47 results on '"Atsushi Okano"'
Search Results
2. Meningiomas in patients with neurofibromatosis type 2 predominantly comprise ‘immunogenic subtype’ tumours characterised by macrophage infiltration
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Yu Teranishi, Satoru Miyawaki, Masahiro Nakatochi, Atsushi Okano, Kenta Ohara, Hiroki Hongo, Daiichiro Ishigami, Yu Sakai, Daisuke Shimada, Shunsaku Takayanagi, Masako Ikemura, Daisuke Komura, Hiroto Katoh, Jun Mitsui, Shinichi Morishita, Tetsuo Ushiku, Shumpei Ishikawa, Hirofumi Nakatomi, and Nobuhito Saito
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Neurofibromatosis type 2 ,Meningioma ,Tumour microenvironment ,Immune infiltration ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Abstract Although recent molecular analyses revealed that sporadic meningiomas have various genetic, epigenetic, and transcriptomic profiles, meningioma in patients with neurofibromatosis type 2 (NF2) have not been fully elucidated. This study investigated meningiomas' clinical, histological, and molecular characteristics in NF2 patients. A long-term retrospective follow-up (13.5 ± 5.5 years) study involving total 159 meningiomas in 37 patients with NF2 was performed. Their characteristics were assessed using immunohistochemistry (IHC), bulk-RNA sequencing, and copy number analysis. All variables of meningiomas in patients with NF2 were compared with those in 189 sporadic NF2-altered meningiomas in 189 patients. Most meningiomas in NF2 patients were stable, and the mean annual growth rate was 1.0 ± 1.8 cm3/year. Twenty-eight meningiomas (17.6%) in 25 patients (43.1%) were resected during the follow-up period. WHO grade I meningiomas in patients with NF2 were more frequent than in sporadic NF2-altered meningiomas (92.9% vs. 80.9%). Transcriptomic analysis for patients with NF2/sporadic NF2-altered WHO grade I meningiomas (n = 14 vs. 15, respectively) showed that tumours in NF2 patients still had a higher immune response and immune cell infiltration than sporadic NF2-altered meningiomas. Furthermore, RNA-seq/IHC-derived immunophenotyping corroborated this enhanced immune response by identifying myeloid cell infiltration, particularly in macrophages. Clinical, histological, and transcriptomic analyses of meningiomas in patients with NF2 demonstrated that meningiomas in NF2 patients showed less aggressive behaviour than sporadic NF2-altered meningiomas and elicited a marked immune response by identifying myeloid cell infiltration, particularly of macrophages.
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- 2023
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3. Case report and literature review: exploration of molecular therapeutic targets in recurrent malignant meningioma through comprehensive genetic analysis with Todai OncoPanel
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Kenta Ohara, Satoru Miyawaki, Hirofumi Nakatomi, Atsushi Okano, Yu Teranishi, Yuki Shinya, Daiichiro Ishigami, Hiroki Hongo, Shunsaku Takayanagi, Shota Tanaka, Aya Shinozaki-Ushiku, Shinji Kohsaka, Hidenori Kage, Katsutoshi Oda, Kiyoshi Miyagawa, Hiroyuki Aburatani, Hiroyuki Mano, Kenji Tatsuno, and Nobuhito Saito
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malignant meningioma ,malignant progression ,Todai OncoPanel ,comprehensive genomic analysis ,actionable gene aberration ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
BackgroundDespite accumulating research on the molecular characteristics of meningiomas, no definitive molecularly targeted therapy for these tumors has been established to date. Molecular mechanisms underlying meningioma progression also remain unclear. Comprehensive genetic testing approaches can reveal actionable gene aberrations in meningiomas. However, there is still limited information on whether profiling the molecular status of subsequent recurrent meningiomas could influence the choice of molecular-targeted therapies.Case presentationWe report a case of meningioma with malignant progression and multiple recurrences. We performed matched tumor pair analysis using the Todai OncoPanel to investigate the possibility of additional standard treatments. The loss of several chromosomal regions, including NF2 and CDKN2A, which is associated with aggressive meningiomas, was considered a significant driver event for malignant progression. Using additional matched tumor pair analysis, mutations in TRAF7, ARID1A, and ERBB3 were identified as subclonal driver events at the time of recurrence. No genetic aberrations were found for which evidence-based targeted therapy was applicable. We also reviewed previous reports of molecular therapies in meningioma to discuss issues with the current molecular testing approach.ConclusionGene panel testing platforms such as the Todai OncoPanel represent a powerful approach to elucidate actionable genetic alterations in various types of tumors, although their use is still limited to the diagnosis and prediction of prognosis in meningiomas. To enable targeted molecular therapy informed by gene-panel testing, further studies including matched tumor pair analyses are required to understand the molecular characteristics of meningiomas and develop treatments based on genetic abnormalities.
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- 2023
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4. Advances in Molecular Biological and Translational Studies in World Health Organization Grades 2 and 3 Meningiomas: A Literature Review
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Atsushi OKANO, Satoru MIYAWAKI, Yu TERANISHI, Kenta OHARA, Hiroki HONGO, Yu SAKAI, Daiichiro ISHIGAMI, Hirofumi NAKATOMI, and Nobuhito SAITO
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genomic alteration ,copy number alteration ,mrna expression ,dna methylation ,systemic medical therapy ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
The treatment of World Health Organization (WHO) grades 2 and 3 meningiomas remains difficult and controversial. The pathogenesis of high-grade meningiomas was expected to be elucidated to improve treatment strategies. The molecular biology of meningiomas has been clarified in recent years. High-grade meningiomas have been linked to NF2 mutations and 22q deletion. CDKN2A/B homozygous deletion and TERT promoter mutations are independent prognostic factors for WHO grade 3 meningiomas. In addition to 22q loss, 1p, 14p, and 9q loss have been linked to high-grade meningiomas. Meningiomas enriched in copy number alterations may be biologically invasive. Furthermore, several new comprehensive classifications of meningiomas have been proposed based on these molecular biological features, including DNA methylation status. The new classifications may have implications for treatment strategies for refractory aggressive meningiomas because they provide a more accurate prognosis compared to the conventional WHO classification. Although several systemic therapies, including molecular targeted therapies, may be effective in treating refractory aggressive meningiomas, these drugs are being tested. Systemic drug therapy for meningioma is expected to be developed in the future. Thus, this review aims to discuss the distinct genomic alterations observed in WHO grade 2 and 3 meningiomas, as well as their diagnostic and therapeutic implications and systemic drug therapies for high-grade meningiomas.
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- 2022
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5. Early prediction of functional prognosis in neurofibromatosis type 2 patients based on genotype–phenotype correlation with targeted deep sequencing
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Yu Teranishi, Satoru Miyawaki, Hirofumi Nakatomi, Kenta Ohara, Hiroki Hongo, Shogo Dofuku, Atsushi Okano, Shunsaku Takayanagi, Takahiro Ota, Jun Yoshimura, Wei Qu, Jun Mitsui, Shinichi Morishita, Shoji Tsuji, and Nobuhito Saito
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Medicine ,Science - Abstract
Abstract Regardless of treatment, the clinical progression of neurofibromatosis type 2 (NF2), particularly in terms of hearing, swallowing, and gait, tend to worsen throughout the patients’ lives. We performed a retrospective analysis of functional outcomes in Japanese NF2 patients to predict their functional prognosis. We analyzed genotype–phenotype correlation based on genetic data from a cohort of 57 patients with a mean follow-up of 14.5 ± 6.0 years. Their functional outcomes, including hearing, swallowing, and ambulation, were reviewed. Performing a targeted deep sequencing, germline NF2 mutations were identified in 28 patients (49.1%), and mosaic NF2 was identified in 20 patients (20, 35.0%). The functional preservation period and outcome differed significantly depending on clinical/genetic factors. Among these factors, “Truncating”, “Mosaic”, and “Age of symptom onset ≥ 25” had the most significant effects on functional disability. By applying a combination of an NF2 mutation type/location, and age of symptom onset, we classified different degrees of functional preservation and progression, schwannoma growth rate and total interventions per year per patient. The prediction of detailed functional outcomes in NF2 patients can plan better strategies for life-long disease management and social integration.
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- 2022
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6. Clinical significance of NF2 alteration in grade I meningiomas revisited; prognostic impact integrated with extent of resection, tumour location, and Ki-67 index
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Yu Teranishi, Atsushi Okano, Satoru Miyawaki, Kenta Ohara, Daiichiro Ishigami, Hiroki Hongo, Shogo Dofuku, Hirokazu Takami, Jun Mitsui, Masako Ikemura, Daisuke Komura, Hiroto Katoh, Tetsuo Ushiku, Shumpei Ishikawa, Masahiro Shin, Hirofumi Nakatomi, and Nobuhito Saito
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Meningioma genomics ,WHO grade ,Tumor location ,Tumor prognosis ,Precision medicine ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Abstract NF2 alteration is the most commonly–found genetic abnormality in meningiomas and is known to initiate events for aggressive-type meningiomas. Whereas the prognosis of meningiomas differs depending on their epigenomic/transcriptomic profile, the effect of NF2 alteration on the prognosis of benign meningiomas is not fully elucidated. This study aimed to probe the importance of NF2 alteration in prognosis of WHO grade I meningiomas. A long-term retrospective follow-up (5.3 ± 4.5 years) study involving 281 consecutive WHO grade I meningioma patients was performed. We assessed tumour recurrence in correlation with extent of resection (EOR), histopathological findings, tumour location, and NF2 alteration. “NF2 meningioma” was defined as meningiomas with presence of NF2 mutation and/or 22q loss. Overall, NF2 meningioma per se was not a predictor of prognosis in the whole cohort; however, it was a predictor of recurrence in supratentorial meningiomas, together with EOR and Ki-67. In a striking contrast, NF2 meningioma showed a better prognosis than non-NF2 meningioma in infratentorial lesion. Supratentorial NF2 meningiomas had higher Ki-67 and forkhead box protein M1 expression than those of others, possibly explaining the worse prognosis in this subtype. The combination of NF2 alteration, high Ki-67 and supratentorial location defines subgroup with the worst prognosis among WHO grade I meningiomas. Clinical connotation of NF2 alteration in terms of prognosis of WHO grade I meningioma differs in an opposite way between supratentorial and infratentorial tumors. Integrated anatomical, histopathological, and genomic classifications will provide the best follow-up schedule and proactive measures.
