Papers by Masatsune Ishikawa
Frontiers in Neurology
Background: We analyzed the predictive value of the tap test (TT) on the outcome of cerebrospinal... more Background: We analyzed the predictive value of the tap test (TT) on the outcome of cerebrospinal fluid (CSF) shunting in patients with idiopathic normal pressure hydrocephalus (iNPH) and cognitive impairment up to 12 months postoperatively.Methods: We analyzed the data of two prospective multicenter studies on ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS) use in iNPH patients. We selected patients with Mini-Mental State Examination (MMSE) scores ≤ 26 points as study subjects. We used a multivariate logistic regression model to obtain the optimal threshold of MMSE scores after TT to predict the score improvement at 12 months following shunting and that helped to control for confounding factors such as age and MMSE scores before TT. We used logistic regression models to identify variables with age-adjusted odds ratio (A-OR) and multivariate-adjusted OR (M-OR).Results: For an improvement of ≥3 points in the MMSE score cutoff 7 days following TT in VPS and LPS cohort...
Fluids and Barriers of the CNS, 2014
Background: Idiopathic normal pressure hydrocephalus (iNPH) is a treatable cause of dementia, gai... more Background: Idiopathic normal pressure hydrocephalus (iNPH) is a treatable cause of dementia, gait disturbance, and urinary incontinence in elderly patients with ventriculomegaly. Its unique morphological feature, called disproportionately enlarged subarachnoid-space hydrocephalus (DESH), may also be a diagnostic feature. Lipocalin-type prostaglandin D synthase (L-PGDS) is a major cerebrospinal fluid (CSF) protein produced by arachnoid cells, and its concentration in the CSF is reportedly decreased in iNPH. L-PGDS acts as a prostaglandin D2-producing enzyme and behaves as a chaperone to prevent the neurotoxic aggregation of amyloid beta (Aβ) implicated in Alzheimer's disease, a major comorbidity of iNPH. The aim of this study was to confirm the L-PGDS decrease in DESH-type iNPH and to clarify its relationship with clinico-radiological features or other CSF biomarkers. Methods: We evaluated 22 patients (age: 76.4 ± 4.4 y; males: 10, females: 12) referred for ventriculomegaly without CSF pathway obstruction, and conducted a CSF tap test to determine the surgical indication. CSF concentrations of L-PGDS, Aβ42, Aβ40, and total tau (t-tau) protein were determined using enzyme-linked immunosorbent assays. Clinical symptoms were evaluated by the iNPH grading scale, mini-mental state examination, frontal assessment battery (FAB), and timed up and go test. The extent of DESH was approximated by the callosal angle, and the severity of parenchymal damage was evaluated by the age-related white matter change (ARWMC) score. Results: L-PGDS and t-tau levels in CSF were significantly decreased in DESH patients compared to non-DESH patients (p = 0.013 and p = 0.003, respectively). L-PGDS and t-tau showed a significant positive correlation (Spearman r = 0.753, p < 0.001). Among the clinico-radiological profiles, L-PGDS levels correlated positively with age (Spearman r = 0.602, p = 0.004), callosal angle (Spearman r = 0.592, p = 0.004), and ARWMC scores (Spearman r = 0.652, p = 0.001), but were negatively correlated with FAB scores (Spearman r = 0.641, p = 0.004). Conclusions: Our data support the diagnostic value of L-PGDS as a CSF biomarker for iNPH and suggest a possible interaction between L-PGDS and tau protein. In addition, L-PGDS might work as a surrogate marker for DESH features, white matter damage, and frontal lobe dysfunction.
Frontiers in Neurology, 2022
Treatment for idiopathic normal pressure hydrocephalus (iNPH) continues to develop. Although vent... more Treatment for idiopathic normal pressure hydrocephalus (iNPH) continues to develop. Although ventriculoperitoneal shunt surgery has a long history and is one of the most established neurosurgeries, in the 1970s, the improvement rate of iNPH triad symptoms was poor and the risks related to shunt implantation were high. This led experts to question the surgical indication for iNPH and, over the next 20 years, cerebrospinal fluid (CSF) shunt surgery for iNPH fell out of favor and was rarely performed. However, the development of programmable-pressure shunt valve devices has reduced the major complications associated with the CSF drainage volume and appears to have increased shunt effectiveness. In addition, the development of support devices for the placement of ventricular catheters including preoperative virtual simulation and navigation systems has increased the certainty of ventriculoperitoneal shunt surgery. Secure shunt implantation is the most important prognostic indicator, but...
