Kosaku Amano

Cerebrospinal fluid (CSF) leakage is a common but sometimes serious complication after transsphen... more Cerebrospinal fluid (CSF) leakage is a common but sometimes serious complication after transsphenoidal surgery (TSS). To avoid this postsurgical complication, we usually repair the CSF leaking area using an autologous material, such as fat, fascia, or muscle graft and sometimes nasonasal septal flap. In this report, we propose a technique using a novel autologous material, sphenoid sinus mucosa (SSM), to repair intraoperative CSF leakage or prevent it postoperatively. On 26 February 2007, we introduced the technique of using SSM to repair or prevent CSF leakage in TSS. Until 30th of June 2014, we performed 500 TSSs for patients with pituitary or parasellar lesions. They were 195 men and 305 women with a mean age of 48.5 years (range, 5-85 years). We used SSM for patching or suturing the arachnoid laceration or dural defect, in lieu of fat or fascia harvested from abdomen or thigh, or made pedicle flap of SSM instead of nasonasal septal flap to cover the sellar floor. Comparing the p...

Long-term Outcomes of Surgical Management for Rathke's Cleft Cyst

[(5)Complications of transsphenoidal surgery]

No shinkei geka. Neurological surgery

Transnasal Surgery for the Anterior Skull Base : Visualization using High Definition Type Endoscope

Japanese Journal of Neurosurgery

Effectiveness of octoreotide administration before surgery for GH-TSH co-secreting pituitary adenoma with thyrotoxicosis: a case report

Endocrine Abstracts, 2015

Isolated pituitary sarcoidosis stained with a specific MAB against Propionibacterium acnes: a case report

by Kosaku Amano and Yoshikazu Okada

Endocrine Abstracts, 2015

[Extracapsular removal of pituitary adenomas]

No shinkei geka. Neurological surgery, 2009

[Current treatment of acromegaly]

No shinkei geka. Neurological surgery, 2015

Clinicopathological features of sellar region xanthogranuloma: correlation with Rathke's cleft cyst

by Tomokatsu Hori and Kosaku Amano

Brain tumor pathology, 2013

Xanthogranuloma of the sellar region is a rare clinical observation. Although it was included in ... more Xanthogranuloma of the sellar region is a rare clinical observation. Although it was included in the World Health Organization (WHO) brain tumor classification in 2000, its clinical features and pathogenesis remain uncertain. We report herein seven cases of xanthogranuloma of the sellar region who underwent transsphenoidal surgery at Tokyo Women's Medical University between 2005 and 2011, and discuss the clinical characteristics of this tumor. Six out of these 7 patients (86 %) presented with endocrinological dysfunction, six (86 %) had headaches, five (71 %) had visual field disturbances, and three (43 %) had diplopia including two with unilateral ptosis. Pathological findings revealed cholesterol clefts, hemosiderin deposits, chronic inflammatory infiltrates, multinucleated giant cells, macrophages, and fibrous proliferation. Of these seven cases, components of Rathke's cleft cyst were observed for six. Xanthogranuloma in the sellar region is suspected of being a terminal ...

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[Complications of transsphenoidal surgery]

No shinkei geka. Neurological surgery, 2012

[Repair of cerebrospinal fluid leakage in transsphenoidal surgery]

No shinkei geka. Neurological surgery, 2010

[Clinical standard of neurosurgical disorder (10). Syncope]

No shinkei geka. Neurological surgery, 2009

[Minimally invasive anterior interhemispheric lamina terminalis approach for craniopharyngiomas. Anatomical, hormonal, and neuropsychological considerations]

No shinkei geka. Neurological surgery, 2007

Pulsed Laser-induced Liquid Jet System for Treatment of Sellar and Parasellar Tumors: Safety Evaluation

Journal of neurological surgery. Part A, Central European neurosurgery, Jan 16, 2015

Objective The pulsed laser-induced liquid jet (LILJ) system is an emerging surgical instrument in... more Objective The pulsed laser-induced liquid jet (LILJ) system is an emerging surgical instrument intended to assist both maximal removal of the lesion and functional maintenance through preservation of fine vessels and minimal damage to the surrounding tissue. The system ejects the minimum required amount of pulsed water through a handy bayonet-shaped catheter. We have already shown a significant increase in removal rate, in addition to a noteworthy reduction of intraoperative blood loss and procedure time in the treatment of large pituitary and skull base tumors in a single-institution series. The present study evaluated the safety of the system in multiple institutions. Methods The study included 46 patients, 29 men and 17 women (mean age: 59.1 years) who underwent microsurgical/endoscopic resection of lesions in or in the vicinity of the pituitary fossa through the transsphenoidal approach between October 2011 and June 2012 at six institutions. The histologic diagnoses were pituita...