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- 2022
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7. Associations of pathological diagnosis and genetic abnormalities in meningiomas with the embryological origins of the meninges
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Atsushi Okano, Satoru Miyawaki, Hiroki Hongo, Shogo Dofuku, Yu Teranishi, Jun Mitsui, Michihiro Tanaka, Masahiro Shin, Hirofumi Nakatomi, and Nobuhito Saito
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Medicine ,Science - Abstract
Abstract Certain driver mutations and pathological diagnoses are associated with the anatomical site of meningioma, based on which the meninges have different embryological origins. We hypothesized that mutations and pathological diagnoses of meningiomas are associated with different embryological origins. We comprehensively evaluated associations among tumor location, pathological diagnosis (histological type), and genetic alterations including AKT1, KLF4, SMO, POLR2A, and NF2 mutations and 22q deletion in 269 meningioma cases. Based on the embryological origin of meninges, the tumor locations were as follows: neural crest, paraxial mesodermal, and dorsal mesodermal origins. Tumors originating from the dura of certain embryologic origin displayed a significantly different pathological diagnoses and genetic abnormality ratio. For instance, driver genetic mutations with AKT1, KLF4, SMO, and POLR2A, were significantly associated with the paraxial mesodermal origin (p = 1.7 × 10−10). However, meningiomas with NF2-associated mutations were significantly associated with neural crest origin (p = 3.9 × 10–12). On analysis of recurrence, no difference was observed in embryological origin. However, POLR2A mutation was a risk factor for the tumor recurrence (p = 1.7 × 10−2, Hazard Ratio 4.08, 95% Confidence Interval 1.28–13.0). Assessment of the embryological origin of the meninges may provide novel insights into the pathomechanism of meningiomas.
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- 2021
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8. NF2 Alteration/22q Loss Is Associated with Recurrence in WHO Grade 1 Sphenoid Wing Meningiomas
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Yu Sakai, Satoru Miyawaki, Yu Teranishi, Atsushi Okano, Kenta Ohara, Hiroki Hongo, Daiichiro Ishigami, Daisuke Shimada, Jun Mitsui, Hirofumi Nakatomi, and Nobuhito Saito
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sphenoid wing meningioma ,recurrence ,NF2 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Sphenoid wing meningiomas account for 11–20% of all intracranial meningiomas and have a higher recurrence rate than those at other sites. Recent molecular biological analyses of meningiomas have proposed new subgroups; however, the correlation between genetic background and recurrence in sphenoid wing meningiomas has not yet been fully elucidated. In this study, we evaluated the clinical characteristics, pathological diagnosis, and molecular background of 47 patients with sphenoid wing meningiomas. Variants of NF2, AKT1, KLF4, SMO, POLR2A, PIK3CA, TRAF7, and TERT were determined using Sanger sequencing, and 22q loss was detected using multiplex ligation-dependent probe amplification. Alterations were localized at NF2 in 11 cases, had other genotypes in 17 cases, and were not detected in 12 cases. Interestingly, WHO grade 1 meningiomas with NF2 alteration/22q loss (p = 0.008) and a MIB-1 labeling index > 4 (p = 0.03) were associated with a significantly shorter recurrence-free survival, and multivariate analysis revealed that NF2 alteration/22q loss was associated with recurrence (hazard ratio, 13.1). The duration of recurrence was significantly shorter for meningiomas with NF2 alteration/22q loss (p = 0.0007) even if gross-total resection was achieved. Together, these findings suggest that NF2 alteration/22q loss is associated with recurrence in WHO grade 1 sphenoid wing meningiomas.
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- 2022
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9. Clinical effects of constant rate infusions of medetomidine–propofol combined with sevoflurane anesthesia in Thoroughbred racehorses undergoing arthroscopic surgery
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Hirotaka Tokushige, Atsushi Okano, Daisuke Arima, Hideki Ito, Yoshinori Kambayashi, Yohei Minamijima, and Minoru Ohta
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Constant rate infusion ,Medetomidine ,Propofol ,Racehorse ,Sevoflurane ,Veterinary medicine ,SF600-1100 - Abstract
Abstract Background The aim of the present study was to evaluate clinical efficacy of constant rate infusions (CRIs) of medetomidine–propofol combined with sevoflurane anesthesia in Thoroughbred racehorses undergoing arthroscopic surgery. Thirty horses were sedated intravenously (IV) with medetomidine (6.0 μg/kg) and midazolam (0.02 mg/kg) and induced IV with ketamine (1.0 mg/kg) and propofol (1.0 mg/kg). These horses were randomly allocated to three groups and maintained with sevoflurane and CRI of either medetomidine (3.0 μg/kg/h) (Group M; n = 10); or medetomidine (3.0 μg/kg/h) and propofol (3.0 mg/kg/h) (Group MP3; n = 10); or medetomidine (3.0 μg/kg/h) and propofol (6.0 mg/kg/h) (Group MP6; n = 10). End-tidal sevoflurane concentration (ETSEVO), cardiovascular parameters, plasma propofol concentration, and recovery time and quality were compared among groups. Data were analyzed by using ANOVA with Tukey’s multiple comparison test, considering P
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- 2018
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10. Clinical evaluation of constant rate infusion of alfaxalone–medetomidine combined with sevoflurane anesthesia in Thoroughbred racehorses undergoing arthroscopic surgery
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Hirotaka Tokushige, Asuka Kushiro, Atsushi Okano, Tatsuya Maeda, Hideki Ito, Ai Wakuno, Shun-ichi Nagata, and Minoru Ohta
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Alfaxalone–medetomidine ,Constant rate infusion ,Equine anesthesia ,Racehorse ,Recovery ,Sevoflurane ,Veterinary medicine ,SF600-1100 - Abstract
Abstract Background Alfaxalone has a number of pharmacological properties which are desirable for constant rate infusion (CRI). Previously, the co-administration of alfaxalone and medetomidine is shown to be suitable for short-term anesthesia in horses. However, the use of alfaxalone–medetomidine CRI with inhalational anesthesia under surgical procedures have not been investigated in clinical cases. The aim of the present study was to evaluate the clinical efficacy of alfaxalone–medetomidine CRI in sevoflurane-anesthetized Thoroughbred racehorses undergoing arthroscopic surgery. Sevoflurane requirement, cardiovascular function, and induction/recovery quality were compared between horses maintained with sevoflurane in combination with medetomidine CRI (3 µg/kg/h) (Group M; n = 25) and those maintained with sevoflurane in combination with alfaxalone–medetomidine CRI (0.5 mg/kg/h and 3 µg/kg/h, respectively) (Group AM; n = 25). Results The mean end-tidal sevoflurane concentrations were significantly lower in Group AM (1.8 ± 0.2%) than in Group M (2.4 ± 0.1%). The mean dobutamine infusion rate required for maintaining mean arterial blood pressure within the target values (60–80 mmHg) was significantly lower in Group AM (0.53 ± 0.20 µg/kg/min) than in Group M (0.85 ± 0.32 µg/kg/min). Induction and recovery scores were not significantly different between two groups. However, excitatory response during recovery were observed in five horses in Group AM. The mean plasma alfaxalone concentrations were stable throughout the maintenance period (0.77 ± 0.12 to 0.85 ± 0.13 µg/mL), and decreased significantly immediately after standing (0.32 ± 0.07 µg/mL). Conclusions Alfaxalone–medetomidine CRI reduced sevoflurane requirement by approximately 26% with good maintenance of cardiopulmonary function in Thoroughbred racehorses undergoing arthroscopic surgery. Sevoflurane in combination with alfaxalone–medetomidine CRI may be a clinically effective anesthetic technique for Thoroughbred racehorses. However, 20% of horses administered alfaxalone showed remarkable excitatory response during recovery. Greater attention to excitatory response may be advisable if alfaxalone is used for induction or maintenance of anesthesia. A larger study is needed to explore the clinical relevance of these findings.
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- 2018
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11. Evaluation of bleeding risk in dural arteriovenous fistula using susceptibility-weighted imaging: A case report
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Satoshi Koizumi, Gakushi Yoshikawa, Masaaki Shojima, Yosuke Kitagawa, So Fujimoto, Atsushi Okano, Yuta Fukushima, Shikou Shimada, and Kazuo Tsutsumi
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Dural arteriovenous fistula ,Bleeding ,Susceptibility-weighted imaging ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Susceptibility weighted imaging (SWI) is a new imaging modality for the detailed depiction of cerebral venous hemodynamics. We report a case of a dural arteriovenous fistula (dAVF) in which a symptomatic intracranial hemorrhage occurred at the lesion site where previously performed SWI showed marked hypointensity. Previous reports about SWI findings in patients with dAVF have focused on their correlations with angiography and there has been no report mentioning the direct relationship of SWI finding and the risk of dAVF bleeding. This case shows the possibility that SWI might be useful for estimating the bleeding risk.
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- 2014
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12. POLR2A Mutation is a Poor Prognostic Marker of Cerebellopontine Angle Meningioma.
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Atsushi Okano, Satoru Miyawaki, Yu Teranishi, Hiroki Hongo, Shogo Dofuku, Kenta Ohara, Yu Sakai, Masahiro Shin, Hirofumi Nakatomi, and Nobuhito Saito
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- 2024
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13. Long-Term Outcomes of Stereotactic Radiosurgery for Postoperative World Health Organization Grade I Skull Base Meningioma: Utility of Ki-67 Labeling Index as a Prognostic Indicator.
