Biomedical subjects

Yuichiro Tanaka

Publications and source records attributed to Yuichiro Tanaka.

At least 55 records · Page 3Linked to original sources

PubMed2003

CYP1B1 gene in endometrial cancer.

Metabolic activation of estradiol has been shown to be a key factor in endometrial carcinogenesis. 4-hydroxy estrogens (CYP1B1 metabolites) received particular attention because of their causative role in malignant transformation of various organs including endometrium. CYP1B1 displays the highest level of expression in endometrium. 4-hydroxy estrogens can bind to DNA via their quinone metabolites and cause oxidative damage in endometrial cancer. Moreover, the 4-hydroxy estrogens bind to the estrogen receptor and have estrogenic effects on target tissues. Six polymorphisms of the CYP1B1 gene have been described of which four result in amino acid substitutions; 1-13C-->T, codon 48C-->G, codon 119G-->T, codon 432C-->G, codon 449T-->C and codon 453A-->G. The polymorphisms on exons 2 and 3 have significant effects on the catalytic function of CYP1B1. Polymorphisms on specific regions of CYP1B1 gene result in hyperactivation of the protein and can lead to a higher susceptibility in the incidence of various cancers. Thus, inherited alterations in CYP1B1 hydroxylation activity may be associated with significant changes in estrogen metabolism and, thereby, may possibly explain inter-individual differences in endometrial cancer risk associated with estrogen-mediated carcinogenesis.

Amino Acid Substitution↗

PubMed2003

Hypermethylation can selectively silence multiple promoters of steroid receptors in cancers.

Multiple promoters and differential splicing of 5' upstream exons are often found in various nuclear receptor genes including steroid receptors. Three promoters control the expression of human estrogen receptor alpha (ERalpha) isoforms: ERalpha-A, ERalpha-B, and ERalpha-C, and two promoters control the expression of human progesterone receptor (PR) isoforms: PR-A and PR-B. The expression levels of these isoforms differ with respect to each other in certain target tissues. The role of these isoforms may differ in various types of cells and tissues. The ER and PR contain CpG islands in the 5' upstream regions. One possible mechanism for changing the transcriptional status is methylation of CpG-enriched regions in these isoforms. We have investigated the expression and methylation status of the three different ERalpha promoters and the two different PR gene promoters by using methylation specific PCR (MSP) and direct DNA sequencing in several endometrial and prostate cancer cell lines and tissues. The results of these experiments suggest that ERalpha-A, ERalpha-B, and PR-A were expressed and ERalpha-C and PR-B were inactivated in endometrial cancers. To the contrary, ERalpha-A and ERalpha-B were inactivated and ERalpha-C, PR-A and PR-B were expressed in all prostate cancer. Treatment with demethylating agent (5-aza-2'-deoxycytidine) restored these gene expressions, suggesting that inactivation of this gene is through methylation. Our MSP and direct DNA sequencing showed that ERalpha-A, ERalpha-B, and PR-A genes were unmethylated and ERalpha-C and PR-B were methylated in endometrial cancers although ERalpha-A and ERalpha-B were methylated and ERalpha-C, PRA and PRB were unmethylated in prostate cancers. These reports clearly demonstrate that selective hypermethylation can selectively silence multiple promoters of steroid receptors in carcinogenesis.

Animals↗

PubMed2003

Alleles of polymorphic sites that correspond to hyperactive variants of CYP1B1 protein are significantly less frequent in Japanese as compared to American and German populations.

CYP1B1 metabolites receive particular attention because of their causative role in malignant transformation of various steroid-related organs. Rare variants at residues c.701, c.1294 and c.1358 of CYP1B1 gene result in hyper-activity of protein and can lead to a higher susceptibility to estrogen-related cancers. However, in Japan, the incidences of estrogen-related cancers are remarkably lower than in Western countries. We hypothesize that polymorphisms of CYP1B1 gene can relate to lower incidence of estrogen-related diseases in the Japanese population. To test this hypothesis, the genetic distributions of six different CYP1B1 gene polymorphisms were evaluated among 200 Japanese, 200 Americans and 112 Germans by an allele-specific PCR (ASP) technique. The frequencies of rare variants at residues c.701 and c.1294 were significantly lower in the Japanese population compared to that of other populations. 5.5% of Japanese showed the genotype 701T/T (versus 9.0% in Americans and 10.7% in Germans). 6.5% of Japanese showed the genotype 1294G/G (versus 14.5% in Americans and 12.5% in Germans). The polymorphism at residue c.1358 was not detected in the Japanese population although other populations showed the variant genotypes. This report clearly demonstrates rare variants that correspond to hyper-activity of CYP1B1 protein are significantly 1ess frequent in the Japanese population.

