Yukihiko Fujii

Niigata University, Niahi-niigata, Niigata, Japan

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Publications (136)254.17 Total impact

  • No shinkei geka. Neurological surgery 01/2015; 43(1):31-40. · 0.13 Impact Factor
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    ABSTRACT: IntroductionPrevious magnetic resonance spectroscopy (MRS) and mass spectroscopy studies have shown accumulation of 2-hydroxyglutarate (2HG) in mutant isocitrate dehydrogenase (IDH) gliomas. IDH mutation is known to be a powerful positive prognostic marker in malignant gliomas. Hence, 2HG accumulation in gliomas was assumed to be a positive prognostic factor in gliomas, but this has not yet been proven. Here, we analyzed 52 patients harboring World Health Organization (WHO) grade II and III gliomas utilizing 3.0-tesla MRS.ResultsMutant IDH gliomas showed significantly higher accumulation of 2HG (median 5.077 vs. 0.000, p =0.0002, Mann¿Whitney test). 2HG was detectable in all mutant IDH gliomas, whereas in 10 out of 27 (37.0%) wild-type IDH gliomas, 2HG was below the detectable range (2HG =0) (p =0.0003, chi-squared test). Screening for IDH mutation by 2HG analysis was highly sensitive (cutoff 2HG =1.489 mM, sensitivity 100.0%, specificity 72.2%). Gliomas with high 2HG accumulation had better overall survival than gliomas with low 2HG accumulation (p =0.0401, Kaplan-Meier analysis).Discussion2HG accumulation detected by 3.0-tesla MRS not only correlates well with IDH status, but also positively correlates with survival in WHO grade II and III gliomas.
    Acta neuropathologica communications. 11/2014; 2(1):158.
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    ABSTRACT: Objectives: The study objectives are (1) to identify factors predicting the excellent visual recovery after transsphenoidal removal of pituitary tumors and (2) to describe the association of excellent visual recovery and early restoration of symmetry of the decompressed optic chiasm. Methods: Thirty-five patients with visual symptoms due to pituitary tumors underwent endoscopic endonasal surgery. All patients received perioperative diagnostic magnetic resonance (MR) imaging and ophthalmological assessments within 2 weeks before surgery, within 2 weeks after surgery, and 3 months or later after surgery. Preoperative best-corrected visual acuity (BCVA ≧ 20/20), degree of visual field deficit (VFD, less than half of VF), thickness of retinal nerve fiber layer (RNFL) measured by optical coherence tomography (OCT), and thickness of ganglion cell complex (GCC) measured by OCT were considered for statistical analysis as predictive factors of VF outcome. Multivariate logistic regression models were used in statistical evaluation of data. Results: In the multivariate analysis, RNFL (odds ratio = 62·137, P < 0·001) and preoperative VFD (odds ratio = 8·244, P < 0·02) proved to be effective as factors predicting sufficient VF recovery. Postoperative restoration of symmetry of the optic chiasm was related to sufficient VF recovery (P < 0·0001, Fisher's exact test) and RNFL (P < 0·0001, Fisher's exact test). Discussion: Early decompression is crucial for sufficient VF recovery, in particular, while RNFL preserves normal or borderline thickness and while VFD keeps within hemianopia. Morphological reversibility is associated with functional reversibility in the optic chiasm compressed by a pituitary tumor. In particular, early morphological recovery suggests functional recovery, which indicates neurocyte reserve in the compressed optic pathway with functional recovery.
    Neurological Research 06/2014; · 1.45 Impact Factor
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    ABSTRACT: To determine whether various clinical factors are related to the long-term outcomes of patients with sporadic cerebellar hemangioblastomas.
    World Neurosurgery 06/2014; · 2.42 Impact Factor
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    ABSTRACT: Introduction Supratentorial dermoid cysts arise due to the misplacement of embryonic inclusions in the vicinity of the developing neural tube up to the third week of life, when the neural groove begins to close. This report describes a case of a suprasellar dermoid cyst anchored to the anterior optic chiasm, which was accurately located by endoscopic observation, removed gross-totally without visual disturbance, and confirmed pathologically. Although the cyst wall was gross-totally resected, the patient’s impaired visual field returned to a normal level. The resection procedure under endoscopic vision is demonstrated. Material and Method A 22-year-old man gradually developed bitemporal hemianopsia with retrobulbar pain over two months. Magnetic resonance imaging demonstrated a suprasellar cyst with intracystic fat contents forming a fluid level within the lesion. The suprasellar cyst was gross-totally removed with endoscopic endonasal transsphenoidal procedures. Intraoperative inspection confirmed that this cyst arose from the optic chiasm. Pathological examination showed the lesion as a dermoid cyst. Result After gross-totally resection of the cyst, the patient presented a further, transient impairment of bitemporal hemianopsia; at four month follow-up, his visual disturbance was not evident any longer. Conclusion To the best of our knowledge, ours is the only case of a dermoid cyst anchored to the anterior optic chiasma, which was visually confirmed under endoscopic observation. After surgery, the patient presented a transient impairment of the visual field, which was not evident at four month follow-up. It will contribute to a similar case, in which surgeons hesitate to make an incision in the optic chiasm. A subtotal excision should be considered in cases of dermoid cysts anchored to the anterior optic chiasm, because all the previously reported cases of suprasellar dermoid cysts are young people or those who have a relatively long life expectancy.
