Search

We report a case of lumbar spinal synovial cyst located on the midline. A 72-year-old man was admitted to our hospital with the chief complaint of low back pain radiating to the left buttock and posterior thigh. An MR image revealed an extradural cystic lesion adjacent to the dorsal side of the dural sac at the L4-5 level. The cyst was remote from the facet joints and existed on the midline just in front of the L4 lamina. A CT scan showed a concave deformity of the ventral aspect of the L4 lamina because of compression by the cyst. The patient underwent L4 laminectomy and total removal of the cyst. The cyst was in contact with the anterior surface of the ligamentum flavum and it had no connection with the facet joint. In the histological examination, the cyst was multilobular and lined with synovial epithelium. Therefore the cyst was diagnosed as a synovial cyst. After the operation, the pain radiating to the buttock and thigh completely disappeared. Intraspinal synovial cysts are usually located in the lower lumbar spine and most of them are adjacent to the facet joint. The cysts that are located on the midline are very rare. We review previous reports and discuss clinical and pathological features of spinal synovial cysts.

We report a 36-year-old man with proximal dominant muscle weakness, thymic tumor, diabetes mellitus, hypokalemia, and increased levels of plasma ACTH and cortisol. The diagnosis of carcinoid tumor was made on the basis of pathological findings in the biopsied specimen of the thymic tumor. The proximal muscle weakness was considered to be due to steroid myopathy resulting from the overproduction of cortisol from the adrenal glands induced by the ectopic ACTH secreted by the thymic carcinoid tumor. Although thymoma in frequently associated with myasthenia gravis, we should also consider carcinoid tumors in patients with a thymic tumor presenting with a proximal muscle weakness.

The effects of photic stimulation on the visual cortex of human brain were studied by means of gradient-echo magnetic resonance imaging (MRI). Fast low-angle shot (FLASH) MRI was used to monitor changes in brain oxygenation in the human visual cortex during photic stimulation (PS). Whole-body 1.5 T clinical MR system was used. Elevation of image intensity up to 2% was observed in primary and associative visual cortex, corresponding to an increase of blood oxygenation in regions of increased neural activity. After the PS was switched off, the MR signal fell below the pre-PS baseline level, which may be understood as an displacement of the oxygen-hemoglobin dissociation curve (the Bohre effect).

Nineteen cases of primary malignant lymphoma of the central nervous system were reported. The clinical characteristics, diagnostic procedure and therapeutic method, especially concerning chemotherapy, were analysed. The following conclusions were obtained: 1) histological classifications and surgical procedures were not factors involved in prognosis. 2) radiotherapy was regarded as an effective but a palliative treatment. 3) combined chemotherapy for systemic malignant lymphoma, such as VEMP, VEP, COPP, seemed to be of little use for intracranial malignant lymphoma. 4) intra-arterial administration of high-dose methotrexate, ACNU and intravenous administration of high-dose cytosine arabinoside can be expected to be a useful chemotherapeutic approach.