A Highly Sensitive and Specific Chemiluminescent Enzyme Immunoassay for Placental Alkaline Phosphatase in the Cerebrospinal Fluid of Patients with Intracranial Germinomas

Pediatric Neurosurgery, 2012

Placental alkaline phosphatase (PLAP) in cerebrospinal fluid (CSF) has been proposed as a tumor m... more Placental alkaline phosphatase (PLAP) in cerebrospinal fluid (CSF) has been proposed as a tumor marker for intracranial germinomas. The purpose of the present study was to develop a sensitive assay for measuring CSF PLAP and to evaluate the clinical significance of PLAP in patients with germinomas. A chemiluminescent enzyme assay for PLAP was developed using an anti-human-PLAP monoclonal antibody. PLAP concentrations were determined in 37 controls, 36 germinomas, 3 nongerminomatous germ cell tumors, 21 gliomas and 12 other brain tumors. The assay detection limit was 5 pg/ml. The median PLAP concentration in the control group was below the detection limit. Significantly higher PLAP levels were detected in all 36 germinoma patients, with values ranging from 16 to 3,700 pg/ml. The high PLAP concentrations of 17 germinoma patients decreased to below the detection limit after complete remission had been achieved with radiochemotherapy. The sensitivity and specificity of PLAP for germinomas were 94 and 97%, respectively, with a cutoff value of 30 pg/ml. The results of this study suggest that the determination of CSF PLAP by the chemiluminescent method described here provides a clinically useful tumor marker for the diagnosis and monitoring of intracranial germinomas.

A novel simple real-time electrooculographic monitoring system during transsphenoidal surgeries to prevent postoperative extraocular motor nerve dysfunction

Neurosurgical Review, 2013

In transsphenoidal surgery (TSS) for pituitary tumors, the use of endoscopes allows approach to t... more In transsphenoidal surgery (TSS) for pituitary tumors, the use of endoscopes allows approach to the lateral sides in and around the cavernous sinus. However, this approach is often associated with a risk of cranial nerve dysfunction causing impaired extraocular movement. We employed a novel, simple, and real-time monitoring system using electrooculography during TSS to avoid postoperative extraocular motor nerve dysfunction. A conventional electroencephalograph, which is available in every hospital, was used to detect effects induced by intraoperative manipulation on the cranial nerves related to extraocular movement (EOM) during TSS for pituitary adenomas. One hundred patients with pituitary adenomas who underwent endonasal endoscope-assisted TSS with EOM monitoring were included in the present study. When the extraocular motor nerves were stimulated mechanically directly or even indirectly by surgical procedures, abnormal extraocular muscle responses [electrooculograms (EOGm)] appeared on the monitor screen. When repeated or continuous EOGm were recorded, surgical procedures were discontinued briefly for around 5 to 10 s. The EOGm disappeared promptly when surgical procedures were stopped. Permanent extraocular dysfunction did not occur in the present series of patients. One, who was the fifth patient in the present series, of 100 patients (1.0 %) had transient delayed diplopia after TSS. We have not experienced any more postoperative EOM dysfunction since the first case. EOM monitoring during TSS is a novel, efficient, and simple method to prevent postoperative cranial nerve palsy related to EOM.

Novel flexible forceps for endoscopic transsphenoidal resection of pituitary tumors: technical report

Neurosurgical Review, 2007

The endoscope has become an essential tool for transsphenoidal pituitary surgeries because of the... more The endoscope has become an essential tool for transsphenoidal pituitary surgeries because of the panoramic view and the ability to visualize structures beyond the direct line of vision. However, the regular dedicated instruments for these surgeries sometimes do not reach the areas visualized by an angled endoscope, and instrument maneuverability is limited. To overcome or minimize these problems, we constructed a new flexible tumor forceps that can be manipulated to change shape after placing into the surgical fields via the endonasal or sublabial route, to reach any desirable location for tumor dissection and excision. We applied this newly developed instrument in endonasal endoscopic resection complementing microsurgical procedure in 20 cases of pituitary tumors. The flexible forceps was able to access sites where regular dedicated instruments for transsphenoidal pituitary surgeries could not readily reach despite endoscopic visualization. No complication was observed in the present series, confirming the safety of the newly designed flexible forceps. Our newly developed flexible forceps improves the instrument maneuverability of endoscopic transsphenoidal resection of pituitary tumors, especially those located laterally at the cavernous sinuses or with frontal extension. The use of this instrument makes the best use of endoscopic panoramic visualization for tumor removal.