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Yuki Shinya, Hirotaka Hasegawa, Masahiro Shin, Mariko Kawashima, Motoyuki Umekawa, Atsuto Katano, Masako Ikemura, Tetsuo Ushiku, Kenta Ohara, Atsushi Okano, Yu Teranishi, Satoru Miyawaki, and Nobuhito Saito
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- 2023
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14. Transuncal Selective Amygdalohippocampectomy by an Inferolateral Preseptal Endoscopic Approach Through Inferior Eyelid Conjunctival Incision: An Anatomic Study
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Breno Câmara, Arianna Fava, Fumihiro Matano, Atsushi Okano, Daniel Ronconi, Bruno Silva Costa, Eberval Gadelha Figueiredo, Francine Chassoux, Bertrand Devaux, and Sébastien Froelich
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Surgery ,Neurology (clinical) - Published
- 2023
15. Genome-Wide Association Study of Intracranial Artery Stenosis Followed by Phenome-Wide Association Study
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Shogo Dofuku, Kyuto Sonehara, Satoru Miyawaki, Saori Sakaue, Hideaki Imai, Masahiro Shimizu, Hiroki Hongo, Yuki Shinya, Kenta Ohara, Yu Teranishi, Atsushi Okano, Hideaki Ono, Hirofumi Nakatomi, Akira Teraoka, Kenichi Yamamoto, Yuichi Maeda, Takuro Nii, Toshihiro Kishikawa, Ken Suzuki, Jun Hirata, Meiko Takahashi, Koichi Matsuda, Atsushi Kumanogoh, Fumihiko Matsuda, Yukinori Okada, and Nobuhito Saito
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General Neuroscience ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
16. Transuncal Selective Amygdalohippocampectomy by an Inferolateral Preseptal Endoscopic Approach Through Inferior Eyelid Conjunctival Incision: An Anatomic Study.
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Câmara, Breno, Fava, Arianna, Fumihiro Matano, Atsushi Okano, Ronconi, Daniel, Silva Costa, Bruno, Gadelha Figueiredo, Eberval, Chassoux, Francine, Devaux, Bertrand, and Froelich, Sébastien
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- 2023
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17. Somatic GJA4 gain-of-function mutation in orbital cavernous venous malformations
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Hiroki Hongo, Satoru Miyawaki, Yu Teranishi, Jun Mitsui, Hiroto Katoh, Daisuke Komura, Kinya Tsubota, Takashi Matsukawa, Masakatsu Watanabe, Masakazu Kurita, Jun Yoshimura, Shogo Dofuku, Kenta Ohara, Daiichiro Ishigami, Atsushi Okano, Motoi Kato, Fumihiko Hakuno, Ayaka Takahashi, Akiko Kunita, Hiroyuki Ishiura, Masahiro Shin, Hirofumi Nakatomi, Toshitaka Nagao, Hiroshi Goto, Shin-Ichiro Takahashi, Tetsuo Ushiku, Shumpei Ishikawa, Mutsumi Okazaki, Shinichi Morishita, Shoji Tsuji, and Nobuhito Saito
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Cancer Research ,Physiology ,Clinical Biochemistry - Abstract
Orbital cavernous venous malformation (OCVM) is a sporadic vascular anomaly of uncertain etiology characterized by abnormally dilated vascular channels. Here, we identify a somatic missense mutation, c.121G > T (p.Gly41Cys) in GJA4, which encodes a transmembrane protein that is a component of gap junctions and hemichannels in the vascular system, in OCVM tissues from 25/26 (96.2%) individuals with OCVM. GJA4 expression was detected in OCVM tissue including endothelial cells and the stroma, through immunohistochemistry. Within OCVM tissue, the mutation allele frequency was higher in endothelial cell-enriched fractions obtained using magnetic-activated cell sorting. Whole-cell voltage clamp analysis in Xenopus oocytes revealed that GJA4 c.121G > T (p.Gly41Cys) is a gain-of-function mutation that leads to the formation of a hyperactive hemichannel. Overexpression of the mutant protein in human umbilical vein endothelial cells led to a loss of cellular integrity, which was rescued by carbenoxolone, a non-specific gap junction/hemichannel inhibitor. Our data suggest that GJA4 c.121G > T (p.Gly41Cys) is a potential driver gene mutation for OCVM. We propose that hyperactive hemichannel plays a role in the development of this vascular phenotype.
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- 2022
18. A case of cerebral venous thrombosis caused by idiopathic eosinophilia
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Yoshihito Hasegawa, Atsushi Okano, Muneyoshi Yasuda, Masahiro Kanai, Daisuke Mizui, Yoshiyuki Nakai, Keisuke Ito, Keiji Yamaguchi, and Yohei Maruga
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medicine.medical_specialty ,Venous thrombosis ,business.industry ,Internal medicine ,medicine ,Idiopathic eosinophilia ,business ,medicine.disease ,Gastroenterology - Published
- 2021
19. A case of primary intramedullary spinal cord lymphoma diagnosed by spinal cord biopsy of long spinal cord lesions showing persistent gadolinium contrast enhancement
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Yoshiyuki Nakai, Masahiro Kanai, Atsushi Okano, Keiji Yamaguchi, Hiroaki Okada, and Takanobu Kita
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Male ,medicine.medical_specialty ,Biopsy ,Myelitis ,Gadolinium ,Spinal Cord Diseases ,Lesion ,Myelopathy ,Paralysis ,medicine ,Humans ,Spinal Cord Neoplasms ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Spinal cord ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Spinal Cord ,Histopathology ,Lymphoma, Large B-Cell, Diffuse ,Neurology (clinical) ,Radiology ,medicine.symptom ,business ,Diffuse large B-cell lymphoma - Abstract
An 82-year-old man presented with subacute bilateral lower limb paralysis, deep sensory disturbance, and vesico-rectal disturbance. MRI of the spinal cord revealed a large gray matter-dominant lesion extending from the medulla oblongata to the lower thoracic spinal cord. The patient was treated with steroid-pulse therapy for myelitis, but without symptomatic improvement. A spinal cord biopsy was performed for treatment-resistant myelopathy, and histopathology revealed a diffuse large B-cell lymphoma, that was diagnosed as a primary intramedullary spinal cord lymphoma because systemic examination didn't show any other findings suggestive of malignant lymphoma. A spinal cord biopsy is necessary for the definitive diagnosis of this disease, but in the case of poor response to treatment and a progressive course, intramedullary malignant lymphoma should be considered if there is a persistent elevation of CSF IL-10 or a prolonged contrast effect.
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- 2021
20. Surgical morbidity of the extradural anterior petrosal approach: the Lariboisière experience.
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Giammattei, Lorenzo, Passeri, Thibault, Abbritti, Rosaria, Lieber, Stefan, Matano, Fumihiro, Le Van, Tuan, Atsushi Okano, Fava, Arianna, di Russo, Paolo, and Froelich, Sébastien
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- 2023
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21. Oculomotor Neurofibroma: A Different Histology Implying an Unsatisfying Clinical Outcome
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Breno Camara, Arianna Fava, Fumihiro Matano, Lorenzo Giammattei, Thibault Passeri, Nicolas Penet, Atsushi Okano, Paolo di Russo, Sébastien Froelich, and Marc Polivka
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medicine.medical_specialty ,Surgical strategy ,genetic structures ,medicine.diagnostic_test ,Oculomotor nerve ,business.industry ,Tumor resection ,Magnetic resonance imaging ,Histology ,Patient counseling ,Schwannoma ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,Neurofibroma ,Surgery ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
Background Tumors arising from oculomotor nerve are rare, with few cases reported in the literature. Generally, whereas schwannomas are well encapsulated tumors, neurofibromas tend to invade the entire nerve fibers. These differences influence surgical resection and neurological clinical outcome, with neurofibroma often requiring the sacrifice of the nerve. Accordingly, an incorrect preoperative diagnosis can lead to incomplete patient counseling before surgery. Case Description We report 2 cases: a patient with oculomotor schwannoma and a patient with oculomotor neurofibroma. After tumor resection, the patient with a diagnosis of schwannoma recovered with 3rd nerve palsy, while patient with the neurofibroma developed a complete oculomotor nerve deficit. For each patient, surgical strategy and neurological outcome are elucidated in relation with differences in preoperative magnetic resonance imaging and histology. Conclusions To the best of our knowledge, this is the first report of an oculomotor neurofibroma. When an oculomotor nerve tumor is suspected, a careful preoperative evaluation of magnetic resonance imaging guides in distinguishing the different histology, in selecting the treatment strategy, and in correctly informing the patient on expected postoperative neurologic outcome.
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- 2020
22. Utility of systemic voriconazole in equine keratomycosis based on pharmacokinetic‐pharmacodynamic analysis of tear fluid following oral administration
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Taisuke Kuroda, Kentaro Fukuda, Yoshikazu Matsuda, Norihisa Tamura, Hidekazu Niwa, Kanichi Kusano, Shun-ichi Nagata, Hiroshi Mita, and Atsushi Okano
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Male ,Antifungal Agents ,040301 veterinary sciences ,Administration, Oral ,keratomycosis ,Microbial Sensitivity Tests ,Pharmacology ,0403 veterinary science ,03 medical and health sciences ,Minimum inhibitory concentration ,0302 clinical medicine ,tear fluid ,Pharmacokinetics ,Oral administration ,pharmacodynamics ,Animals ,Medicine ,Horses ,Dosing ,Voriconazole ,General Veterinary ,business.industry ,Pharmacokinetic pharmacodynamic ,Horse ,Original Articles ,04 agricultural and veterinary sciences ,horse ,Aspergillus ,Area Under Curve ,Tears ,Pharmacodynamics ,030221 ophthalmology & optometry ,Original Article ,Female ,Horse Diseases ,business ,pharmacokinetics ,Eye Infections, Fungal ,medicine.drug - Abstract
Objective To clarify the detailed pharmacokinetics (PK) of orally administered voriconazole in tear fluid (TF) of horses for evaluating the efficacy of voriconazole secreted into TF against equine keratomycosis. Animals studied Five healthy Thoroughbred horses. Procedures Voriconazole was administrated through a nasogastric tube to each horse at a single dose of 4.0 mg/kg. TF and blood samples were collected before and periodically throughout the 24 hours after administration. Voriconazole concentrations in plasma and TF samples were analyzed using liquid chromatography‐electrospray tandem‐mass spectrometry. The predicted voriconazole concentration in both samples following multiple dosing every 24 hours was simulated by the superposition principle. Results The mean maximum voriconazole concentrations in plasma and TF were 3.3 μg/mL at 1.5 h and 1.9 μg/mL at 1.6 h, respectively. Mean half‐life in both samples were 16.4 and 25.2 h, respectively. The ratio of predicted AUC0–24 at steady state in TF (51.3 μg∙h/mL) to previously published minimum inhibitory concentration (MIC) of Aspergillus and Fusarium species was >100 and 25.7, respectively. Conclusions This study demonstrated the detailed single‐dose PK of voriconazole in TF after oral administration and simulated the predicted concentration curves in a multiple oral dosing. Based on the analyses of PK‐PD, the simulation results indicated that repeated oral administration of voriconazole at 4.0 mg/kg/d achieves the ratio of AUC to MIC associated with treatment efficacy against Aspergillus species. The detailed PK‐PD analyses against pathogenic fungi in TF can be used to provide evidence‐based medicine for equine keratomycosis.
