した。

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記述言語：日本語   出版者・発行元：(株)医学書院  

59歳男性。患者は左内頸動脈瘤破裂によるくも膜下出血に対する開頭クリッピング手術15年後に右上下肢の不全麻痺が出現し、頭部MRIにて左鉤ヘルニアを認め、入院となった。頭部単純X線では可変式バルブによる脳室-腹腔シャントシステムが留置されていたが、CTでは遊離骨弁の落ち込みがみられ、MRIでは左鉤の一部が小脳テントを超え大脳脚を圧迫していた。以上より、治療としてナビゲーションを用いて鉤切除を行い、骨弁はチタンプレートにて固定した結果、術後、右麻痺は徐々に改善し、経過良好となった。

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

1歳2ヵ月男児。進行性の頭囲拡大を主訴として近医受診し、MRIで小脳腫瘍および水頭症を指摘され当科紹介となった。腹臥位による後頭下開頭術を予定し、術中の眼球および顔面への圧迫対策として、整形外科領域で使用されている頭部支持用デバイスProne View(DUPACO社製)を採用した。ミラーで眼球圧迫がないことを確認し、気管内挿管チューブが自重で抜けないように、クッションの一部を削除して外側尾側へと導いた。頸部は正中位になるため、大孔後頭孔付近での処理に術野が狭くなることも危惧されたが、術中一時的に前屈位をとることが用手的に可能であり、問題なく処理できた。顕微鏡操作時における固定性にもまったく支障はなく、約8時間の装着であったが直後に前頭部の軽度の発赤を認めたのみで、翌日には消失した。眼球および顔面にもまったく問題はなかった。

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

妊娠を契機とした脳血管障害7例(23〜40歳)のうち代表例を提示した。症例1(34歳)は陣痛後に全身痙攣を来たし、MRIで後頭葉中心に白質異常信号、MRAで脳血管攣縮を認め、子癇と診断した。全身麻酔下に緊急帝王切開を行い、術後経過は良好で、画像所見も改善した。症例2(27歳)は妊娠28週に全身痙攣を来たし、MRIではFLAIRとT1・T2強調像で後頭葉中心に異常信号を認めたが、DWIおよびMRAでは異常を認めなかった。子癇と診断して緊急帝王切開を行い、術後経過良好で、異常信号も消失した。症例3(39歳)は妊娠8週に全身痙攣を来たし、CTで右前頭葉に低吸収域と静脈洞の高吸収を認め、静脈洞血栓症と診断した。母体の安全を考慮し、1週間後に中絶となった。症例4(31歳)は妊娠22週に意識障害が出現し、MRIで小脳に梗塞像を認め、MRAでは脳底動脈先端部の描出が不良であった。脳底動脈塞栓症と診断し、血栓溶解術により再開通が得られた。抗凝固療法併用で27週まで妊娠継続し、帝王切開で出産した。母児ともに経過良好であった。

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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  

中枢神経系の悪性腫瘍の特異な進展形態として、髄腔内播種があげられる。これは腫瘍細胞が脳脊髄液を介して脳表やクモ膜下腔、さらには脳室内や脳槽内に進展・浸潤した病態である。原発性および転移性脳腫瘍でともに発症し、その頻度は原発性脳腫瘍で4.2%、転移性脳腫瘍で5.1%といわれている。原発性脳腫瘍では胚芽腫、髄芽腫、上衣腫、膠芽腫などに好発し、転移性脳腫瘍では乳癌、肺癌、胃癌などで好発し、癌性髄膜炎ともいわれている。髄腔内播種の予後は不良であり、従来の全身化学療法や放射線療法では難治性である。このため特異的な治療法として、抗癌剤の髄腔内投与が行われている。髄腔内化学療法の利点としては、速やかに髄腔内に分布し、そのクリアランスが遅く分解も遅いため作用時間が長い、といった点があげられる。投与経路については、側脳室内にOmmaya reservoirを留置して、これを頭皮上より穿刺して脳室内に投与する方法、腰椎穿刺下に腰部クモ膜下腔内に投与する方法、また、両者を交互にあるいは同時に行う方法などがあり、また投与方法もbolus injectionや灌流療法などが行われている。現在汎用されている薬剤としては、methotrexate(MTX),cytarabine(Ara-C),3-[(4-amino-2-methyl-5-pyrimidinyl)methyl]-1-(2-chloroethyl)-1-nitrosourea hydrochloride(ACNU)があげられ、その他、最近は新薬の臨床応用も行われはじめている。治療成績に関しては、腫瘍の組織型や投与薬剤や投与法により差異はあるものの、response rateは40〜80%程度であり、平均生存期間も約4〜25ヵ月である。抗癌剤独自の副作用は全身化学療法と同様の対処でよいと思われるが、特異的な副作用として、非特異性薬物反応性髄膜炎ないし脳室炎、一過性または持続性不全麻痺や脳症があげられる。これらは投与量の減量や中止により軽快することが多く、場合によっては髄注時に少量の副腎皮質ホルモンも追加投与する。また、髄注に際し、刺入部よりの細菌性髄膜炎の併発も認められ、抗癌剤の投与中止、Ommaya reservoirなどの抜去や抗生剤の全身および髄腔内投与を行う。このように髄腔内播種は特異な転移形式であり、極めて予後不良な病態ではあるが、本治療法による有効例も散見され、今後有用な治療法の一つとなり得ると考えられる。(著者抄録)

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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  

1歳6ヵ月女児.生後5ヵ月頃より体重増加が停止したため近医小児科にて経過観察を受けた.しかし,その後も体重増加を認めず1歳2ヵ月に自院小児科を受診し,頭部MRIにて異常を指摘され脳神経外科に入院となった.身長71.6cm,体重5500gと著しいるいそうを認め,精神運動発達は1歳相当であった.内分泌学的にはGHの異常高値とIGF-Iの低下が認められた以外は正常であった.MRIにて視床下部前部原発腫瘍を認め,これによりDiencephalic syndromeを呈しているものと考え,腫瘍摘出術を施行した,視交叉部分は部分切除に留めた.病理組織学的にFibrillary astrocytoma,grade 2と診断された.術後に化学療法を6クール施行し,頭部MRIでは腫瘍の縮小を認め,血清GHも正常化した.現在は経過観察中である

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