Prof. Jun MUTOJapan
Fujita Health University
2002/Nov to present | Associate Professor, Fujita Health University, Department of Neurosurgery, Nagoya Japan, Associate professor. Aichi, JAPAN |
2018/Jun - 2022/Oct | Assistant professor Fujita Health University, Department of Neurosurgery, Nagoya Japan, Senior. Aichi, JAPAN |
2005 - 2009 | Assistant professor, Department of Neurosurgery KEIO university, School of Medicine, Tokyo, JAPAN |
2012 - 2016 | Postdoctoral fellow, The Ohio state university, Department of neurological surgery, Ohio USA |
2016 - 2017 | Clinical fellow,Service de Neurochirurgie, Centre Hospitalier Sainte-Anne, Paris Descartes University, Sorbonne Paris Cité, Paris, France |
Skull base surgery, Endoscope surgery, Neuroonocological surgery, Brain tumors
Dr Jun MUTO is Associate Professor of Neurosurgery at Fujita Health University, in Aichi Japan.
His clinical expertise harnesses multimodality techniques to treat brain tumors especially skull base and hypothalamic-pituitary pathologies.In addition, he leads a research team focusing on the translational biology of genetics of brain tumors, fluorescence surgery and robotic neurosurgery.
From 2005 to 2012, he received skull base training under Dr Takeshi Kawase at Keio University, from 2012 to 2016, he received endoscope training under Dr Daniel Prevedello at The Ohio State University, from 2016 to 2017, he received brain tumors training under Dr Johan Pallud at Sainte-Anne Hospital, and since 2018, he has been receiving brain tumors training under Dr Yuichi Hirose at Fujita Health University."
He has works as Board member of WFNS skull base committee since 2022, and Board member of WFNS education and training committee since 2024, and Board member of organizing committee in Japanese Congress of Neurological Surgeons, since 2024.
Transoral robotic neurosurgery for skull base surgery: Surgical description of a cadaveric study
1109 16:45-16:55
Skull Base/304A
Introduction
he application of endoscopic surgery through the nasal and oral routes for lesions in the nasopharynx and posterior cranial fossa skull base is expanding, but it remains challenging. In this study, using the Da Vinci Xi system, we approached the skull base region transorally and the vascular region via craniotomy, and evaluated the advantages and challenges of robot-assisted surgery in suturing.
Method
Using nine cadavers, we performed robot-assisted transoral skull base surgery and craniotomy vascular anastomosis surgery with the Da Vinci Xi system. Observations were also made via a transnasal endoscope. For the arms, we used Black Diamond, and Potts scissors were used for cutting.
Results
A retractor was used to create a corridor by incising the soft palate. A 1 cm² dural defect was created at both the anterior cranial fossa and clivus. The dural defects were closed using deep sutures with 7-0 Prolene and fascia lata. The closure involved 8-10 sutures around the circumference. Although suturing and passing the needle in a confined space required skill in navigating vertically, horizontally, and laterally, the sutures were completed without issues. The lack of tactile feedback, a potential disadvantage, can be partially overcome with experience. Additionally, a craniotomy was performed, the Sylvian fissure was split, and an end-to-side anastomosis was conducted between the harvested radial artery and the internal carotid artery, as well as between the radial artery and the middle cerebral artery, using 7-0 Prolene. Each side was sutured with 4-5 stitches.
Conclusions
Using existing tools and the Da Vinci Xi system, we were able to confirm the feasibility of deep dural suturing and superficial vascular anastomosis and show novel approach to be feasible for lesions from the sellar to C2 in the sagittal plane and foramen ovale in the coronal plane. Although the lack of tactile feedback is a disadvantage, we believe that it can be partially overcome with experience. Further discussion is needed regarding the optimal techniques for robotic surgery in the future.
New developments in intraoperative fluorescence imaging using the delayed window ICG technique (DWIG) with an exoscope
1109 16:55-17:05
Skull Base/304A
Introduction
We have previously reported the usefulness of intraoperative fluorescence imaging using indocyanine green (ICG) in metastatic brain tumors, meningiomas, spinal schwannomas, and pituitary adenomas. We have been utilizing the second window ICG technique (SWIG), where ICG is administered the day before surgery. However, by improving the dosage and timing of administration, we developed the Delayed Window ICG Technique (DWIG). This report presents the results of intraoperative fluorescence imaging using DWIG with an exoscope.
Methods
The subjects were 36 cases registered in a clinical study since August 2019, in which an exoscope was used during surgery. The breakdown included 18 cases of meningiomas, 3 cases of schwannoma 6 cases of gliomas, and 9 cases of metastatic brain tumors. In the SWIG technique, 5 mg/kg of ICG was administered over 1 hour before surgery, while in the DWIG technique, 0.5 mg/kg of ICG was administered at least 1 hour before intraoperative observation. For near-infrared irradiation and observation, KINEVO 900 (Carl Zeiss) was used in 21 cases, ORBEYE (Olympus) in 4 cases, and Iridium (Visionsense) in 11 cases.
Result
The Signal Background Ratio (SBR), which represents the ratio of fluorescence emission between the tumor and normal brain parenchyma, was 3.4 ± 1.9. Observation in the near-infrared field provided a clearer view of the tumor localization than overlaying it on the bright field. There was no significant difference in fluorescence values between the SWIG and DWIG administration methods. There was also no significant difference in fluorescence values between tumor types. In five cases, tumor fluorescence emission could not be confirmed. In cases of total resection, no contrast-enhancing lesions were observed on postoperative MRI. No perioperative complications related to ICG administration were observed.
Discussion
Advantages of the ORBEYE include the brightness of the 5-ALA and ICG fluorescence and the small size of the scope. However, it is important to note that the ICG fluorescence is so strong that the entire field can appear bright, leading to a higher likelihood of false positives. Compared to a microscope, the biggest advantage is that the navigation probe can be used without moving the scope, allowing for frequent integration of positional information from navigation, fluorescence navigation, and feedback from the bright field during surgery.
Conclusions
Fluorescence navigation using intraoperative fluorescence imaging with the Delayed Window ICG Technique via an exoscope allows real-time confirmation of tumor localization during resection and is useful for tumor removal.