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- 2020
23. The mini-combined transpetrosal approach: an anatomical study and comparison with the combined transpetrosal approach
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Arianna Fava, Paolo di Russo, Thibault Passeri, Breno Camara, Francesco Paglia, Fumihiro Matano, Atsushi Okano, Lorenzo Giammattei, and Sébastien Froelich
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Skull Base ,Humans ,Surgery ,Neurology (clinical) ,Skull Base Neoplasms ,Craniotomy ,Neurosurgical Procedures ,Petrous Bone - Abstract
The combined transpetrosal approach (CTPA) is a versatile technique suitable for challenging skull base pathologies. Despite the advantages provided by a wide surgical exposure, the soft tissue trauma, complex and time-consuming bony work, and cosmetic issues make it far from patient expectations. In this study, the authors describe a less invasive modification of the CTPA, the mini-combined transpetrosal approach (mini-CTPA), and perform a quantitative comparison between these two approaches.Five human specimens were used for this study. CTPA was performed on one side and mini-CTPA on the opposite side. The surgical freedom, petroclival and brainstem area of exposure, and maneuverability for 6 anatomical targets, provided by the CTPA and mini-CTPA, were calculated and statistically compared. The bony volumes corresponding to each anterior petrosectomy were also measured and compared. Three clinical cases with an operative video are also reported to illustrate the effectiveness of the approach.The question-mark skin incision done along the muscle attachments permits an optimal cosmetic result. Even though the limited incision, the smaller craniotomy, and the less extensive bone drilling of mini-CTPA provide a smaller area of surgical freedom, the areas of exposure of petroclival region and brainstem were not statistically different between the two approaches. The antero-posterior maneuverability for the oculomotor foramen (OF), Meckel's cave (MC) and the REZ of trigeminal nerve, and the supero-inferior maneuverability for OF, MC, Dorello's canal, and REZ of CN VII are significantly reduced by the smaller opening. The bony volume of anterior petrosectomy resulted similar among the approaches.The mini-CTPA is an interesting alternative to the CTPA, providing comparable surgical exposure both for petroclival region and for brainstem. Although the lesser soft tissue dissection and bony opening decrease the surgical maneuverability, the mini-CTPA may reduce surgical time, potential approach-related morbidities, and improve cosmetic and functional outcomes for the patients.
- Published
- 2021
24. Genome-Wide Association Study of Intracranial Artery Stenosis Followed by Phenome-Wide Association Study
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Shogo, Dofuku, Kyuto, Sonehara, Satoru, Miyawaki, Saori, Sakaue, Hideaki, Imai, Masahiro, Shimizu, Hiroki, Hongo, Yuki, Shinya, Kenta, Ohara, Yu, Teranishi, Atsushi, Okano, Hideaki, Ono, Hirofumi, Nakatomi, Akira, Teraoka, Kenichi, Yamamoto, Yuichi, Maeda, Takuro, Nii, Toshihiro, Kishikawa, Ken, Suzuki, Jun, Hirata, Meiko, Takahashi, Koichi, Matsuda, Atsushi, Kumanogoh, Fumihiko, Matsuda, Yukinori, Okada, and Nobuhito, Saito
- Abstract
The genetic background of intracranial artery stenosis (ICAS), a major cause of ischemic stroke, remains elusive. We performed the world's first genome-wide association study (GWAS) of ICAS using DNA samples from Japanese subjects, to identify the genetic factors associated with ICAS and their correlation with clinical features. We also conducted a phenome-wide association study (PheWAS) of the top variant identified via GWAS to determine its association with systemic disease. The GWAS involved 408 patients with ICAS and 349 healthy controls and utilized an Asian Screening Array of venous blood samples. The PheWAS was performed using genotypic and phenotypic data of the Biobank Japan Project, which contained information on 46 diseases and 60 quantitative trait data from 150,000 Japanese individuals. The GWAS revealed that the East Asian-specific functional variant of RNF213, rs112735431 (c.14429G A, p.Arg4810Lys), was associated with ICAS (odds ratio, 12.3; 95% CI 5.5 to 27.5; P = 7.8 × 10
- Published
- 2021
25. Long-term follow-up for patients with infantile hydrocephalus treated by choroid plexus coagulation
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Atsushi Okano and Hideki Ogiwara
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Male ,medicine.medical_specialty ,Cautery ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Intellectual Disability ,medicine ,Humans ,Prospective cohort study ,Wechsler Intelligence Scale for Children ,Intelligence quotient ,business.industry ,Endoscopic third ventriculostomy ,Infant ,General Medicine ,Infantile hydrocephalus ,medicine.disease ,Hydrocephalus ,Surgery ,Treatment Outcome ,Child, Preschool ,030220 oncology & carcinogenesis ,Choroid Plexus ,Neuroendoscopy ,Population study ,Female ,Choroid plexus ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
OBJECTIVEShunt surgery is the most common treatment for hydrocephalus, but it is associated with several long-term complications. Endoscopic choroid plexus coagulation (CPC) and endoscopic third ventriculostomy (ETV) are alternative surgeries that may avoid the need for shunt surgery. Although the short-term efficacy and safety of CPC have been reported in previous studies, long-term outcome, including not only avoiding shunt placement but also intellectual development, remains to be elucidated. The purpose of the present study was to investigate the long-term outcome of CPC.METHODSThe study population comprised patients who had infantile hydrocephalus treated by endoscopic CPC before the age of 24 months and who were followed until at least 5 years of age. Retrospective review was performed using the medical charts. The authors assessed educational status and the full-scale intelligence quotient (FSIQ) using the Wechsler Intelligence Scale for Children (WISC) IV as the means to evaluate the intellectual development.RESULTSFourteen patients with infantile hydrocephalus underwent CPC with or without ETV as a primary surgery. There were no intraoperative complications. In 7 patients (50%), hydrocephalus was successfully controlled without shunt placement. Six patients (43%) eventually required shunt placement. In one patient hydrocephalus was controlled by additional ETV. In the shunt-independent group, 4 patients went to age-appropriate school or achieved age-appropriate development according to intelligence quotient (IQ), 1 patient went to specialized school, and 2 patients had disabilities. In the shunt-dependent group, 4 patients went to an age-appropriate school or achieved age-appropriate development by IQ, 1 patient went to specialized school, and 1 patient had disabilities. The mean FSIQ score in 3 patients without shunts was 90 (range 89–91) and the mean FSIQ score in 4 patients with shunts was 80 (range 48–107). There was no significant difference in the rate of normal development between the shunt-independent group and the shunt-dependent group (p = 0.72).CONCLUSIONSThe CPC with or without ETV can be a safe and effective treatment in children with infantile hydrocephalus. Long-term control of hydrocephalus and normal intellectual development can be achieved in successful cases. Further prospective studies should be required to elucidate appropriate indications.
- Published
- 2018
26. Comprehensive investigation of RNF213 nonsynonymous variants associated with intracranial artery stenosis
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Yu Teranishi, Hiroyuki Ishiura, Masahiro Shimizu, Shinichi Yagi, Wei Qu, Hideaki Imai, Jun Yoshimura, Tsuneo Shimizu, Shoji Tsuji, Jun Mitsui, Shinichi Morishita, Koichiro Doi, Hiroki Hongo, Nobuhito Saito, Atsushi Okano, Hirofumi Nakatomi, Satoru Miyawaki, and Hideaki Ono
- Subjects
Adult ,Male ,Nonsynonymous substitution ,medicine.medical_specialty ,dbSNP ,Adolescent ,Genotype ,Ubiquitin-Protein Ligases ,Mutation, Missense ,lcsh:Medicine ,Constriction, Pathologic ,030204 cardiovascular system & hematology ,Polymorphism, Single Nucleotide ,Gastroenterology ,Article ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Polymorphism (computer science) ,Internal medicine ,medicine ,Humans ,Missense mutation ,Genetic Predisposition to Disease ,Moyamoya disease ,lcsh:Science ,Alleles ,Genetic Association Studies ,Aged ,Adenosine Triphosphatases ,Aged, 80 and over ,Multidisciplinary ,Molecular medicine ,business.industry ,lcsh:R ,Genetic Variation ,Intracranial Artery ,Sequence Analysis, DNA ,Middle Aged ,medicine.disease ,Stenosis ,Amino Acid Substitution ,Risk factors ,Female ,lcsh:Q ,Intracranial Arterial Diseases ,business ,030217 neurology & neurosurgery - Abstract
Intracranial artery stenosis (ICAS) is the most common cause of ischemic stroke worldwide. RNF213 single nucleotide variant c.14429G > A (p.Arg4810Lys, rs112735431) was recently reported to be associated with ICAS in East Asians. However, the disease susceptibility of other RNF213 variants has not been clarified. This study comprehensively investigated ICAS-associated RNF213 variants in a pool of 168 Japanese ICAS patients and 1,194 control subjects. We found 138 nonsynonymous germline variants by target resequencing of all coding exons in RNF213. Association study between ICAS patients and control subjects revealed that only p.Arg4810Lys had significant association with ICAS (P = 1.5 × 10–28, odds ratio = 29.3, 95% confidence interval 15.31–56.2 [dominant model]). Fourteen of 138 variants were rare variants detected in ICAS patients not harboring p.Arg4810Lys variant. Two of these rare variants (p.Cys118Arg and p.Leu2356Phe) consistent with variants previously reported in moyamoya disease patients characterized by stenosis of intracranial artery and association with RNF213, and three rare variants (p.Ser193Gly, p.Val1817Leu, and p.Asp3329Tyr) were found neither in control subjects and Single Nucleotide Polymorphism Database. The present findings may improve our understanding of the genetic background of intracranial artery stenosis.