    Interdisciplinary Neurosurgery. 06/2014;
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    ABSTRACT: Object Sacrococcygeal dimples in the gluteal fold, also known as coccygeal pits, are observed in 2%-4% of newborns. Sacrococcygeal dimples are not generally considered to be associated with a significant risk of intraspinal anomalies and therefore are not thought to require further radiographic evaluation. Accordingly, the precise incidence and nature of intraspinal lesions that may be associated with sacrococcygeal dimples is unclear. This study was conducted to determine the incidence of intraspinal lesions in patients with intergluteal dimples. Methods In this study, the authors used MRI to evaluate 103 children who were seen at the Niigata University Medical and Dental Hospital between 2006 and 2011 because of skin abnormalities in the lumbosacral region. Of these children, 14 were excluded as having a subcutaneous fatty mass, and 5 were excluded because the dimples were above the gluteal fold or did not end at the coccyx. The remaining 84 patients were classified according to whether the bottom of the dimple was visible (shallow) or not (deep). The authors also retrospectively examined other skin abnormalities and coexisting anomalies. Results The mean age at the time of MRI evaluation was 11.7 months. Magnetic resonance imaging led to the identification of fibrolipoma of the terminal filum (FTF) in 14 cases (16.7%); 6 of these patients also had a low conus. Classified by depth, there were 58 cases with shallow and 26 with deep dimples. Fibrolipoma of the terminal filum was found in significantly more patients with deep dimples (9 [34.6%]) than in those with shallow dimples (5 [8.6%]). The frequency of other congenital anomalies was significantly higher in patients with FTF-associated dimples (6 [42.9%] of 14) than in those with dimples that were not associated with FTF (9 [12.9%] of 70). Conclusions Fibrolipoma of the terminal filum was identified by MRI in 16.7% of patients with sacrococcygeal dimples. The risk of FTF increased when the dimples were deeply excavated or were accompanied by congenital anomalies. Magnetic resonance imaging should be performed to identify intraspinal lesions when there are high risk factors for intraspinal abnormalities, or when an ultrasound screening suggests intraspinal abnormalities.
    Journal of Neurosurgery Pediatrics 05/2014; · 1.63 Impact Factor
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    ABSTRACT: The authors report a rare case of a huge hypervascular tentorial cavernous angioma treated with preoperative endovascular embolization, followed by successful gross-total removal. A 15-year-old girl presented with scintillation, diplopia, and papilledema. Computed tomography and MRI studies revealed a huge irregularly shaped tumor located in the right occipital and suboccipital regions. The tumor, which had both intra- and extradural components, showed marked enhancement and invasion of the overlying occipital bone. Angiography revealed marked tumor stain, with blood supply mainly from a large branch of the left posterior meningeal artery. Therefore, this lesion was diagnosed as a tentorium-based extraaxial tumor. For differential diagnosis, meningioma, hemangiopericytoma, and malignant skull tumor were considered. Tumor feeders were endovascularly embolized with particles of polyvinyl alcohol. On the following day, the tumor was safely gross totally removed with minimum blood loss. Histopathological examination confirmed the diagnosis of cavernous angioma. To date, there have been no reports of tentorium-based cavernous angiomas endovascularly embolized preoperatively. A tentorial cavernous angioma is most likely to show massive intraoperative bleeding. Therefore, preoperative embolization appears to be quite useful for safe maximum resection. Hence, the authors assert that the differential diagnosis of tentorium-based tumors should include tentorial cavernous angioma, for which preoperative endovascular embolization should be considered.