In operation for gliomas, it is our principle to remove extensively by sucker dissection technique. But, in many cases, we cannot achieve total removal because of invasion of tumor cells into the deep or vital structure. Postoperatively we apply irradiation, chemotherapy and immunotherapy in every cases. Even after multimodality treatment, recurrence may be inevitable. In order to check the recurrence as early as possible, we took follow-up CT scan regularly. When the recurrence appeared on CT scan, we actively performed reoperation. In this paper, we present characteristics of follow-up CT scan and result of the reoperation. Since introduction of CT scan in 1977, we have followed 30 supratentorial malignant gliomas and 16 supratentorial low grade gliomas postoperatively. CT scan was taken in every three months to check the course of contrast enhancement. After removal of the tumor, round low density area appeared on CT scan showing residual cavity. By contrast enhancement, various shape of high density area were seen. We divide the postoperative CT scan in 4 types by mode of contrast enhancement. In the type 1, enhanced area was persistent around the low density area. In the type 2, enhanced area was present around the low density area just after operation, but gradually disappeared. In the type 3, no enhanced area was present. In the type 4, dissemination occurring late after operation. Among the malignant gliomas, 12 cases belonged to the type 1, 6 cases to the type 2, 10 cases to the type 3, and 2 cases to the type 4. Among the low grade gliomas, 3 cases belonged to the type 1, 2 cases to the type 2, and 9 cases to the type 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Among the causes of precocious puberty, hypothalamic hamartoma comprises a small percentage. However, the frequency of precocious puberty in the presence of hypothalamic hamartoma is quite high. Recently, results of surgery in 14 cases of hypothalamic hamartoma were reported. Precocious puberty completely subsided in three cases and slight improvement was achieved in another three cases. We performed surgery in four patients with hypothalamic hamartomas, with the goal of decreasing the symptoms of precocious puberty. The patients were two females (aged 1 yr, 3 mo and 6 mo) and two males (aged 3 yr, 7 mo and 1 yr, 9 mo). The main symptoms were precocious puberty and mental retardation of varying degrees. The males had excessive growth of body and external genitalia, while the females had genital bleeding and premature breast development. In each case, computed tomographic scans disclosed a round, isodense mass in the interpeduncular cistern, attached to the base of the hypothalamus. Contrast enhancement was negative. Endocrinologically, in case 1, testosterone was 92.6 ng/ml, FSH was 16 mIU/ml, and LH was 2.2 mIU/ml. Although LH was within normal limits, it overresponded to LH-RH stimulation. In case 2, estrogen was 13.5 ng/day, LH was 5.2 mIU/ml, FSH was 5.3 mIU/ml, and LH showed an exaggerated response to LH-RH stimulation. In case 3, testosterone was 362 ng/ml, LH was 8.8 mIU/ml, FSH was 4.8 mIU/ml, and LH showed an abnormally high response to LH-RH stimulation. In case 4, LH was 18.4 mIU/ml, FSH was 12.0 mIU/ml, and both hormones were stimulated abnormally strongly by LH-RH.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors report a case of epidermoid tumor of the lateral ventricle. Epidermoid tumors are relatively uncommon intracranial lesions and the one situated in the lateral ventricle has not been reported in this country. A 42 year old house wife was admitted to Asahi Central Hospital on February 14, 1973, complaining of progressive right hemiparesis for 2 years. The patient had no headache and no other symptoms of increased intracranial pressure. Neurological examination revealed disorientation, dyscalculia, amnestic aphasia, morter dysphasia, right facial paresis (central type) and right hemiparesis. The laboratory findings, which included complete blood count, serum electrolytes, urinalysis, electrocardiogram and blood Wassermann, were normal. Initial pressure of the spinal tap was 410 mmH2O and crystal clear CSF was obtained. tplain craniogram showed no calcification and was normal. The left CAG showed clearly the signs of the temporal lobe tumor (Fig. 1, 2, 3, 4.), but showed no early veins and no tumor stains. The brain scintigram was normal. A left temporo-parietooccipital craniotomy was performed. The epidural Echogram (horizontal section-Fig. 5, coronall section-Fig. 6) revealed the clear demarcated, multicystic round tumor in the inferior horn of the left lateral ventricle. After the whitesoap like tumor was totaly removed, the all interior surface of the left inferior horn of the lateral ventricle was seen (Fig. 8). Tumor was 5.5 cm in diameter and 50 g in weight. Histological findings of the tumor showed typical epidermoid (Fig. 9, 10). The origin of the intravetricular epidermoids and the usefulness of echo-encephalorgaphy were briefly discussed.

A 36-year-old male with jugular foramen neurinoma was operated upon using a rotatable head holder, which enables the surgeon to rotate the patient's head at any time during the procedure and to gain access in multiple directions to the tumor. The tumor was situated primarily in the jugular foramen and showed partial extension into intracranial as well as into extracranial space. The patient was placed in the lateral position with a rotatable head holder, which allows rotation of the patient's head with the range of 10 degrees face up to 80 degrees face down from the horizontal plane. A linear skin incision was made, beginning behind the auricle and extending along the anterior margin of the sternocleidomastoid muscle, and the sternocleidomastoid muscle was divided just below the tip of the mastoid process. During mastoidectomy and suboccipital craniectomy, the patient's head was rotated 15 degrees face down and sigmoid sinus was exposed toward the jugular foramen, meanwhile the posterior fossa dura mater was opened and the intracranial portion of the tumor was removed with the head positioned 45 degrees-60 degrees face down. The patient's head is then turned 30 degrees face down and the facial canal was opened to displace the facial nerve forward. This oblique posterior approach minimized facial nerve displacement and provided excellent exposure of the large tumor rest which was situated mainly in the jugular foramen and partly extended extracranially. The rotatable head holder allows excellent access in multiple directions and is very helpful in approaching to jugular foramen neurinomas which grow primarily in the jugular foramen and extend both into intra- and extracranially.