Neurourology and Urodynamics, 2007
Sakakibara R, Uchida Y, Ishii K, Kazui H, Hashimoto M, Ishikawa M, Uchiyama T, Yamamoto T, Takaha... more Sakakibara R, Uchida Y, Ishii K, Kazui H, Hashimoto M, Ishikawa M, Uchiyama T, Yamamoto T, Takahashi H, Shirai K, Hattori T, SINPHONI Members 8 1. Neurology, Internal Medicine, Sakura Medical Center, Toho University, 2. Radiology, Chiba University, 3. Radiology, Hyogo Brain and Heart Center, 4. Psychiatry, Osaka University, 5. Neurosurgery, Noto General Hospital, 6. Neurosurgery, Kitano Hospital, 7. Neurology, Chiba University, 8. (Study of Idiopathic Normal Pressure Hydrocephalus On Neurological Improvement)
Fluids and Barriers of the CNS, 2021
Idiopathic normal pressure hydrocephalus (iNPH) is considered an age-dependent chronic communicat... more Idiopathic normal pressure hydrocephalus (iNPH) is considered an age-dependent chronic communicating hydrocephalus associated with cerebrospinal fluid (CSF) malabsorption; however, the aetiology of ventricular enlargement in iNPH has not yet been elucidated. There is accumulating evidence that support the hypothesis that various alterations in CSF dynamics contribute to ventricle dilatation in iNPH. This review focuses on CSF dynamics associated with ventriculomegaly and summarises the current literature based on three potential aetiology factors: genetic, environmental and hydrodynamic. The majority of gene mutations that cause communicating hydrocephalus were associated with an abnormal structure or dysfunction of motile cilia on the ventricular ependymal cells. Aging, alcohol consumption, sleep apnoea, diabetes and hypertension are candidates for the risk of developing iNPH, although there is no prospective cohort study to investigate the risk factors for iNPH. Alcohol intake may...
The Japanese Journal of Rehabilitation Medicine, 2020
Objective：Currently, there is no reliable evidence on the usefulness of rehabilitation for idiopa... more Objective：Currently, there is no reliable evidence on the usefulness of rehabilitation for idiopathic, normal-pressure hydrocephalus(iNPH)patients after cerebrospinal shunt surgery. Therefore, in this study we investigated the association between the duration of rehabilitation and outcomes. Methods：We evaluated the changes before and after cerebrospinal shunt surgery and rehabilitation by applying the 3-m timed up-and-go test(TUG) , 10-m straight walk test, 180-degree turn, 30-seconds chair-stand test(CS-30) , mini-mental state examination (MMSE) , and frontal assessment battery(FAB)in 81 patients with iNPH. Clinical outcomes were classified as excellent, good, or unsatisfactory. Results：At discharge, TUG, 180-degree turn, and CS-30 were significantly improved in 38 patients who had been in rehabilitation for 2 weeks, compared to those with ＜ 2 weeksrehabilitation after shunt surgery. However, there was no significant difference between MMSE and FAB tests in the two groups. Rehabilitation for 2 weeks significantly improved the patient outcome, especially for those patients with severe gait disturbance before treatment. In 53 patients whose initial TUG time was 13.5 s, rehabilitation for 2 weeks was effective, and resulted in an excellent outcome(odds ratio：4.52, 95％ confidence interval： 1.22-18.7, P value：0.012). Conclusion：In-hospital rehabilitation after cerebrospinal shunt surgery was useful for patients with iNPH and severe disability in daily activities. Therefore, we suggest that these patients require in-hospital rehabilitation after shunt surgery until sufficient improvement of gait disturbance is achieved, in order to maximize activities of daily living.