- Published
- 2020
27. Associations of pathological diagnosis and genetic abnormalities in meningiomas with the embryological origins of the meninges
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Masahiro Shin, Hirofumi Nakatomi, Shogo Dofuku, Michihiro Tanaka, Atsushi Okano, Hiroki Hongo, Nobuhito Saito, Yu Teranishi, Satoru Miyawaki, and Jun Mitsui
- Subjects
Male ,Pathology ,Molecular biology ,Diseases ,medicine.disease_cause ,Meninges ,Meningeal Neoplasms ,Child ,Aged, 80 and over ,Mutation ,Multidisciplinary ,Neural crest ,DNA-Directed RNA Polymerases ,Middle Aged ,Smoothened Receptor ,Tumor recurrence ,medicine.anatomical_structure ,Neurology ,Oncology ,KLF4 ,Neural Crest ,Child, Preschool ,embryonic structures ,Medicine ,Female ,Meningioma ,Dorsum ,Adult ,medicine.medical_specialty ,Adolescent ,Science ,Kruppel-Like Transcription Factors ,Biology ,Article ,Kruppel-Like Factor 4 ,Young Adult ,medicine ,otorhinolaryngologic diseases ,Humans ,Pathological ,Aged ,Infant, Newborn ,Infant ,medicine.disease ,Proto-Oncogene Proteins c-akt ,Neuroscience - Abstract
Certain driver mutations and pathological diagnoses are associated with the anatomical site of meningioma, based on which the meninges have different embryological origins. We hypothesized that mutations and pathological diagnoses of meningiomas are associated with different embryological origins. We comprehensively evaluated associations among tumor location, pathological diagnosis (histological type), and genetic alterations including AKT1, KLF4, SMO, POLR2A, and NF2 mutations and 22q deletion in 269 meningioma cases. Based on the embryological origin of meninges, the tumor locations were as follows: neural crest, paraxial mesodermal, and dorsal mesodermal origins. Tumors originating from the dura of certain embryologic origin displayed a significantly different pathological diagnoses and genetic abnormality ratio. For instance, driver genetic mutations with AKT1, KLF4, SMO, and POLR2A, were significantly associated with the paraxial mesodermal origin (p = 1.7 × 10−10). However, meningiomas with NF2-associated mutations were significantly associated with neural crest origin (p = 3.9 × 10–12). On analysis of recurrence, no difference was observed in embryological origin. However, POLR2A mutation was a risk factor for the tumor recurrence (p = 1.7 × 10−2, Hazard Ratio 4.08, 95% Confidence Interval 1.28–13.0). Assessment of the embryological origin of the meninges may provide novel insights into the pathomechanism of meningiomas.
- Published
- 2020
28. Targeted deep sequencing of DNA from multiple tissue types improves the diagnostic rate and reveals a highly diverse phenotype of mosaic neurofibromatosis type 2
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Hirofumi Nakatomi, Hiroki Hongo, Nobuhito Saito, Satoru Miyawaki, Takahiro Ota, Shoji Tsuji, Shunsaku Takayanagi, Wei Qu, Yu Teranishi, Atsushi Okano, Shinichi Morishita, Jun Yoshimura, Jun Mitsui, and Shogo Dofuku
- Subjects
0301 basic medicine ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Pathology ,Neurofibromatosis 2 ,DNA Mutational Analysis ,Biology ,Germline ,Deep sequencing ,Meningioma ,03 medical and health sciences ,0302 clinical medicine ,Genotype-phenotype distinction ,Genes, Neurofibromatosis 2 ,otorhinolaryngologic diseases ,Genetics ,medicine ,Humans ,Genetic Predisposition to Disease ,Neurofibromatosis type 2 ,Gene ,Genetics (clinical) ,Genetic Association Studies ,Mosaicism ,Computational Biology ,High-Throughput Nucleotide Sequencing ,Sequence Analysis, DNA ,medicine.disease ,Phenotype ,030104 developmental biology ,030220 oncology & carcinogenesis ,Mutation ,Medical genetics ,Nucleic Acid Amplification Techniques - Abstract
BackgroundAlthough 60% of patients with de novo neurofibromatosis type 2 (NF2) are presumed to have mosaic NF2, the actual diagnostic rate of this condition remains low at around 20% because of the existing difficulties in detecting NF2 variants with low variant allele frequency (VAF). Here, we examined the correlation between the genotype and phenotype of mosaic NF2 after improving the diagnostic rate of mosaic NF2.MethodsWe performed targeted deep sequencing of 36 genes including NF2 using DNA samples from multiple tissues (blood, buccal mucosa, hair follicle and tumour) of 53 patients with de novo NF2 and elucidated their genotype–phenotype correlation.ResultsTwenty-four patients (45.2%) had the NF2 germline variant, and 20 patients with NF2 (37.7%) had mosaic NF2. The mosaic NF2 phenotype was significantly different from that in patients with NF2 germline variant in terms of distribution of NF2-related disease, tumour growth rate and hearing outcome. The behaviour of schwannoma correlated to the extent of VAF with NF2 variant in normal tissues unlike meningioma.ConclusionWe have improved the diagnostic rate of mosaic NF2 compared with that of previous studies by targeted deep sequencing of DNA from multiple tissues. Many atypical patients with NF2 diagnosed with ‘unilateral vestibular schwannoma’ or ‘multiple meningiomas’ presumably have mosaic NF2. Finally, we suggest that the highly diverse phenotype of NF2 could result not only from the type and location of NF2 variant but also the extent of VAF in the NF2 variant within normal tissue DNA.
- Published
- 2020
29. Clinical Importance of RNF213 rs112735431 Revealed by Genome-Wide Association Study of Intracranial Artery Stenosis and Phenome-Wide Association Study
- Author
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Shogo Dofuku, Kyuto Sonehara, Satoru Miyawaki, Saori Sakaue, Hideaki Imai, Masahiro Shimizu, Hiroki Hongo, Yuki Shinya, Kenta Ohara, Yu Teranishi, Atsushi Okano, Hideaki Ono, Hirofumi Nakatomi, Akira Teraoka, Kenichi Yamamoto, Yuichi Maeda, Takuro Nii, Toshihiro Kishikawa, Ken Suzuki, Jun Hirata, Meiko Takahashi, Koichi Matsuda, Atsushi Kumanogoh, Fumihiko Matsuda, Yukinori Okada, and Nobuhito Saito
- Published
- 2020
30. Targeted deep sequencing of DNA from multiple tissue types improves the diagnostic rate and reveals a highly diverse phenotype of mosaic neurofibromatosis type 2.
- Author
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Yu Teranishi, Satoru Miyawaki, Hiroki Hongo, Shogo Dofuku, Atsushi Okano, Shunsaku Takayanagi, Takahiro Ota, Jun Yoshimura, Wei Qu, Jun Mitsui, Hirofumi Nakatomi, Shinichi Morishita, Shoji Tsuji, and Nobuhito Saito
- Abstract
Background Although 60% of patients with de novo neurofibromatosis type 2 (NF2) are presumed to have mosaic NF2, the actual diagnostic rate of this condition remains low at around 20% because of the existing difficulties in detecting NF2 variants with low variant allele frequency (VAF). Here, we examined the correlation between the genotype and phenotype of mosaic NF2 after improving the diagnostic rate of mosaic NF2. Methods We performed targeted deep sequencing of 36 genes including NF2 using DNA samples from multiple tissues (blood, buccal mucosa, hair follicle and tumour) of 53 patients with de novo NF2 and elucidated their genotype-phenotype correlation. Results Twenty-four patients (45.2%) had the NF2 germline variant, and 20 patients with NF2 (37.7%) had mosaic NF2. The mosaic NF2 phenotype was significantly different from that in patients with NF2 germline variant in terms of distribution of NF2-related disease, tumour growth rate and hearing outcome. The behaviour of schwannoma correlated to the extent of VAF with NF2 variant in normal tissues unlike meningioma. Conclusion We have improved the diagnostic rate of mosaic NF2 compared with that of previous studies by targeted deep sequencing of DNA from multiple tissues. Many atypical patients with NF2 diagnosed with 'unilateral vestibular schwannoma' or 'multiple meningiomas' presumably have mosaic NF2. Finally, we suggest that the highly diverse phenotype of NF2 could result not only from the type and location of NF2 variant but also the extent of VAF in the NF2 variant within normal tissue DNA. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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31. Prediction of Hearing Prognosis in NF2-Related Vestibular Schwannoma by Genetic Analysis
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Shogo Dofuku, Hirohumi Nakatomi, Atsushi Okano, Yu Teranishi, Hiroki Hongo, Shunsaku Talayanagi, Nobuhito Saito, and Satoru Miyawaki
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Vestibular system ,medicine.medical_specialty ,business.industry ,Medicine ,Audiology ,Schwannoma ,business ,medicine.disease ,Genetic analysis - Published
- 2019
32. Cardiorespiratory and anesthetic effects of combined alfaxalone, butorphanol, and medetomidine in Thoroughbred horses
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Atsushi Okano, Kentaro Fukuda, Hajime Ohmura, Toshiyuki Takahashi, and Kazutaka Mukai
- Subjects
medicine.medical_specialty ,Mean arterial pressure ,Respiratory rate ,040301 veterinary sciences ,Butorphanol ,medetomidine ,TIVA ,0403 veterinary science ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,medicine ,alfaxalone ,Equine ,business.industry ,Alfaxalone ,04 agricultural and veterinary sciences ,Thoroughbred ,Medetomidine ,Surgery ,Anesthesia ,Anesthetic ,Midazolam ,Original Article ,butorphanol ,Premedication ,business ,medicine.drug - Abstract
This study evaluated induction of anesthesia and cardiorespiratory and anesthetic effects during maintained anesthesia with the combination of alfaxalone, medetomidine, and butorphanol. Alfaxalone (1.0 mg/kg) was administered to induce anesthesia after premedication with medetomidine (7.0 µg/kg), butorphanol (25 µg/kg), and midazolam (50 µg/kg) in six Thoroughbred horses. Intravenous general anesthesia was maintained with alfaxalone (2.0 mg/(kg∙hr)), medetomidine (5.0 µg/(kg∙hr)), and butorphanol (30 µg/(kg∙hr)) for 60 min. Electrical stimulation of the upper oral mucosa was used to assess anesthetic depth at 10 min intervals during anesthesia. Heart rate (HR), respiratory rate (RR), and mean arterial pressure (MAP) were measured. All horses became recumbent within 1 min after alfaxalone administration. Induction scores were 5 (best) in five horses and 4 in one horse. During the 60-min anesthesia, average HR, RR, and MAP were 35.8 ± 2.6 beat/min, 4.7 ± 0.6 breath/min, and 129 ± 3 mmHg, respectively. No horse moved with electrical stimulation; however, two horses experienced apnea (no respiration for 1 to 3 min). Recovery scores were 5 (best) in two horses and 3 in four horses. These results suggest that alfaxalone is effective for induction and maintenance of anesthesia and analgesia when combined with butorphanol and medetomidine for 60 min in Thoroughbreds. However, respiratory depression might require support.