It is interesting to note the pathological findings that the rupture of multiple microaneurysms in the basal ganglia appears to be the cause of the hypertensive intracerebral hematoma. But there is few report that the carotid angiogram demonstrated multiple leakages of contrast medium of intracerebral hematoma in vivo than in Westberg's postmortem angiogram. The authors experienced 15 cases of hypertensive intracerebral hematoma whose cerebral angiogram showed extravasation of contrast material. It was fifty-seven per cent of which angiogram within 6 hours after the stroke showed leakage of contrast medium. However, there was remarkably decreased appearance of the extravasation after 9 hours after the stroke. Moreover, emphasis showed be placed upon the facts that eleven cases of 15 cases showed more than two adjacent spotty extravasations of contrast medium and that six cases demonstrated the simultaneous multiple leakages of contrast material from more than two lentriculostriate arteries. These angiographic findings has led us to the conclusion that there is intimate correlation between the large hematoma and multiple ruptures of the microaneurysms of lentriculostriate arteries.

31phosphorus nuclear magnetic resonance (31P-NMR) measurements have provided new and valuable insights for studying the metabolism of living systems. The aim of this paper is to introduce a technique of application of 31P-NMR measurements using a surface coil method, and to discuss the effects of halothane anesthesia and hypoxic hypoxia on the energetic metabolism of intact rat brains. All measurements were made using a JEOL FX 270 spectrometer with a super conducting magnet of 54-mm bore diameter. The magnetic field intensity of this machine is 6.3 tesla, and the resonance frequency used for 31P was 109.14 MHz. We remodelled an ordinary probe to take a live rat, and the animals were made to inhale anesthetic halothane or mixture of oxygen and nitrogen at various concentrations controlled by a flow regulator. The best conditions for measurements with our surface coil method were determined in this study as follows: (1) 90 degrees pulse width and selectivity, Fig. 1 shows signal selectivity in depthwise direction changed with 90 degrees pulse width, which was set to 20 microseconds. (2) Sensitivity and resolution; To obtain a spectrum of 31P-NMR from a rat brain 500 accumulations of free induction decays were considered suitable for both time and space resolution. Fig. 2 shows variations of signal intensity with pulse repetition time, which was set to 2 sec. It took about 17 min for averaging to get a spectrogram. (3) Quantitative accuracy and qualification; As shown in Fig. 3, a linear relationship was found between the signal intensity of beta-phosphate of ATP and the concentration of ATP solutions, thus proving the quantitative accuracy of our systems.(ABSTRACT TRUNCATED AT 250 WORDS)

A 48-year-old man had his left eye ball enucleated by fingers of an assailant. The optic nerve, measuring 4 cm in length, was attached to the enucleated eye ball, but there was neither a wound in his eyelids nor cerebrospinal fluid leakage from inside the orbit. He was confused, but responsive and was able to recognize other persons with his right eye. His right-eye vision deteriorated within 24 hours and was almost totally lost for about one month. Three months after the trauma his vision recovered to 0.1, but his visual field showed severe concentric narrowing. An emergency CT on admission showed a small subarachnoid hemorrhage in the suprasellar cistern, and follow-up CT scanning on day 7 demonstrated a small infarction in the left globus pallidus and putamen. Cerebral angiography performed on day 17 showed residual vasospasm of the horizontal portion of left anterior cerebral artery. Left ophthalmic artery was patent and there was no aneurysm formation either on the intracranial or on the intraorbital arteries. Literature review yielded only three cases of eye ball enucleation by an assailant. Intracranial complications reported in the literature, including those associated with eye ball enucleation caused by other mechanisms, are; contralateral visual field defect: seven cases, hypothalamic involvement: two cases, subarachnoid hemorrhage: two cases, cerebrospinal fluid leakage: one case, and meningitis: one case. The optic nerve, from just behind the eye ball to the chiasm, is reported to be 40-50 mm long, and eye ball enucleation with the optic nerve measuring 4 cm or more is quite likely to cause intracranial complications such as are cited above.