Journal of Alzheimer's Disease, 2019
Background: Extensive research into cerebrospinal fluid (CSF) biomarkers was performed in patient... more Background: Extensive research into cerebrospinal fluid (CSF) biomarkers was performed in patients with idiopathic normal pressure hydrocephalus (iNPH). Most prior research into CSF biomarkers has been one-point observation. Objective: To investigate dynamic changes in CSF biomarkers during routine tap test in iNPH patients. Methods: We analyzed CSF concentrations of tau, amyloid- (A) 42 and 40, and leucine rich ␣-2-glycoprotein (LRG) in 88 consecutive potential iNPH patients who received a tap test. We collected two-point lumbar CSF separately at the first 1 ml (First Drip (FD)) and at the last 1 ml (Last Drip (LD)) during the tap test and 9 patients who went on to receive ventriculo-peritoneal shunt surgery each provided 1 ml of ventricular CSF (VCSF). Results: Tau concentrations were significantly elevated in LD and VCSF compared to FD (LD/FD = 1.22, p = 0.003, VCSF/FD = 2.76, p = 0.02). Conversely, A 42 (LD/FD = 0.80, p < 0.001, VCSF/FD = 0.38, p = 0.03) and LRG (LD/FD = 0.74, p < 0.001, VCSF/FD = 0.09, p = 0.002) concentrations were significantly reduced in LD and VCSF compared to FD. Gait responses to the tap test and changes in cognitive function in response to shunt were closely associated with LD concentrations of tau (p = 0.02) and LRG (p = 0.04), respectively. Conclusions: Dynamic changes were different among the measured CSF biomarkers, suggesting that LD of CSF as sampled during the tap test reflects an aspect of VCSF contributing to the pathophysiology of iNPH and could be used to predict shunt effectiveness.
Journal of Alzheimer's Disease, 2018
Background: Dilated perivascular spaces in the centrum semiovale (CSO-PVS) are closely related to... more Background: Dilated perivascular spaces in the centrum semiovale (CSO-PVS) are closely related to small vessel disease. However, recent studies have revealed that cerebral amyloid angiopathy can cause dilation of the CSO-PVS and obstruction of interstitial fluid flow along the intramural periarterial drainage. Objective: To examine the severity and age-related prevalence of CSO-PVS through magnetic resonance imaging (MRI) and investigate their clinically relevant factors. Methods: This study included 1,060 subjects who participated in our brain program. The subjects ranged from 23 to 83 years in age and were active in society. The frequencies of the MRI abnormalities of small vessel diseases, including CSO-PVS, were examined. The CSO-PVS severity was classified into three grades: G0, G1, G2, according to the visual rating. The subjects were divided into five age groups and their age-related frequencies were also studied. Using the clinico-laboratory data of 712 subjects, the clinically relevant factors of CSO-PVS were investigated using logistic regression analysis. Results: The frequencies of all G0 ("normal") MRI abnormalities significantly decreased with age. A high prevalence of G2 CSO-PVS was observed (24%) in the youngest group aged ≤39 years, whereas other MRI abnormalities in this group were not or rarely observed. In multivariable logistic regression analyses, G2 CSO-PVS was found to be closely associated with age, hypertension, and the estimated glomerular filtration ratio. Conclusions: This study reveals that CSO-PVS begin to develop in subjects aged less than 39 years. Age-related changes are involved. Further studies are necessary to elucidate the pathophysiological role of the CSO-PVS.
Acta neurochirurgica, 2017
We showed that ventriculoperitoneal (VP) shunt and lumboperitoneal (LP) shunt surgeries are benef... more We showed that ventriculoperitoneal (VP) shunt and lumboperitoneal (LP) shunt surgeries are beneficial for patients with idiopathic normal pressure hydrocephalus (iNPH) in the Study of Idiopathic Normal Pressure Hydrocephalus on Neurological Improvement (SINPHONI; a multicenter prospective cohort study) and in SINPHONI-2 (a multicenter randomized trial). Although therapeutic efficacy is important, cost-effectiveness analysis is equally valuable. Using both a set of assumptions and using the data from SINPHONI and SINPHONI-2, we estimated the total cost of treatment for iNPH, which consists of medical expenses (e.g., operation fees) and costs to the long-term care insurance system (LCIS) in Japan. Regarding the natural course of iNPH patients, 10% or 20% of patients on each modified Rankin Scale (mRS) show aggravation (aggravation rate: 10% or 20%) every 3 months if the patients do not undergo shunt surgery, as described in a previous report. We performed cost-effectiveness analyses ...
Surgical Neurology, 2003
BACKGROUND CONCLUSION A neurenteric cyst may recur after partial removal, and the patient's condi... more BACKGROUND CONCLUSION A neurenteric cyst may recur after partial removal, and the patient's condition may deteriorate during postoperative follow-up. The anterior surgical approach provides good visualization and facilitates safe removal of the lesion.