Adult↗

PubMed2003

Polymorphisms of estrogen receptor alpha in prostate cancer.

Estrogen receptor (ER) alpha polymorphisms have been shown to be involved in the oncogenesis of several organs. We hypothesize that polymorphisms of the ERalpha gene are risk factors for prostate cancer. The genotypic distributions of six different loci (codons: 10 T-->C, 87 G-->C, 243 C-->T, 325 C-->G, 594 G-->A, and intron 1 C-->T) of the ERalpha gene were analyzed in prostate cancer tissues. The DNA from 115 cases of prostate cancer (Japanese population) was analyzed by sequence-specific polymerase chain reaction (PCR) and direct sequencing to determine the genotypic and allelic frequencies of the six different polymorphic loci of ERalpha. The relative risk of variant genotype was calculated by comparison with 200 healthy controls. Results of this study showed that the frequency of the variant genotype (C/C) on codon 10 was significantly higher in prostate cancer patients. The odds ratio (OR) was calculated as 3.26 compared to wild-type (T/T) with a 95% confidence interval (CI) of 1.58-6.73. Allele frequency at codon 10 also differed between groups. No association was found between codon 10 polymorphism and the stage of cancer. Polymorphism was not observed in codon 87, and frequencies of genotypes and alleles at other loci (intron 1, codons 243, 325, and 594) were not statistically different between cancer and controls. The present study suggests that polymorphism in codon 10 of ERalpha may be a risk factor for prostate cancer. These results are important in understanding the role of ERalpha polymorphism in the pathogenesis of prostate cancer.

Base Sequence↗

PubMed2003

Aneurysm at the posterior inferior cerebellar artery of extradural origin for preoperative evaluation of safe clipping: case report and review of the literature.

BACKGROUND: As far as we know, 6 cases of extracranial (including craniocervical junction) intradural aneurysms of the posterior inferior cerebellar artery have been previously reported. However, preoperative detailed evaluation of the origin site and a course of the posterior inferior cerebellar artery by means of angiography were not reported in previous papers. CASE DESCRIPTION: We report a rare case of aneurysm of the posterior inferior cerebellar artery, which originated extradurally from the right vertebral artery. A 69-year-old woman experienced a sudden headache 16 years ago and a computed tomography scan showed a subarachnoid hemorrhage around the midbrain. Four-vessel cerebral angiography, however, failed to disclose a source of the hemorrhage. Magnetic resonance angiography incidentally revealed an aneurysm at the craniocervical junction 16 years after the subarachnoid hemorrhage. The aneurysm was exposed and clipped via a suboccipital route. At surgery, it was of no use to apply a temporary clip on the intradural segment of the vertebral artery, because the posterior inferior cerebellar artery was found to enter the intradural space separately from the vertebral artery. The blood flow to such an aneurysm cannot be stopped with this procedure. CONCLUSIONS: Careful neuroimaging study is essential for the accurate diagnosis and successful treatment of such a rare aneurysm.

Aged↗

PubMed2003

Harvesting blood stem cells from cranial bone at craniotomy--a preliminary study.

Primary brain tumors seldom infiltrate into the cranium, even if they are invasive in the central nervous system. In this study, we examined whether blood stem cells can be harvested from cranial bone at craniotomy. Bone marrow cells in cranial bone were counted in 181 craniotomy specimens after staining with hematoxylin and eosin. Marrow volume was measured in 37 specimens using three-dimensional computed tomography (CT). In 10 cases, viable cells collected from very small bone pieces at craniotomy were cultured to examine granulocyte/macrophage colony-forming units (CFU-GM). In 2 cases, bone marrow cells were practically harvested from removed bone at surgery. The weight of bone flap at craniotomy was 35.0 +/- 18.0 g. Bone flap marrow contained 1.5 x 10(9) cells/ml. CT examination showed that bone flap volume was 35.0 +/- 9.0 ml and marrow ratio was 65.1 +/- 13.5%. Thus, at craniotomy, a typical bone flap contained about 3.4 x 10(10) cells. Bone marrow cell count gradually decreased as subject age increased. The bone pieces obtained at craniotomy contained 3.1 +/- 3.4 x 10(6) cells/g, and CFU-GM count was 0.4 x 10(5) cells/g. In one case, we collected 3.4 x 10(8) cells, including 1.8 x 10(6) CFU-GM colonies. In another case, we collected 9.7 x 10(8) cells, including 4.8 x 10(6) CFU-GM colonies. These findings indicate that, at craniotomy, the number of blood stem cells in a typical bone flap is sufficient for autologous blood stem cell rescue.