- Published
- 2016
33. Clinical evaluation of constant rate infusion of alfaxalone–medetomidine combined with sevoflurane anesthesia in Thoroughbred racehorses undergoing arthroscopic surgery
- Author
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Asuka Kushiro, Atsushi Okano, Hideki Ito, Hirotaka Tokushige, Minoru Ohta, Ai Wakuno, Tatsuya Maeda, and Shun-ichi Nagata
- Subjects
medicine.medical_specialty ,Constant rate infusion ,040301 veterinary sciences ,Sevoflurane ,Pregnanediones ,0403 veterinary science ,03 medical and health sciences ,Arthroscopy ,0302 clinical medicine ,030202 anesthesiology ,Recovery ,Heart Rate ,Heart rate ,Medicine ,Animals ,Hypnotics and Sedatives ,Horses ,Alfaxalone–medetomidine ,lcsh:Veterinary medicine ,Racehorse ,General Veterinary ,business.industry ,Alfaxalone ,Research ,04 agricultural and veterinary sciences ,General Medicine ,Medetomidine ,Surgery ,Drug Combinations ,Blood pressure ,Anesthetic ,lcsh:SF600-1100 ,Equine anesthesia ,Dobutamine ,business ,medicine.drug - Abstract
Background Alfaxalone has a number of pharmacological properties which are desirable for constant rate infusion (CRI). Previously, the co-administration of alfaxalone and medetomidine is shown to be suitable for short-term anesthesia in horses. However, the use of alfaxalone–medetomidine CRI with inhalational anesthesia under surgical procedures have not been investigated in clinical cases. The aim of the present study was to evaluate the clinical efficacy of alfaxalone–medetomidine CRI in sevoflurane-anesthetized Thoroughbred racehorses undergoing arthroscopic surgery. Sevoflurane requirement, cardiovascular function, and induction/recovery quality were compared between horses maintained with sevoflurane in combination with medetomidine CRI (3 µg/kg/h) (Group M; n = 25) and those maintained with sevoflurane in combination with alfaxalone–medetomidine CRI (0.5 mg/kg/h and 3 µg/kg/h, respectively) (Group AM; n = 25). Results The mean end-tidal sevoflurane concentrations were significantly lower in Group AM (1.8 ± 0.2%) than in Group M (2.4 ± 0.1%). The mean dobutamine infusion rate required for maintaining mean arterial blood pressure within the target values (60–80 mmHg) was significantly lower in Group AM (0.53 ± 0.20 µg/kg/min) than in Group M (0.85 ± 0.32 µg/kg/min). Induction and recovery scores were not significantly different between two groups. However, excitatory response during recovery were observed in five horses in Group AM. The mean plasma alfaxalone concentrations were stable throughout the maintenance period (0.77 ± 0.12 to 0.85 ± 0.13 µg/mL), and decreased significantly immediately after standing (0.32 ± 0.07 µg/mL). Conclusions Alfaxalone–medetomidine CRI reduced sevoflurane requirement by approximately 26% with good maintenance of cardiopulmonary function in Thoroughbred racehorses undergoing arthroscopic surgery. Sevoflurane in combination with alfaxalone–medetomidine CRI may be a clinically effective anesthetic technique for Thoroughbred racehorses. However, 20% of horses administered alfaxalone showed remarkable excitatory response during recovery. Greater attention to excitatory response may be advisable if alfaxalone is used for induction or maintenance of anesthesia. A larger study is needed to explore the clinical relevance of these findings.
- Published
- 2018
34. The effectiveness of microsurgical fenestration for middle fossa arachnoid cysts in children
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Atsushi Okano and Hideki Ogiwara
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Male ,Microsurgery ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Subdural Space ,Skull Base Neoplasms ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Skull Base Neoplasm ,medicine ,Humans ,Subdural space ,Child ,Retrospective Studies ,Cranial Fossa, Middle ,business.industry ,Infant ,Retrospective cohort study ,General Medicine ,medicine.disease ,Middle fossa ,Surgery ,Arachnoid Cysts ,body regions ,Treatment Outcome ,medicine.anatomical_structure ,Subdural hygroma ,Child, Preschool ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Female ,Neurology (clinical) ,Neurosurgery ,business ,Fenestration ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Although middle fossa arachnoid cysts (MFACs) are common, the optimal surgical treatment for these lesions remains controversial. In this study, we present our experiences of treating MFACs by microsurgical fenestration and evaluate its effectiveness.We performed retrospective review of 28 patients who underwent microsurgical fenestration for MFACs between May 2003 and December 2014. We reviewed patient characteristics and treatment outcomes including age, sex, symptoms, complicating hydrocephalus, Gallasi classification, change in cyst size after surgery, complicating subdural hygroma, symptom resolution, regrowth of the cyst, and reoperation (including additional CSF diversion).Twenty-eight MFACs in 28 patients were investigated. The average age at the time of surgery was 61.6 months. The average follow-up duration was 53.5 months. After surgery, 19 (90.5 %) of 21 patients with symptomatic MFACs experienced improvements. The cysts decreased in size in all cases (100 %, 28/28) and disappeared in three cases (11 %, 3/28). None of the cases experienced regrowth of the cyst. Subdural hygroma was identified in 23 cases (82.1 %) at the immediate postoperative period. Hygroma was asymptomatic in all cases but one. Hygroma disappeared in 19 cases (83 %) and decreased in size in three cases (13 %) in the long term. Only one case (4 %) required an additional subdural-peritoneal shunt. The rate of CSF diversion after the fenestration was significantly higher in patients with preoperative ventricular dilation (p = 0.0002).Microsurgical fenestration for pediatric MFACs was considered to be safe and effective. Although subdural hygroma developed in significant number of patients at the immediate postoperative period, it was mostly asymptomatic and disappeared or decreased in size in the long term.
- Published
- 2015
35. Effects of an extended photoperiod on gonadal function and condition of hair coats in Thoroughbred colts and fillies
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Yasuo Nambo, Akira Matsui, Mutsuki Ishimaru, Kentaro Nagaoka, Gen Watanabe, Kazuyoshi Taya, Atsushi Okano, Fumio Sato, Hirokazu Kunii, Kazuki Fujii, and Yo Asai
- Subjects
photoperiodism ,medicine.medical_specialty ,endocrine system ,Thoroughbred colt and filly ,endocrine changes ,Equine ,media_common.quotation_subject ,molting of winter coats ,Horse ,Biology ,gonadal function ,Prolactin ,Endocrinology ,Animal science ,Internal medicine ,medicine ,Endocrine system ,Original Article ,Luteinizing hormone ,Ovulation ,extended photoperiod ,Testosterone ,media_common ,Hormone - Abstract
The effects of an extended photoperiod (EP) in Thoroughbreds colts and fillies from winter at one year old to spring at two years old on the gonadal functions, coat condition, and endocrine changes were investigated. Sixty-two Thoroughbreds (31 colts and 31 fillies) reared in the Hidaka Training and Research Center (Hidaka), Japan Racing Association were used. Thirty of them (15 colts and 15 fillies) were reared under EP conditions from December 20 to April 10, and the remaining 32 horses were reared under natural light alone as a control group. For EP, a 100-watt white bulb was set near the ceilings of stalls, and lighting conditions of 14.5-hr light and 9.5-hr dark periods were established. Blood was collected from the jugular vein once a month from October at one year old to February at two years old in both colts and fillies, and then twice a month in colts and weekly in fillies after March, and the coat condition was evaluated in January and April in 56 horses. To investigate endocrine changes, the plasma concentrations of prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), immunoreactive (ir-) inhibin, testosterone, estradiol-17β and progesterone were measured. No significant difference was noted in the coat condition between the two groups in January, but they changed from winter to summer coats (molting of winter coats) in April in the EP group compared with the control group. Regarding endocrine changes, the plasma concentrations of prolactin, FSH, ir-inhibin and testosterone were significantly higher in the EP colts than in the control group from January to April. The plasma concentrations of LH tended to rise in the EP colts from January to April compared with the control group. In the EP fillies, the plasma concentrations of prolactin, LH, ir-inhibin, estradiol-17β and progesterone were significantly higher during January and April, but a significantly high level of FSH was noted in the control than EP group in January. The ovulation day was advanced in the EP fillies compared with the control group. The present study clearly demonstrated that EP treatment during rearing advanced the molting of winter coats in both colts and fillies. These results suggested to be due to the action of prolactin being increased by EP treatment. In addition, EP treatment stimulated the hypothalamus-pituitary-gonadal axis even in yearlings, and advanced ovulation in fillies. Since EP treatment-induced changes in the yearlings were within the physiological range, and the method is safe and simple, EP treatment may be an effective technique in horse husbandry.