Journal of Clinical Neuroscience, 2001
The present study identified predictors for surgical internal carotid artery (ICA) dissection in ... more The present study identified predictors for surgical internal carotid artery (ICA) dissection in cases showing ICA involvement in parasellar meningiomas. Twelve cases encountered over the past 4 years were reviewed. Based on MRI findings, patients were divided into two groups; six patients demonstrated complete ICA involvement (encasement) and the other six showed partial ICA involvement (engulfment). The ICA was dissected in all cases in the engulfment group and in four of six cases in the encasement group. The ICA can be dissected even if it is involved at the centre of the tumour if the tumour is soft and can be aspirated. Preservation of the perforating arteries is more important and more difficult. Angiographic finding showing encasement of a long segment of the ICA is unfavourable because of the high possibility that the perforating arteries are involved. Local stenosis of ICA is another unfavourable finding for surgical dissection because tumour invasion of the arterial wall would be suspected. Thus, ICA encasement by the tumour is the less favourable finding for surgery but it is not a decisive predictor. More important findings for ICA dissection in cases showing ICA encasement are involvement of a long segment of the ICA and local ICA stenosis on angiogram.
Dementia and Geriatric Cognitive Disorders, 2007
Background/Aims: We developed an idiopathic normal-pressure hydrocephalus grading scale (iNPHGS) ... more Background/Aims: We developed an idiopathic normal-pressure hydrocephalus grading scale (iNPHGS) to classify a triad of disorders (cognitive impairment, gait disturbance and urinary disturbance) of iNPH with a wide range of severity. The purpose of this study was to assess the reliability and validity of this scale in 38 patients with iNPH. Results: The interrater reliability of this scale was high. The iNPHGS cognitive domain score significantly correlated with the cognitive test scores, including the Mini-Mental State Examination (MMSE), the gait domain score with the Up and Go Test and Gait Status Scale scores, and the urinary domain score with the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score. The MMSE, Gait Status Scale and ICIQ-SF scores significantly improved in patients whose iNPHGS scores improved after CSF tapping but not in those whose iNPHGS scores did not improve after CSF tapping. Fourteen of the 38 patients received shunt operatio...
Acta Neurochirurgica, 2011
Background We prospectively evaluate the role of computerized tomographic cisternography (CTC) in... more Background We prospectively evaluate the role of computerized tomographic cisternography (CTC) in idiopathic normal pressure hydrocephalus (iNPH). Methods The cerebrospinal fluid kinetics of 70 patients who passed the entry criteria for the Study of iNPH on Neurological Improvement (SINPHONI) and underwent insertion of a shunt were studied. Results Stasis of the contrast medium at the lateral ventricles over 24 h (positive ventricular stasis) was observed in 60 patients and at the Sylvian fissure or parietal sulci over 48 h (positive surface stasis) in 59 patients. Sixty patients showed a good response to shunt insertion. The sensitivities of CTC findings at the lateral ventricles and brain surface for shunt effectiveness were 81.7 and 86.7%, respectively; however, the specificities were 20 and 0%. Among the 60 patients who showed a good response to the shunt, 49 had positive surface stasis. Positive ventricular stasis was observed in 52 of the 60 patients, and both findings were observed in 44 patients. Three patients who responded to the shunt had negative stasis in both sites. The 11 patients who had negative surface stasis had significantly lower (p<0.05) preoperative iNPH grading scale-R scores than the 49 patients with positive surface stasis; these patients were considered to be in an early stage of iNPH. Conclusions CTC did not provide additional diagnostic value for predicting the shunt response among patients selected using SINPHONI criteria. We suggest that factors other than disturbances in CSF circulation may be related to the pathogenesis of iNPH. Keywords Idiopathic normal pressure hydrocephalus. Computerized tomographic cisternography. Ventriculoperitoneal shunt. Cerebrospinal fluid circulation Clinical trial registration number This study is registered with ClinicalTrials.gov, number NCT00221091.