    Journal of Neurosurgery Pediatrics 05/2014; · 1.37 Impact Factor
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    ABSTRACT: Acute deprivation of unilateral sensory input rapidly enhances contralateral hand motor function, but the underlying mechanisms remain poorly understood. We herein used functional MRI to evaluate, in 14 healthy individuals, motor cortical activation for right finger motion before, during, and after sensory deprivation of left forearm induced by reversible, noninvasive ischemic nerve block (INB). Before INB, the motor task activated the left primary sensorimotor cortex (SM1) as expected. During INB, the volume of the left SM1 activation significantly increased, and, after INB, it returned to the pre-INB, baseline level. The effectiveness of the INB of the left forearm was ensured by confirming disappearance of the activation in right primary sensory cortex that is normally caused by tactile stimulation of the left index finger. These findings demonstrate that acute deafferentation of unilateral forearm causes rapid and reversible changes in the neural substrates for contralateral finger motion, mediated possibly by attenuation of transcallosal interhemispheric inhibition.
    Neuroreport 03/2014; · 1.40 Impact Factor
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    ABSTRACT: Age is one of the most important prognostic factors in glioblastoma patients, but no standard treatment has been established for elderly patients with this condition. We therefore conducted a retrospective cohort study to evaluate treatment regimens and outcomes in elderly glioblastoma patients. The study population consisted of 79 glioblastoma patients aged ≥76 years (median age 78.0 years; 34 men and 45 women). The median preoperative Karnofsky performance status (KPS) score was 60. Surgical procedures were classified as biopsy (31 patients, 39.2 %), <95 % resection of the tumor (21 patients, 26.9 %), and ≥95 % resection of the tumor (26 patients, 33.3 %). Sixty-seven patients (81.0 %) received radiotherapy and 45 patients (57.0 %) received chemotherapy. The median overall progression-free survival time was 6.8 months, and the median overall survival time was 9.8 months. Patients aged ≥78 years were significantly less likely to receive radiotherapy (p = 0.004). Patients with a postoperative KPS score of ≥60 were significantly more likely to receive maintenance chemotherapy (p = 0.008). Multivariate analyses identified two independent prognostic factors: postoperative KPS score ≥60 (hazard ratio [HR] = 0.531, 95 % confidence interval [CI] 0.315-0.894, p = 0.017) and temozolomide therapy (HR = 0.442, 95 % CI 0.25-0.784, p < 0.001).The findings of this study suggest that postoperative KPS score is an important prognostic factor for glioblastoma patients aged ≥76 years, and that these patients may benefit from temozolomide therapy.
    Journal of Neuro-Oncology 10/2013; · 3.12 Impact Factor
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    ABSTRACT: The efficacy and toxicity of high-dose methotrexate (HD-MTX)-based chemotherapy were retrospectively reviewed in patients with primary central nervous system lymphoma (PCNSL). All immunocompetent patients with histologically or radiographically diagnosed PCNSL treated between 2006 and 2012 at Niigata University Hospital were enrolled. Thirty-eight patients with a diagnosis of PCNSL were treated with one of two regimens during different time periods. During the first period, from 2006 to 2009, three 3-week cycles of MPV (MTX + procarbazine + vincristine) were administered (MPV3 group). In the second period, from 2010 to 2012, five 2-week cycles of MTX were administered (MTX5 group). High-dose cytarabine was used in both groups following HD-MTX-based chemotherapy. Whole-brain radiotherapy was used for patients who did not attain a complete response (CR) based on magnetic resonance images. In the MPV3 group, 20 out of 23 patients (87%) completed the planned treatment. The CR rate after chemotherapy was 30%, and 57% after radiation therapy. Thirteen out of 15 patients (87%) in the MTX5 group completed the planned treatment. The CR rates after chemotherapy and radiation therapy were 53% and 93%, respectively. Renal dysfunction was assessed by measuring creatinine clearance rates, which were very similar in both groups. In terms of hematologic toxicity and other adverse reactions, there was no significant difference between the two groups. In conclusion, dose-dense MTX chemotherapy improved outcome with acceptable toxicity compared with the treatment schedule for three cycles of MPV treatment.
    Neurologia medico-chirurgica 10/2013; · 0.49 Impact Factor
  • Neuropathology 09/2013; · 1.80 Impact Factor
  • Clinical Neurophysiology 08/2013; 124(8):e32-e33. · 2.98 Impact Factor
  • Clinical Neurophysiology 08/2013; 124(8):e32. · 2.98 Impact Factor
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    ABSTRACT: Medulloblastoma (MB) is a malignant cerebellar tumor arising in children, and its ontogenesis is regulated by Sonic Hedgehog (Shh) signaling. No data are available regarding the correlation between expression of Gli3, a protein lying downstream of Shh, and neuronal differentiation of MB cells, or the prognostic significance of these features. We re-evaluated the histopathological features of surgical specimens of MB taken from 32 patients, and defined 15 of them as MB with neuronal differentiation (ND), three as MB with both glial and neuronal differentiation (GD), and 14 as differentiation-free (DF) MB. Gli3-immunoreactivity (IR) was evident as a clear circular stain outlining the nuclei of the tumor cells. The difference in the frequency of IR between the ND+GD (94.4%) and DF (0%) groups was significant (P < 0.001). The tumor cells with ND showed IR for both Gli3 and neuronal nuclei. Ultrastructurally, Gli3-IR was observed at the nuclear membrane. The overall survival and event-free survival rates of the patients in the ND group were significantly higher than those in the other groups. The expression profile of Gli3 is of considerable significance, and the association of ND with this feature may be prognostically favorable in patients with MB.