Adolescent↗

PubMed2003

Diabetes induced erectile dysfunction and apoptosis in penile crura are recovered by insulin treatment in rats.

PURPOSE: We hypothesized that apoptosis is a downstream event in erectile dysfunction, and pro-apoptotic (Bak and Bax) and anti-apoptotic (Bcl-2 and Bcl-x) factors are involved in the etiology of diabetes induced erectile dysfunction. To test this hypothesis the intracavernous pressure of diabetic and insulin treated rats was measured to assess erectile function. Molecular and immunohistochemical analyses for apoptosis were then performed in rat crura to assess their role in diabetes induced erectile dysfunction and insulin treatment. MATERIALS AND METHODS: A total of 70, 6-month-old male Sprague-Dawley rats were divided into 2 groups, including a diabetic (50) and a healthy control (20) group. The diabetic group received intraperitoneal injection of streptozotocin (STZ) (Sigma-Aldrich Co., St. Louis, Missouri) to induce diabetes. Subcutaneous injection of insulin was administered daily to 9 diabetic rats 4 and 8 weeks after STZ injections for 4 and 8 weeks, respectively. Functional studies were performed in 9 diabetic rats each 4, 8 and 12 weeks after STZ injections, in 6 age matched control rats and in insulin treated rats at the termination of therapy. After the completion of functional study the penile crura were collected from rats for molecular and immunohistochemical studies. RESULTS: Mean intracavernous pressure of diabetic rats was significantly lower than in control rats and the decrease in intracavernous pressure was significantly recovered by insulin treatment. Gene expressions of pro-apoptotic and anti-apoptotic factors were present in control, diabetic and insulin treated rat crura. However, anti-apoptotic protein expression was lacking in diabetic rat crura and pro-apoptotic protein expression was lost in insulin treated rat crura. The apoptotic index of diabetic rat crura was significantly higher than that of control rat crura and this index was significantly decreased in insulin treated rat crura. CONCLUSIONS: There was a significant correlation between the decrease and recovery in intracavernous pressure, and protein expression of apoptotic factors in diabetic and insulin treated rat crura. To our knowledge this is the first report demonstrating that the relief of diabetes associated erectile dysfunction by insulin treatment is due to alterations in the protein expression of apoptotic factors in rat crura.

Animals↗

PubMed2003

Internal carotid artery rotation technique to expose an aneurysm neck: technical note.

OBJECTIVE: Full exposure of a neck of an aneurysm is important to obliterate it completely. METHODS: A 51-year-old woman in whom an unruptured aneurysm projecting medially under the optic nerve was incidentally found underwent clipping surgery. The edge of the circumferentially cut distal dural ring was pulled with forceps to rotate the internal carotid artery and to expose the neck of the aneurysm. RESULTS: The neck of the aneurysm was completely obliterated under direct vision. CONCLUSION: This single, neat method exposes the neck of an unruptured paraclinoid aneurysm of the internal carotid artery.

Carotid Artery Diseases↗

PubMed2003

Double-insurance bypass for internal carotid artery aneurysm surgery.

OBJECTIVE: The aim of this article is to present the usefulness of a double-bypass method in the surgical treatment of complex internal carotid artery (ICA) aneurysms. For patients with clippable but complex aneurysms of the ICA having poor collateral circulation, bypass surgery is needed before temporary occlusion of the ICA. We propose a double bypass for safety. METHODS: The superficial temporal artery was anastomosed to the distal cortical branch of the middle cerebral artery (MCA), followed by anastomosis between the radial artery and the inferior trunk of the MCA. For patients with clippable ICA aneurysms, the radial artery was temporarily anastomosed to the inferior trunk of the MCA by raising the ipsilateral forearm to the head after the radial artery was harvested. After the aneurysm had been clipped, the anastomosed radial artery was cut close to the anastomosed site and repositioned back to the original arm. RESULTS: This double-bypass procedure was performed in two patients, and no ischemic complications related to revascularization were observed. Temporary occlusion times of the MCA for superficial temporal artery-to-MCA anastomosis and radial artery-to-MCA anastomosis were 30 and 46 minutes in one patient and 28 and 55 minutes in another. CONCLUSION: This surgical procedure, which we called "double-insurance bypass," can reduce the risk of ischemic complications associated with revascularization of the ICA.