Sensors, Jan 5, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Japanese Journal of Neurosurgery, 2018
According to a new concept for cerebrospinal fluid(CSF)dynamics, CSF is not produced mainly from ... more According to a new concept for cerebrospinal fluid(CSF)dynamics, CSF is not produced mainly from the choroid plexus, and it is not absorbed from the arachnoid granule near the superior sagittal sinus, rather it is drained mainly by the lymphatic systems around the cranial nerves or lower cervical nerve root. Furthermore, CSF moves in a pulsatile fashion with blood circulation and respiration as the driving force and does not flow in one direction from the ventricle to the subarachnoid space(bulk flow theory). The CSF pulsatile movement is normally the largest around the cisterna magna and prepontine cistern. The mean total volume of intracranial CSF was ≥300 ml in the healthy controls at 70 years, ＜300 ml in the patients with secondary normal pressure hydrocephalus(sNPH)in which pathogenesis is thought to be due to the inflammatory adhesion in the widespread subarachnoid spaces, and ≥400 ml in the patients with idiopathic NPH (iNPH). Compared with the healthy 70-year-old controls, the patients with iNPH have about 100 ml larger ventricles and almost the same size of subarachnoid space, but the CSF distribution in the subarachnoid spaces was very different between the iNPH patients and age-matched controls. In iNPH, the Sylvian fissure and basal cistern were conspicuously enlarged, whereas the convexity part of the subarachnoid space was severely decreased. The CSF distribution in the subarachnoid space in iNPH is known to be characterized as disproportionately enlarged subarachnoid space hydrocephalus(DESH) which might be due to direct CSF communication between the lateral ventricles and the basal cistern at the inferior choroidal point of the choroidal fissure, acting as the overflow device for the ventricular drainage system. These alternative direct CSF pathways between ventricles and subarachnoid spaces other than the foramina of Luschka and Magendie have been reported. Also, the CSF distribution pattern in iNPH differed strongly from that in sNPH.
Frontiers in Neurology, 2017
In spite of growing evidence of idiopathic normal-pressure hydrocephalus (NPH), a viewpoint about... more In spite of growing evidence of idiopathic normal-pressure hydrocephalus (NPH), a viewpoint about clinical care for idiopathic NPH is still controversial. A continuous divergence of viewpoints might be due to confusing classifications of idiopathic and adult-onset congenital NPH. To elucidate the classification of NPH, we propose that adult-onset congenital NPH should be explicitly distinguished from idiopathic and secondary NPH.
Japanese Journal of Neurosurgery, 2009
multiforme (GBM) is the most aggressive brain tumor in adults ． The median survival period of pat... more multiforme (GBM) is the most aggressive brain tumor in adults ． The median survival period of patients with GBM is appro) drnately twelve months ． Radiation therapy plus temozolomide ， the current standard therapy ， has generally failed to prevent recurrence of GBM ， The e 丗 cacy of chemotherapy for the recurrent GBM is Iimited ． The phase II trial of bevacizumab ， an anti − vascular endothelial groWth factor antibody ， and irinotecan reports the ef 丘 cacy for the recurrent GBM ． We report a patient with recurrent GBM who responded very well to the che − motherapy consisting of bevacizumab and irintoecan ． Bevacizumab and irinotecan may improve the treatment out − come of patients with recurrent GBM ，
Japanese Journal of Neurosurgery, 2003
Fluids and barriers of the CNS, Jan 22, 2016
To improve the diagnostic performance of the cerebrospinal fluid (CSF) tap test (TT), early and d... more To improve the diagnostic performance of the cerebrospinal fluid (CSF) tap test (TT), early and delayed assessments of gait were performed after the removal of 30 ml of CSF in patients with probable idiopathic normal pressure hydrocephalus. Assessments of gait included the 3-m timed up and go test (TUG), and the 10-m walk in time (10Ti) and in step (10St) tests. Quantitative data for the TUG, the 10Ti, and the 10St were obtained before CSF removal and on days 1 and 4 after removal of 30 ml CSF. CSF shunt surgery was performed in 61 patients within one month after the TT. The gait outcome was assessed 3 months after surgery. The area under the curve (AUC), sensitivity, specificity, and cutoff values were computed for the TUG, the 10Ti, and the 10St on day 1 and day 4 using receiver operating characteristic (ROC) curve analysis. The positive response rate in three measures on day 4 was equal to or higher than the values on day 1. Times were reduced significantly in the TUG and the 10m...
Uploads
Papers by Masatsune Ishikawa