    Neuropathology 07/2013; · 1.80 Impact Factor
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    ABSTRACT: The seizure onset zone (SOZ) and propagation pathways in supplementary motor area (SMA) seizures are difficult to identify because of the short duration and swift propagations of this seizure type. Herein, we studied ictal cerebral blood flow changes, seizure electrical activities, and clinical signs employing simultaneous near-infrared spectroscopy (NIRS) and electrocorticography (ECoG) recordings in a brain tumor patient with SMA seizures. Increased cerebral blood flow was observed from the SOZ in the ipsilateral SMA and spread to the ipsilateral premotor cortex, ipsilateral sensorimotor cortex, and also the contralateral hemisphere. These propagation patterns were concordant with ictal ECoG seizure activities and clinical signs. Removal of the SOZ and surrounding areas, where the higher blood flow and higher frequency oscillations had been identified, achieved a good outcome for this patient. Our ictal NIRS-ECoG technique is robust and useful for detecting the SOZ and seizure propagations.
    Journal of Biomedical Optics 07/2013; 18(7):76022. · 2.75 Impact Factor
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    ABSTRACT: The affected artery in glossopharyngeal neuralgia (GPN) is most often the posterior inferior cerebellar artery (PICA) from the caudal side or the anterior inferior cerebellar artery (AICA) from the rostral side. This technical report describes two representative cases of GPN, one with PICA as the affected artery and the other with AICA, and demonstrates the optimal approach for each affected artery. We used 3D computer graphics (3D CG) simulation to consider the ideal transposition of the affected artery in any position and approach. Subsequently, we performed microvascular decompression (MVD) surgery based on this simulation. For PICA, we used the transcondylar fossa approach in the lateral recumbent position, very close to the prone position, with the patient's head tilted anteriorly for caudal transposition of PICA. In contrast, for AICA, we adopted a lateral suboccipital approach with opening of the lateral cerebellomedullary fissure, to visualize better the root entry zone of the glossopharyngeal nerve and to obtain a wide working space in the cerebellomedullary cistern, for rostral transposition of AICA. Both procedures were performed successfully. The best surgical approach for MVD in patients with GPN is contingent on the affected artery-PICA or AICA. 3D CG simulation provides tailored approach for MVD of the glossopharyngeal nerve, thereby ensuring optimal surgical exposure.
    Neurosurgical Review 06/2013; · 1.86 Impact Factor
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    ABSTRACT: The present study aimed to identify genes associated with patient survival to improve our understanding of the underlying biology of gliomas. We investigated whether expression of genes selected using random survival forests models could be used to define glioma subgroups more objectively than standard pathology. RNAs from 32 non-treated grade 4 gliomas were analyzed using the GeneChip Human Genome U133 Plus 2.0 Expression array (containing approximately 47,000 genes). Twenty-five genes were identified whose expressions were strongly and consistently related to patient survival. The Prognosis Prediction Score of these genes was most significant among several variables and survival analyses. The Prognosis Prediction Score of three genes and age classifiers also revealed a strong prognostic value among grade 4 gliomas. These results were validated in an independent samples set (n = 488). Our method was effective for objectively classifying grade 4 gliomas, and was a more accurate prognosis predictor than histological grading. This article is protected by copyright. All rights reserved.
    Cancer Science 06/2013; · 3.53 Impact Factor
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    ABSTRACT: A 28-year-old man presented with osteosarcoma of the occipital bone 16 years after 24 Gy of craniospinal irradiation for acute lymphocytic leukemia. The tumor had both intra- and extra-cranial components. However, the affected skull appeared to be normal on imaging because of permeative infiltration by the tumor. Subtotal resection was achieved and the tumor was verified histologically as an osteosarcoma. The residual tumor soon showed remarkable enlargement and disseminated to the spinal cord. Both of the enlarged and disseminated tumor masses were treated by surgical intervention and chemotherapy. However, the patient deteriorated due to the tumor regrowth and died 11 months after the initial diagnosis. This patient had previously developed a leukemia, a colon cancer, a rectal cancer and a hepatocellular carcinoma. His brother also died of leukemia. The patient had a heterozygous TP53 germ-line mutation of codon 248 in the exon 7. In conclusion, we consider the present tumor to be a rare example of radiation-induced skull osteosarcoma in a member of the cancer-prone family with TP53 germ-line mutation which is associated with Li-Fraumeni syndrome.