Aged↗

PubMed2003

Characteristics of distal posteroinferior cerebellar artery aneurysms.

OBJECTIVE: Distal posteroinferior cerebellar artery (PICA) aneurysms are rare and have not been well investigated previously. We report our series of 24 patients with 27 distal PICA aneurysms. METHODS: All patients with distal PICA aneurysms that were surgically treated at Shinshu University Hospital and its affiliated hospitals between 1983 and 2001 were reviewed retrospectively. Data relating to clinical, radiological, and intraoperative findings were analyzed. RESULTS: In our series, distal PICA aneurysms reached an incidence of 0.28 and 0.38% of all intracranial aneurysms and ruptured aneurysms, respectively. There were 23 ruptured and 4 unruptured distal PICA aneurysms. Of these, 74.1% were saccular, 7.4% fusiform, and 18.5% dissecting aneurysms. Primarily the telovelotonsillar segment of the PICA was affected. Usually, the surgical outcome was favorable and was influenced by the obstructive hydrocephalus and the preoperative grade. It was sometimes difficult to detect the ruptured distal PICA aneurysm on the initial angiogram, and an extracranial origin of the PICA was sometimes observed. CONCLUSION: This review summarizes the presentation and outcome of a large series of 24 patients with 27 distal PICA aneurysms, and we conclude that distal PICA aneurysms are benign entities compared with vertebral artery-PICA aneurysms. Characteristics that should be considered in the treatment of distal PICA aneurysms are discussed.

Adult↗

PubMed2003

What is the best method for reporting tumor diameter in vestibular schwannoma?

OBJECTIVE: Various methods have been used to report the tumor diameter of vestibular schwannomas. To clarify the most appropriate method to represent the tumor volume, tumor diameters according to various measuring methods were statistically compared with the actual tumor volume. METHODS: Tumor volume was measured by three-dimensional constructive interference in steady state images in 52 unselected vestibular schwannomas. Pearson's correlation coefficient was obtained between the tumor volume and various tumor diameters, such as diameter parallel to the petrous edge (a); a pons-to-petrous diameter (b); ab, a maximum diameter of the portion in the cerebellopontine angle cistern (max CPA); a maximum diameter of the whole tumor (Max); and a diameter through an axis of the internal auditory canal (Axis). The tumors were divided into three groups on the basis of tumor volume, as follows: Group I (small, <0.5 cm(3)), Group II (medium, 0.5-2 cm(3)), and Group III (large, >2 cm(3)). RESULTS: Max and Axis correlated best with the tumor volume in Group I and correlated least with the tumor volume in Group II. Any of these measurements was acceptable in Group III tumors. The max CPA consistently revealed good correlation with the tumor volume in all three tumor groups. CONCLUSION: The max CPA measurement is the simplest and most appropriate way to represent the tumor volume in unselected tumors. Max or Axis is better only when small tumors (<0.5 cm(3) in volume) are being assessed-that is, those with a max CPA of less than 1 cm.

Adult↗

PubMed2003

Protective dural flap for bone drilling at the paraclinoid region and porus acusticus--technical note.

A new method was developed to avoid the risk of injury to the cranial nerves and vessels during intradural bone resection at the paraclinoid region and porus acusticus. The semicircular dural flap is pulled out with a thread over the anterior clinoid process or the porus acusticus. The flap is extended over the underlying structures with a tapered spatula to create adequate space for drilling the bone. The site for drilling was adequately exposed and bone was drilled away smoothly without damaging the underlying vessels and nerves in 10 patients with paraclinoid aneurysms and in seven patients with vestibular schwannomas. This "protective dural flap" method provides wide exposure for drilling, protects the underlying structures, and allows quick inspection during bone resection.

Brain Diseases↗

PubMed2003

Growth pattern and rate in residual nonfunctioning pituitary adenomas: correlations among tumor volume doubling time, patient age, and MIB-1 index.