Optimal treatment strategy for craniopharyngiomas based on long-term functional outcomes of recent and past treatment modalities

by Tomokatsu Hori and Kosaku Amano

Neurosurgical Review, 2010

Although many authors have described treatment strategies for craniopharyngiomas, the optimal tre... more Although many authors have described treatment strategies for craniopharyngiomas, the optimal treatment of craniopharyngiomas remains controversial. This study aimed to define an adequate surgical strategy for craniopharyngiomas by reviewing the long-term functional performance of patients treated by current and past treatment modalities. Fifty-five patients with longer than 5 years of follow-up were selected for the present long-term study. The duration of follow-up ranged from 5.5 to 33 years (median, 14.8 years). There were 28 adult patients (14 males; median age, 44.4 years) and 27 children younger than 16 years of age (15 males; median age, 8.1 years). The patients were divided into the following treatment groups: single surgery (group A; n=14 multiple surgeries (group B; n=8), surgery or surgeries followed by radiotherapy (group C; n=23), surgery or surgeries (partial removal) followed by radiotherapy + additional treatments (multiple surgeries and/or re-irradiation; group D; n=10). In addition to the routine assessments of neurological, endocrine, and visual outcomes, the level of daily functioning was analyzed using the Karnofsky Performance Scale (KPS). Statistical analysis of relationship between KPS score and treatment mode demonstrated that group D had a significantly lower KPS score (F=5.82, p=0.0017). Furthermore, mortality, cognitive function, and visual function were significantly better in groups A, B, and C than in group D. Multiple regression analysis demonstrated that cognitive dysfunction, visual disturbance, and treatment mode were independent covariates that significantly affected postoperative KPS score. Adequate primary treatment for craniopharyngiomas is important to avoid subsequent multiple treatments. Craniopharyngiomas should be removed surgically as far as possible but without further deteriorating cognitive and visual functions, either as total resection or subtotal resection with a small remnant that is controllable by radiation therapy.

Prospective Study of High-Dose Cabergoline Treatment of Prolactinomas in 150 Patients

The Journal of Clinical Endocrinology and Metabolism, Oct 1, 2008

Context: Cabergoline fails to normalize hyperprolactinemia in a considerable proportion of prolac... more

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経鼻前頭蓋底手術

Japanese Journal of Neurosurgery, 2015

Repair and prevention of cerebrospinal fluid leakage in transsphenoidal surgery: a sphenoid sinus mucosa technique

by Kosaku Amano and Tomokatsu Hori

Neurosurgical review, Jan 4, 2015

Long-term Outcomes of Surgical Management for Rathke's Cleft Cyst

[(5)Complications of transsphenoidal surgery]

No shinkei geka. Neurological surgery

Transnasal Surgery for the Anterior Skull Base : Visualization using High Definition Type Endoscope

Japanese Journal of Neurosurgery

Effectiveness of octoreotide administration before surgery for GH-TSH co-secreting pituitary adenoma with thyrotoxicosis: a case report

Endocrine Abstracts, 2015

Isolated pituitary sarcoidosis stained with a specific MAB against Propionibacterium acnes: a case report

by Kosaku Amano and Yoshikazu Okada

Endocrine Abstracts, 2015

[Extracapsular removal of pituitary adenomas]

No shinkei geka. Neurological surgery, 2009

[Current treatment of acromegaly]

No shinkei geka. Neurological surgery, 2015

Clinicopathological features of sellar region xanthogranuloma: correlation with Rathke's cleft cyst

by Tomokatsu Hori and Kosaku Amano

Brain tumor pathology, 2013

Download

[Complications of transsphenoidal surgery]

No shinkei geka. Neurological surgery, 2012

[Repair of cerebrospinal fluid leakage in transsphenoidal surgery]

No shinkei geka. Neurological surgery, 2010

[Clinical standard of neurosurgical disorder (10). Syncope]

No shinkei geka. Neurological surgery, 2009

[Minimally invasive anterior interhemispheric lamina terminalis approach for craniopharyngiomas. Anatomical, hormonal, and neuropsychological considerations]

No shinkei geka. Neurological surgery, 2007

Pulsed Laser-induced Liquid Jet System for Treatment of Sellar and Parasellar Tumors: Safety Evaluation

Journal of neurological surgery. Part A, Central European neurosurgery, Jan 16, 2015

A Highly Sensitive and Specific Chemiluminescent Enzyme Immunoassay for Placental Alkaline Phosphatase in the Cerebrospinal Fluid of Patients with Intracranial Germinomas

Pediatric Neurosurgery, 2012

A novel simple real-time electrooculographic monitoring system during transsphenoidal surgeries to prevent postoperative extraocular motor nerve dysfunction

Neurosurgical Review, 2013

Novel flexible forceps for endoscopic transsphenoidal resection of pituitary tumors: technical report

Neurosurgical Review, 2007

Optimal treatment strategy for craniopharyngiomas based on long-term functional outcomes of recent and past treatment modalities

by Tomokatsu Hori and Kosaku Amano

Neurosurgical Review, 2010

Kosaku Amano

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