- Published
- 2015
36. Effects of Medetomidine Constant Rate Infusion on Sevoflurane Requirement, Cardiopulmonary Function, and Recovery Quality in Thoroughbred Racehorses Undergoing Arthroscopic Surgery
- Author
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Hirotaka Ode, Hirotaka Tokushige, Minoru Ohta, Motoki Aoki, Kazumi Kawasaki, Atsushi Okano, Masashi Kakizaki, Ai Wakuno, and Taisuke Kuroda
- Subjects
medicine.medical_specialty ,Equine ,Chemistry ,Cardiopulmonary function ,Constant rate infusion ,Medetomidine ,Sevoflurane ,Surgery ,Bolus (medicine) ,Blood pressure ,Anesthesia ,medicine ,Dobutamine ,Clinical efficacy ,medicine.drug - Abstract
To evaluate the clinical efficacy of medetomidine constant rate infusion (CRI) in sevoflurane-anesthetized Thoroughbred racehorses undergoing arthroscopic surgery. Sevoflurane requirement and cardiopulmonary function were compared between horses maintained with sevoflurane alone (group S; n = 25) and those maintained with sevoflurane in combination with medetomidine CRI at a rate of 0.05 μg/kg/min (group SM; n = 25). Recovery quality was also compared between the two groups. A single IV bolus of 1.0 μg/kg medetomidine was administered to the horses in group S at the end of anesthesia, whereas no additional sedatives were administered in group SM. Mean end-tidal sevoflurane concentrations were significantly lower in group SM (2.5 ± 0.1%) than in group S (2.8 ± 0.1%). Mean arterial blood pressure (MAP) values were significantly higher in group SM than in group S. On the other hand, mean dobutamine infusion rate required for maintaining MAP within the target values (60–80 mm Hg) was significantly lower in group SM than in group S. The number of attempt to stand was significantly fewer, and recovery score was significantly better in group SM compared with group S. In conclusion, medetomidine CRI reduced sevoflurane requirement by approximately 10% with good maintenance of cardiopulmonary function and better recovery quality.
- Published
- 2015
37. Surgical Treatment for Hemorrhagic Arteriovenous Malformation of the Brainstem
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Yosuke Kitagawa, Satoshi Koizumi, Gakushi Yoshikawa, Shikou Shimada, Yuta Fukushima, Atsushi Okano, Kazuo Tsutsumi, and So Fujimoto
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Midbrain ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Medicine ,Arteriovenous malformation ,Brainstem ,Microsurgery ,business ,medicine.disease ,Surgical treatment ,Surgery - Published
- 2015
38. Coil Embolization of an Unruptured Aneurysm Located at Persistent Primitive Trigeminal Artery: A Case Report and Review of the Literature
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Kazuo Tsutsumi, Gakushi Yoshikawa, Atsushi Okano, Satoshi Koizumi, Shikou Shimada, Masaaki Shojima, So Fujimoto, and Mariko Kawashima
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medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Medicine ,Trigeminal artery ,Unruptured aneurysm ,Radiology ,business ,Surgery ,Coil embolization - Published
- 2014
39. Evaluation of bleeding risk in dural arteriovenous fistula using susceptibility-weighted imaging: A case report
- Author
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Yosuke Kitagawa, Atsushi Okano, Satoshi Koizumi, Shikou Shimada, Masaaki Shojima, So Fujimoto, Yuta Fukushima, Gakushi Yoshikawa, and Kazuo Tsutsumi
- Subjects
medicine.medical_specialty ,cells ,genetic processes ,lcsh:Surgery ,Arteriovenous fistula ,Computed tomography ,macromolecular substances ,lcsh:RC346-429 ,medicine ,In patient ,Dural arteriovenous fistula ,lcsh:Neurology. Diseases of the nervous system ,medicine.diagnostic_test ,business.industry ,Bleeding ,Magnetic resonance imaging ,Susceptibility-weighted imaging ,lcsh:RD1-811 ,medicine.disease ,enzymes and coenzymes (carbohydrates) ,Venous hemodynamics ,Susceptibility weighted imaging ,Angiography ,Surgery ,Neurology (clinical) ,Radiology ,biological phenomena, cell phenomena, and immunity ,business ,Lesion site - Abstract
Susceptibility weighted imaging (SWI) is a new imaging modality for the detailed depiction of cerebral venous hemodynamics. We report a case of a dural arteriovenous fistula (dAVF) in which a symptomatic intracranial hemorrhage occurred at the lesion site where previously performed SWI showed marked hypointensity. Previous reports about SWI findings in patients with dAVF have focused on their correlations with angiography and there has been no report mentioning the direct relationship of SWI finding and the risk of dAVF bleeding. This case shows the possibility that SWI might be useful for estimating the bleeding risk.
- Published
- 2014
40. Analysis of risk factors for chronic subdural haematoma recurrence after burr hole surgery: Optimal management of patients on antiplatelet therapy
- Author
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Toru Matsui, Atsushi Okano, Tsukasa Tsuchiya, Soichi Oya, Han Soo Chang, Naoaki Fujisawa, Masahiro Indo, and Takumi Nakamura
- Subjects
Adult ,Male ,medicine.medical_specialty ,Antiplatelet drug ,medicine.medical_treatment ,Infarction ,Neurosurgical Procedures ,Young Adult ,Postoperative Complications ,Risk Factors ,Trephining ,Secondary Prevention ,Humans ,Medicine ,Medical history ,cardiovascular diseases ,Elective surgery ,Risk factor ,Therapeutic Irrigation ,Aged ,Retrospective Studies ,Aged, 80 and over ,Neurologic Examination ,Univariate analysis ,Anticoagulant drug ,business.industry ,Cerebral infarction ,Age Factors ,Anticoagulants ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Hematoma, Subdural, Chronic ,Female ,Neurology (clinical) ,Tomography, X-Ray Computed ,business ,Platelet Aggregation Inhibitors ,Follow-Up Studies - Abstract
OBJECTIVE. Not much is known about surgical management of patients with chronic subdural haematoma (CSDH) treated with antiplatelet or anticoagulant therapy. The aims of this study were to review the surgical outcomes of patients with CSDH and assess the risks of antiplatelet in their surgical management. METHODS. We retrospectively analysed 448 consecutive patients with CSDH treated by one burr hole surgery at our institution. Among them, 58 patients had been on antiplatelet therapy. We discontinued the antiplatelet agents before surgery for all 58 patients. For 51 of these 58 patients (87.9%), early surgery was performed within 0-2 days from admission. We analysed the association between recurrence and patient characteristics, including history of antiplatelet or anticoagulant therapy; age (< 70 years or ≥ 70 years); side; history of angiotensin receptor II blocker, angiotensin converting enzyme blocker, or statin therapy; and previous medical history of head trauma, infarction, hypertension, diabetes mellitus, haemodialysis, seizure, cancer, or liver cirrhosis. RESULTS. Recurrence occurred in 40 patients (8.9%), which was one of the lowest rates in the literature. Univariate analysis showed that only the presence of bilateral haematomas was associated with increased recurrence rate while antiplatelet or anticoagulant therapy did not significantly increase recurrence risk. Also, the recurrence rate from early surgery (0-2 days from drug cessation) for patients on antiplatelet therapy was not significantly higher than that from elective surgery (5 days or more after drug cessation). However, multivariate analysis revealed that previous history of cerebral infarction was an independent risk factor for CSDH recurrence. CONCLUSIOns. Our overall data support the safety of early surgery for patients on the preoperative antiplatelet therapy without drug cessation or platelet infusion. Patients with a previous history of infarction may need to be closely followed regardless of antiplatelet or anticoagulant therapy.
- Published
- 2013
41. Significance of radical resection for pilomyxoid astrocytoma of the cerebellum: a case report and review of the literature
- Author
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Soichi Oya, Takumi Nakamura, Tsukasa Tsuchiya, Han Soo Chang, Naoaki Fujisawa, Masahiro Indo, Toru Matsui, and Atsushi Okano
- Subjects
Male ,Pilomyxoid astrocytoma ,medicine.medical_specialty ,Pathology ,Cerebellum ,Astrocytoma ,Neurosurgical Procedures ,Humans ,Medicine ,medicine.diagnostic_test ,Pilocytic astrocytoma ,Brain Neoplasms ,business.industry ,Subtotal Resection ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,nervous system ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Near total resection ,Neurology (clinical) ,Neurosurgery ,Tomography, X-Ray Computed ,business ,Radical resection - Abstract
Pilomyxoid astrocytoma (PMA) was recently classified as a variant of pilocytic astrocytoma (PA) with significantly more aggressive clinical features than those of PA. Like PAs, PMAs frequently arise in the chiasmatic/hypothalamic regions. The cerebellum is also a common site of occurrence for PAs but not for PMAs. We present the case of a 31-month-old boy with cerebellar PMA that showed rapid regrowth during the 3 months following the first subtotal resection. Gross total resection was achieved in the second surgery, followed by radiation to the tumor bed. During follow-up over the next 12 years, there has been no evidence of recurrence on magnetic resonance imaging. Although the prognosis of cerebellar PMAs remains unknown because of the paucity of cases, the relevant literature reports a more favorable outcome for cerebellar PMAs than for PMAs occurring at other locations. The results of this case study and a review of the relevant literature advocate radical resection, sometimes involving multiple surgeries, for cerebellar PMAs because gross total or near total resection is more feasible in the cerebellum than in other locations.