OBJECT: Surgical cure can be achieved in pituitary adenomas when they are completely removed. It is controversial whether postoperative radiation therapy should be given to prevent recurrence, and whether an early reoperation should be performed for residual adenomas, because we have little information about the natural history of postoperative residual adenomas. METHODS: The residual tumor volume was serially measured in 40 nonfunctioning pituitary adenomas (NFPAs) and the tumor volume doubling time (TVDT) was calculated. Correlations between the patients' age, tumor volume, log TVDT, and MIB-1 index were examined. Other factors including the patient's sex, cavernous sinus (CS) invasion by the tumor, or presence of an intratumoral cyst were analyzed to assess their influence on the TVDT. Values are expressed as the means +/- standard deviations. Thirty-eight adenomas increased in volume and two decreased during a follow-up period ranging from 4 to 141 months (mean 52.5 months). Exponentially linear tumor growth was observed in the 38 growing adenomas regardless of the residual tumor volume, with the TVDT ranging from 506 to 5378 days (mean 1836 days). The patients' age was 57.1 +/- 15.7 years (range 15-79 years), the tumor volume at the beginning of the magnetic resonance imaging observation period was 2.5 +/- 2.2 cm3 (range 0.07-14.5 cm3), and the MIB-1 index was 0.73 +/- 0.68% (range 0.1-2.9%). There was a correlation between the log TVDT and patient age (R = 0.73), an inverse correlation between the log TVDT and MIB-1 index (r = -0.49), and an inverse correlation between the MIB-1 index and patient age (r = -0.61). A significant difference (p = 0.0001) was noted between the TVDT (1,106 days) in the 19 patients younger than 61 years of age and the TVDT (2566 days) in the 19 patients who were 61 years of age or older. There was also a significant difference (p = 0.0002) between the age (50.8 +/- 15.3 years) of the patients with rapidly growing tumors (TVDT < 1,836 days, 24 patients) and the age (69.1 +/- 7.6 years) of the patients with slowly growing tumors (TVDT> 1836 days, 14 patients). Other factors including the patients' sex, CS invasion, and intratumoral cyst formation did not affect the TVDT of residual NFPAs. CONCLUSIONS: The tumor growth rate of residual NFPAs is strongly influenced by the patient's age. The TVDT in elderly patients is much longer than that previously reported. Treatment strategies that take into consideration the natural history of residual adenomas should be established especially in the elderly population.

Adenoma↗

PubMed2003

"Real" three-dimensional constructive interference in steady-state imaging to discern microneurosurgical anatomy. Technical note.

Three-dimensional (3D) neuroimages are generally considered useful for neurosurgical practice. Nevertheless, neuroimaging modalities such as 3D digital subtraction angiography and 3D computerized tomography angiography are still insufficient because the resulting images fail to delineate neural structures. Complex neurosurgical procedures are mostly performed in the cerebrospinal fluid (CSF) space of the basal cistern, where vessels and neural structures are present along with the lesion. The magnetic resonance (MR) imaging-derived 3D constructive interference in steady-state (CISS) imaging displays the margin between the CSF and neural structures, vessels, and dura mater in detail, in a two-dimensional fashion. The authors know that volume-rendered 3D CISS images would be more useful for surgery than conventional ones. Although the usefulness of "virtual MR image endoscopy" was reported previously, the endoscopic view is different from the operative field because of the perspective being emphasized. Therefore, to simulate surgical views, the authors made 3D neuroimages from a 3D CISS MR sequence by using an advanced computer workstation. After generating volume images, a cutting method was used in the desired plane to visualize the lesion with reference to a multiplanar reformatted image. The authors call these "real" 3D CISS images, and they are more comparable to the operative field. This newly developed method of producing a real 3D CISS image was used in 30 cases and contributed to the understanding of the relationship between a lesion and surrounding structures before attempting neurosurgical procedures, with minimal invasiveness to the patient.

Basilar Artery↗

PubMed2003

Microvascular pathological features of immediate perinidal parenchyma in cerebral arteriovenous malformations: giant bed capillaries.

OBJECT: The behavior of brain tissue in cases of arteriovenous malformations (AVMs) is a matter of debate. The authors believe that the local microvascular environment in the AVM bed shares the hemodynamic changes influencing that behavior in one way or another. The purpose of this study was to investigate the microvascular pathological features in the immediate perinidal brain tissue. METHODS: This retrospective study was conducted using excised AVM specimens obtained in 35 patients, from which the authors selected 20 specimens that fulfilled the criteria for sufficient brain tissue around the excised nidus. Specimens were stained with hematoxylin and eosin, and the immediate perinidal microvascular environment was examined using light microscopy. CONCLUSIONS: Eighty-five percent of the AVMs studied showed the presence of huge, dilated capillaries, and 65% showed severe congestion of these capillaries. The authors have named these capillaries "giant bed capillaries." In this study capillary bleeding was shown in AVMs, and a pericapillary space was seen around some vessels. The brain parenchyma containing AVMs with these findings proved to be significantly ischemic.

