Yoshikazu Okada

11C-methionine uptake correlates with combined 1p and 19q loss of heterozygosity in oligodendroglial tumors.

BACKGROUND AND PURPOSE: Oligodendroglial tumors with 1p/19q LOH are known to show longer patient survival than those without 1p/19q LOH, but the reason for this clinical difference has not been elucidated, to our knowledge. This study was designed to clarify whether uptake of MET correlates with 1p/19q LOH of oligodendroglial tumors. MATERIALS AND METHODS: This study included 102 consecutive patients with supratentorial WHO grade II and III oligodendroglial tumors (39 oligoastrocytic and 63 oligodendroglial tumors) that were resected and diagnosed between January 2008 and August 2011 at Tokyo Womens Medical University Hospital. These patients underwent MET PET T/N ratio measurement before treatment. T/N ratios were calculated by dividing the maximum SUV for the tumor by the mean SUV of the contralateral normal frontal cortex. After surgery, FISH for resected tissues was used to determine 1p/19q LOH. RESULTS: The mean T/N ratio of tumors with 1p/19q LOH was significantly greater than that of tumors without 1p/19q LOH (P = .0166). The threshold T/N ratio value of 2.46 was found to correlate significantly with 1p/19q LOH by univariate (P = .0011) and multivariate analyses (P = .0209) in all tumors. CONCLUSIONS: The T/N ratio on MET PET might be a useful aid to the diagnosis of 1p/19q LOH. Our data add new information on the biology and imaging characteristics of oligodendroglial tumors with 1p/19q LOH.

Brain temperature measurements during speech in patients with brain tumors: New methods for identification of the speech area in intraoperative brain mappings

Abstract In the present study, the usefulness of a functional thermography (fTG) for determining critical speech area was assessed in three patients with brain tumors in language areas. The results of the fTG were also compared with functional MRI (fMRI), subdural electrodes and intraoperative cortical stimulations. Measurements of the regional brain temperature were done using the thermography. The temperature increased after 8–10 s later from the speech and decreased with a few seconds delay after interruption of the task. The areas of increased temperature were coincident with the bridging veins and functional areas identified using fMRI and direct cortical stimulations. The use of fTG increases the sensitivity and specificity for the detection of essential motor language area.

Transnasal Surgery for the Anterior Skull Base : Visualization using High Definition Type Endoscope: —ハイビジョン内視鏡による可視化—

前頭蓋底病変に対する画期的アプローチ法である経蝶 形骨手術(transsphenoidal surgery:TSS)は 20 世紀の初 頭に創始されたが,その合併症率,致死率の高さから普 及することなく 1920 年代後半には開頭術へと移行し た.光学機器が未発達だった当時,狭く深い術野で十分 な可視化が得られなかったことが原因の一つと考えられ る.しかしながら Hardy らが TSS に再着目し,1960 年 代に手術顕微鏡をこの手術に導入することによってその 安全性は飛躍的に向上し,広く一般的な手術となった. また 1990 年代には神経内視鏡が導入され,TSS は新た な局面を迎えている.頭蓋内最深部に位置する前頭蓋底 部腫瘍に対する経鼻手術において内視鏡の有用性は言を またない.顕微鏡と内視鏡にはそれぞれに優れた点があ り総合的な優劣はつけがたいが,顕微鏡は解像度,立体 感,操作性において優れ,われわれ脳神経外科医が使い 慣れた光学機器である.一方で内視鏡の特性は何といっ ても広い視野角にある.また対象物に近接させることが でき,斜視鏡を用いることで顕微鏡ではみえなかったも のを可視化できるようになった(Table 1).当科では 1998 年に TSS を経鼻孔に変更すると同時に神経内視鏡 を導入した.その後 1,200 例を超える前頭蓋底部腫瘍摘 出術を行う中で,このような内視鏡の特性を利用し腫瘍 摘出率,安全性の向上を目指して内視鏡下手技の習熟, 摘出器具・周辺機器の開発などさまざまな工夫を積み重

Carotid endarterectomy for patients with carotid artery stenosis and reconstructive surgery for blunt injury of the common carotid artery

Abstract The authors reported carotid surgeries of carotid endarterectomy (CEA) and reconstruction of occlusive lesion due to blunt injury. Two hundred four CEAs were performed with a routine use of T-shaped shunt system and under intraoperative multimodal monitoring system. There was no perioperative death and four patients (2%) showed permanent neurological deficits. Six patients with occlusive carotid lesions after blunt injuries were treated by replacement of injured common carotid artery (CCA) with Dacron prosthesis. Postoperative carotid angiography demonstrated good flow through the prosthesis in all patients.

Retroauricular subcutaneous Dacron or Gore-Tex tunnel for extracranial–intracranial autologous vein bypass

Abstract The authors described some techniques to achieve a successful extracranial–intracranial (EC–IC) vein graft bypass using a retroauricular prosthesis tunnel and specially designed silicone stent.