    No shinkei geka. Neurological surgery 06/2013; 41(6):499-505. · 0.13 Impact Factor
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    ABSTRACT: Despite clinical importance of identifying exact anatomical location of neural tracts and nuclei in the brainstem, no neuroimaging studies have validated the detectability of these structures. The aim of this study was to assess the detectability of the structures using three-dimensional anisotropy contrast-periodically rotated overlapping parallel lines with enhanced reconstruction (3DAC-PROPELLER) imaging. Forty healthy volunteers (21 males, 19 females; 19-53 years, average 23.4 years) participated in this study. 3DAC-PROPELLER axial images were obtained with a 3T-MR system at four levels of the brainstem: the lower midbrain, upper and lower pons, and medulla oblongata. Three experts independently judged whether five tracts (corticospinal tract, medial lemniscus, medial longitudinal fasciculus, central tegmental and spinothalamic tracts) and 10 nuclei (oculomotor and trochlear nuclei, spinal trigeminal, abducens, facial, vestibular, hypoglossal, prepositus, and solitary nuclei, locus ceruleus, superior and inferior olives) on each side could be identified. In total, 240 assessments were made. The five tracts and eight nuclei were identified in all the corresponding assessments, whereas the locus ceruleus and superior olive could not be identified in 3 (1.3%) and 16 (6.7%) assessments, respectively. 3DAC-PROPELLER seems extremely valuable imaging method for mapping out surgical strategies for brainstem lesions.
    Journal of neuroimaging: official journal of the American Society of Neuroimaging 04/2013; · 1.82 Impact Factor
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    ABSTRACT: Object In this paper, the authors' goal was to report their novel presurgical simulation method applying interactive virtual simulation (IVS) using 3D computer graphics (CG) data and microscopic observation of color-printed plaster models based on these CG data in surgery for skull base and deep tumors. Methods For 25 operations in 23 patients with skull base or deep intracranial tumors (meningiomas, schwannomas, epidermoid tumors, chordomas, and others), the authors carried out presurgical simulation based on 3D CG data created by image analysis for radiological data. Interactive virtual simulation was performed by modifying the 3D CG data to imitate various surgical procedures, such as bone drilling, brain retraction, and tumor removal, with manipulation of a haptic device. The authors also produced color-printed plaster models of modified 3D CG data by a selective laser sintering method and observed them under the operative microscope. Results In all patients, IVS provided detailed and realistic surgical perspectives of sufficient quality, thereby allowing surgeons to determine an appropriate and feasible surgical approach. Surgeons agreed that in 44% of the 25 operations IVS showed high utility (as indicated by a rating of "prominent") in comprehending 3D microsurgical anatomies for which reconstruction using only 2D images was complicated. Microscopic observation of color-printed plaster models in 12 patients provided further utility in confirming realistic surgical anatomies. Conclusions The authors' presurgical simulation method applying advanced 3D imaging and modeling techniques provided a realistic environment for practicing microsurgical procedures virtually and enabled the authors to ascertain complex microsurgical anatomy, to determine the optimal surgical strategies, and also to efficiently educate neurosurgical trainees, especially during surgery for skull base and deep tumors.
    Journal of Neurosurgery 04/2013; · 3.15 Impact Factor

Publication Stats

593 Citations
254.17 Total Impact Points

Institutions

  • 1997–2014
    • Niigata University
      • • Division of Neurosurgery
      • • Department of Pathology
      • • Brain Research Institute
      Niahi-niigata, Niigata, Japan
  • 2013
    • Stem Cell And Brain Research Institute
      Lyons, Rhône-Alpes, France
    • Saga University
      • Department of Neurosurgery
      Сага Япония, Saga, Japan
    • Kurume University
      • Biostatistics Center
      Куруме, Fukuoka, Japan
  • 2012–2013
    • Oita University
      • Department of Pathology
      Ōita, Ōita, Japan
    • Niigata Cancer Center Hospital
      Niahi-niigata, Niigata, Japan
  • 2009–2011
    • Niigata City General Hospital
      Niahi-niigata, Niigata, Japan
    • Nagaoka Red Cross Hospital
      Нагаока, Niigata, Japan