Adolescent↗

PubMed2003

Clinical and neuroimaging characteristics of hydrocephalus associated with vestibular schwannoma.

OBJECT: The clinical and neuroimaging characteristics of hydrocephalus associated with vestibular schwannoma were retrospectively analyzed to improve the perioperative management of the circulation of cerebrospinal fluid. METHODS: A retrospective analysis was performed in 236 patients with unilateral vestibular schwannomas. The patients' ages ranged from 17 to 83 years (mean 53.6 +/- 13.2 years), and the diameters of the tumors the patients harbored ranged from 5 to 60 mm (mean 30.5 +/- 12.7 mm). Hydrocephalus was present before tumor resection in 33 patients (14%) and in six of these patients focal dilation of the sylvian fissures was noted. There was a significant correlation between the incidence of hydrocephalus and tumor size. The incidence of preoperative hydrocephalus among elderly patients (> or = 65 years of age) was 28.6% and that among younger patients (< 65 years of age) was 10.8%. Tumors in elderly patients with hydrocephalus (mean tumor diameter 32.8 +/- 11.7 mm; 12 patients) were significantly smaller than those in younger patients (mean tumor diameter 41.7 +/- 10.9 mm; 21 patients). Among patients with tumors smaller than 30 mm (114 patients), the incidence of hydrocephalus in elderly patients (25%) was 12-fold higher than that in younger patients (2.1%). Six patients with hydrocephalus who had focal dilation of the sylvian fissures were significantly older than 27 patients with hydrocephalus in whom there was no focal dilation. The dilated sylvian fissures collapsed in two patients spontaneously after tumor resection and in the other four patients after shunt placement. CONCLUSIONS: The incidence of associated hydrocephalus is higher in older patients. Communicating hydrocephalus tends to occur in elderly patients. Enlargement of the ventricles with focal dilation of the sylvian fissures should not be misinterpreted as physiological brain atrophy.

Adolescent↗

PubMed2003

Aneurysmal subarachnoid hemorrhage in young adults: a comparison between patients in the third and fourth decades of life.

OBJECT: Aneurysmal subarachnoid hemorrhage rarely occurs in young adults. The aim of this work was to clarify the clinical characteristics of ruptured aneurysms in young adults in the third and fourth decades of life and to compare these two age groups. METHODS: The authors retrospectively investigated 2493 patients who underwent surgical repair for ruptured cerebral aneurysms during a 14-year period (1988-2001). There were 25 patients (1%) in the third decade of life and 106 patients (4.3%) in the fourth decade. In general, favorable outcome was achieved in both groups. There were significant differences in the sizes and locations of aneurysms between the two age groups. Among patients in the fourth decade of life, the aneurysm was large and was located more often on the anterior cerebral artery. CONCLUSIONS: In this study the authors summarize the clinical characteristics of a large series of 131 young adult patients with ruptured cerebral aneurysms. Congenital factors as well as hemodynamic stress may contribute to differences in aneurysm size and location between the two age groups.

Adolescent↗

PubMed2003

Clinical application of robotic telemanipulation system in neurosurgery. Case report.

The NeuRobot is a telecontrolled microscopic micromanipulator system designed for neurosurgical procedures. The unit houses a three-dimensional endoscope and three robot arms that the surgeon operates without direct contact with the patient. The authors have successfully performed robotics-assisted neurosurgical procedures by using the NeuRobot in a 54-year-old man who had a recurrent atypical meningioma. Following the usual preparation of craniotomy and opening of the dura mater, a portion of the tumor was removed using the NeuRobot with the aid of microscopic observation. No complication related to the use of the NeuRobot was encountered and the patient's postoperative course was uneventful. Although various kinds of robots have been developed for use in neurosurgery in recent years, a robotic telemanipulation system capable of performing several surgical tasks has not previously been introduced to clinical neurosurgery. This is the first case report in which neurosurgical manipulation by a robotics system is described.

Humans↗