- Published
- 2013
42. Validation of the bispectral index as an indicator of anesthetic depth in Thoroughbred horses anesthetized with sevoflurane
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Hirotaka Ode, Ai Wakuno, Atsushi Okano, Minoru Ohta, Jun Okada, Masashi Kakizaki, Taisuke Kuroda, and Hirotaka Tokushige
- Subjects
Guaifenesin ,040301 veterinary sciences ,Equine ,business.industry ,Significant difference ,sevoflurane ,Horse ,04 agricultural and veterinary sciences ,Note ,Sevoflurane ,horse ,0403 veterinary science ,Xylazine ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Bispectral index ,Anesthesia ,Anesthetic ,medicine ,anesthetic depth ,bispectral index ,Premedication ,business ,medicine.drug - Abstract
To evaluate the bispectral index (BIS) as an indicator of anesthetic depth in Thoroughbred horses, BIS values were measured at multiple stages of sevoflurane anesthesia in five horses anesthetized with guaifenesin and thiopental following premedication with xylazine. There was no significant difference between the BIS values recorded at end-tidal sevoflurane concentrations of 2.8% (median 60 ranging from 47 to 68) and 3.5% (median 71 ranging from 49 to 82) in anesthetized horses. These BIS values during anesthesia were significantly lower (P
- Published
- 2016
43. Recurrent cerebral aneurysm formation and rupture within a short period due to invasive aspergillosis of the nasal sinus; pathological analysis of the catastrophic clinical course
- Author
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Yuki, Shinya, Satoru, Miyawaki, Hirofumi, Nakatomi, Atsushi, Okano, Hideaki, Imai, Masahiro, Shin, Kazuya, Sato, Takeyuki, Tsuchida, Toshihiro, Hayashi, Yasuo, Terao, Satoe, Numakura, Teppei, Morikawa, Junji, Shibahara, Shu, Kikuta, Kenji, Kondo, Keita, Tatsuno, Harushi, Mori, Akira, Kunimatsu, Shoji, Tsuji, and Nobuhito, Saito
- Subjects
Male ,Antifungal Agents ,Recurrence ,Aspergillosis ,Humans ,Intracranial Aneurysm ,Case Report ,Aneurysm, Ruptured ,Sinusitis ,Aged - Abstract
Destructive infiltration of invasive fungal sinusitis can easily occur into the central nervous system (CNS). Cerebral aneurysms associated with fungal infection are highly vulnerable to rupture, and can frequently and rapidly take a serious clinical course. We experienced a patient who twice developed cerebral aneurysm followed by rupture due to invasive fugal sinusitis. This 77-year-old man was admitted for progressive bilateral visual disturbance, which was initially treated as idiopathic hypertrophic pachymeningitis. The patient subsequently suffered subarachnoid hemorrhage (SAH) twice in only 12 days. Both SAH originated from different newly formed cerebral aneurysms. Trapping was performed for both ruptured aneurysms. Pathological examination of the resected aneurysms indicated the presence of fungi determined to be Aspergillus. This Aspergillus infection was also discovered inside the frontal sinus by endoscopic biopsy, so a regimen of antifungal agents was instituted. Prolonged antifungal therapy caused renal impairment, which ultimately led to the patient’s death. Autopsy detected no mycotic infiltration of the major cerebral arteries, except for the 2 ruptured cerebral aneurysms. However, prolonged mycosis of the CNS, such as in the deep part in the falx cerebri and in the small veins proximal to the tentorium cerebelli, was observed, indicating that mycosis invading the cranium is refractory even to long-term administration of antifungal agents. The present case strongly suggests that urgent and proactive definitive diagnosis is essential to successfully treat invasive paranasal sinus aspergillosis. If infiltration of the CNS is suspected, early surgical resection and antifungal therapy must be initiated immediately.
- Published
- 2015
44. Intracranial Inflammatory Pseudotumors Associated with Immunoglobulin G4-Related Disease Mimicking Multiple Meningiomas: A Case Report and Review of the Literature
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Tsukasa Tsuchiya, Atsushi Okano, Nobuhito Saito, Hirofumi Nakatomi, and Junji Shibahara
- Subjects
Male ,Pathology ,medicine.medical_specialty ,Vision Disorders ,Autoimmunity ,Granuloma, Plasma Cell ,Lesion ,Diagnosis, Differential ,Adrenal Cortex Hormones ,medicine ,Meningeal Neoplasms ,Humans ,Quadrantanopia ,Autoimmune pancreatitis ,Foramen magnum ,Pseudotumor Cerebri ,Right optic nerve ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Treatment Outcome ,Pancreatitis ,Immunoglobulin G ,Surgery ,IgG4-related disease ,Neurology (clinical) ,medicine.symptom ,Differential diagnosis ,business ,Meningioma - Abstract
Background Immunoglobulin G (IgG)4-related disease is a syndrome that forms inflammatory pseudotumors with increasing IgG4-positive plasma cells and lymphocytes infiltrating the exocrine gland and other organs. The concept of this disease gradually has gained more recognition. However, reports of intracranial pseudotumors associated with IgG4-related disease are very rare. The purpose of this report is to provide further information helpful in distinguishing IgG4-related disease from multiple meningiomas. Case Description We report a case of a 62-year-old man who presented with visual disturbance and quadrantanopia of the right eye. Magnetic resonance imaging revealed uniformly enhancing masses located near the right paraclinoid at the right Meckel's cave and along the left foramen magnum. He had experienced autoimmune pancreatitis 7 years previously, and the condition had responded to steroid therapy. Laboratory data revealed elevation of IgG (1877 mg/dL) and IgG4 (405 ng/dL). The right paraclinoidal lesion causing visual disturbance was subtotally removed, which provided sufficient decompression of the right optic nerve. IgG4 was strongly positive on immunohistochemical staining, and we started oral corticosteroid medication. Consequently, all lesion masses shrank remarkably within 1 month. Conclusion There have been a growing number of reports of such multiple pseudotumors associated with IgG4-related disease. In differential diagnosis, this disease entity requires special attention when multiple dural-based tumors are observed. Preoperative presumption is very important because this disease is likely to respond to steroid therapy.
- Published
- 2014
45. A Case of Feline Adenocarcinoma of the Jejunum with Incomplete Ileus
- Author
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Ryou Tanaka, Noboru Machida, Katsuhiko Konno, Kohji Maruo, Atsushi Okano, and Yoshihisa Yamane
- Subjects
Jejunum ,medicine.medical_specialty ,medicine.anatomical_structure ,Ileus ,business.industry ,Internal medicine ,General surgery ,medicine ,Adenocarcinoma ,medicine.disease ,business ,Gastroenterology - Abstract
7歳齢の雑種, 避妊済みの猫が嘔吐を繰り返すのと主訴で来院した。腹部触診で腹腔内腫瘤が触知され試験的開腹術を行ったところ, 空腸部に腫瘤病変を認めたため摘出し, その後吻合術を実施した。摘出した腫瘤は病理組織学的検査により腸腺癌と診断された。5ヵ月後, 再び嘔吐と食欲不振の主訴で来院し, 腹部触診にて腫瘤が触知され, 胸部X線検査で肺転移が認められた。再び開腹術を実施したところ, 吻合部における腫瘍の再発と腹膜炎, 腹水の貯留, 肝臓, 脾臓, 膀胱, 腸管への転移が認められた。猫は初回手術より169日間生存した。
- Published
- 2001
46. The pathogenesis of intracranial growing teratoma syndrome: proliferation of tumor cells or formation of multiple expanding cysts? Two case reports and review of the literature
- Author
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Atsushi Okano, Soichi Oya, Eiichi Arai, Toru Matsui, Akira Saito, and Kei Yanai
- Subjects
Male ,endocrine system ,Pathology ,medicine.medical_specialty ,endocrine system diseases ,Growing teratoma syndrome ,Adolescent ,medicine.medical_treatment ,Tumor cells ,Pathogenesis ,medicine ,Humans ,Cell Proliferation ,Chemotherapy ,business.industry ,Brain Neoplasms ,Disease progression ,Teratoma ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Mature teratoma ,Pediatrics, Perinatology and Child Health ,Disease Progression ,Neurology (clinical) ,Germ cell tumors ,alpha-Fetoproteins ,business - Abstract
Growing teratoma syndrome (GTS) is a rare clinical phenomenon defined as the paradoxical growth of mature teratoma components during or after chemotherapy. The mechanism of this phenomenon is not well understood. We present two cases of pineal mixed germ cell tumors that exhibited the similar course to GTS and speculate its pathogenesis.The first case was accompanied by slightly elevated alpha-fetoprotein (8.8 ng/ml; normal6.6 ng/ml). The tumor rapidly grew from 1.5 to 2.7 cm in diameter within 4 weeks. Despite this rapid preoperative growth, thorough pathological investigation found only mature teratoma components along with multiple micro- and macro-cysts. The other case was diagnosed as a pure germinoma based on biopsy and serological examinations. During three courses of chemotherapy, this tumor presented a honeycomb-like appearance on magnetic resonance (MR) images and an exceptionally rapid enlargement. Second-look surgery confirmed the histological diagnosis of a mature teratoma. In both cases, meticulous pathological examination of all whole tumor sections revealed no malignant histological features, and the MIB-1 labeling indices were too low to account for the extremely rapid tumor growth. Instead, both MR images and histological findings demonstrated a predominant formation of multiple cysts.We speculate that this paradoxical growth might not be tumorous proliferation but instead the formation and expansion of multiple cysts inside mature teratoma components and that the presence or absence of growth might be a subsidiary phenomenon. Our hypothesis appears consistent with the characteristic radiological findings of GTS reported in the literature.
- Published
- 2013
47. Beneficial effect of selective intra-arterial infusion of fasudil hydrochloride as a treatment of symptomatic vasospasm following SAH
- Author
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Takumi, Nakamura, Toru, Matsui, Atsushi, Hosono, Atsushi, Okano, Naoaki, Fujisawa, Tsukasa, Tsuchiya, Masahiro, Indo, Yasutaka, Suzuki, Soichi, Oya, and Han Soo, Chang
- Subjects
Adult ,Male ,Vasodilator Agents ,Coronary Vasospasm ,Glasgow Outcome Scale ,Middle Aged ,Subarachnoid Hemorrhage ,Coronary Angiography ,Treatment Outcome ,1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine ,Linear Models ,Humans ,Infusions, Intra-Arterial ,Female ,Tomography, X-Ray Computed ,Aged ,Retrospective Studies - Abstract
We envisage the efficacy and safety of intra-arterial infusion of fasudil hydrochloride (IAF) for symptomatic vasospasm (SVS) after subarachnoid hemorrhage (SAH). We compared results obtained from the groups that received selective IAF (a microcatheter inserted in intracranial arteries) and nonselective IAF (a microcatheter inserted in the cervical arteries). Glasgow Outcome Scale (GOS) value and computed tomographic (CT) score were used to evaluate clinical outcome and the extent of infarction due to delayed vasospasm.Over 2 years, 113 patients with SAH underwent clipping or coiling. Among them, 31 patients (27.4%) developed SVS. We performed nonselective IAF in 10 patients and selective IAF in 10 other patients. Eleven patients with SVS were treated without IAF. The data were statistically analyzed.By univariate linear regression analysis, IAF negatively correlated with CT score (p = 0.016), but IAF was significantly correlated with GOS (p = 0.035). By multiple regression analysis, Hunt and Kosnik grade and CT score significantly correlated with GOS.CT score significantly correlated with functional outcome. Although IAF, both selective and nonselective, was significantly effective for the treatment of delayed vasospasm, the former seemed to be more beneficial.
- Published
- 2012
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