Growth factors contained in cultured medium of rat glioma C6 cells (C6 cells) were examined mainly for the activity of transforming growth factors (TGFs). Cultured medium of C6 cells was dialyzed against acetic acid, lyophilized and chromatographed by gel-permeation method, the fractions were assayed by soft agar colony formation, iodine 125 (125I)-epidermal growth factor (EGF)-binding competition and incorporation of tritium-thymidine. Two nontransformed cell lines, clonal NRK49F and BALB/3T3 A 31-1-1 (3T3) cells, were used as indicator cells for the soft agar colony assay. 3T3 cells were also used for the incorporation of tritium-thymidine. EGF receptor-rich A 431 cells were used for 125I-EGF-binding competition assay. The activity of alpha-type TGFs was examined by soft agar colony formation of NRK49F cells and inhibition of EGF-binding to A 431 cells since TGF alpha has sequence homology with EGF and binds to EGF receptors on the cell membrane, while the activity of beta-type TGFs was examined by soft agar colony formation of 3T3 cells and NRK 49 F cells with the addition of EGF. High level of activities of both TGF alpha and TGF beta were detected in 14,000 to 45,000 daltons, and also high level of the activity of DNA synthesis was detected at the same molecular weight. These results suggest that C6 cells produce TGF alpha and TGF beta as well as platelet-derived growth factors (PDGFs)-analogue. Since amplification of EGF receptor gene has been demonstrated in glioma, TGF alpha released by glioma may provide autocrine stimulation through the binding to the amplified EGF receptors. TGF beta is known to increase EGF receptors on the cell membrane. TGF beta has been demonstrated not only to stimulate but also inhibit cell proliferation under certain circumstances.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors have developed a simplified technique of lumbar subarachnoid peritoneal shunt in which the spinal tube is easily introduced through a puncture needle without doing a laminectomy. Seventeen cases of communicating hydrocephalus of various orgin have been treated by this procedure. In this paper, we reported our shunting system and the technique of precedures, and discussed the clinical results and some advantages of this method. The spinal tube is a custom made Silastic tube with small side holes 2 mm apart from each other at slanting tip located within the first 1.0 cm of the end. French No. 5 tube is available for older children and for adults, and French No. 3.6 tube for infants. Total length of the tube measures 30 cm with 4 black markers at 5 cm intervals from the tip for assisting in positioning. The puncture needle is a modified Touhey needle. Two needles different in size are prepared according to the size of the tube. Outer diameter of these needles is 2.1 mn & 1.8 mn. Our operative procedures are divided into following three steps. 1) Puncture of the lumbar subarachnoid space and insertion of the spinal tube through the needle. 2) Introduction and placement of the peritoneal tube into some point of the peritoneal cavity. Concerning to this point, we have the three candidates, namely into the Douglas pouch, the suprahepatic space, and the bursa omental cavity. 3) Connection of the spinal tube and the peritoneal catheter end. We used a kind of flushing device only in some exceptional cases, and recently, we feel that it is not so necessary for this shunting. We have employed this technique in a total of 17 cases. Eleven cases of them are adults and the other 6 cases are children less than 2 years of age. Postoperative follow up period varied from 13 months to 1 month, and all the cases except two had good result, suggesting the shunt system is working well with no evidence of complications such as low pressure syndrome or radicular irritation. Some troubles occurred in two children. One was a disconnection between the spinal and the peritoneal tube, and the other was an obstruction at the peritoneal tube end. The authors believe that our L-P shunt has several advantages as listed below, 1)Procedure is very simple, in other words, there is no need of laminectomy. 2) The entire system is short. 3) No need to pass the catheter into the brain tissue. 4) Obstruction of the spinal catheter end is very unusual. 5) Alteration of communicating hydrocepalus into non communicating one by secondary obstruction of aqueduct of Sylvius is less likely with this shunting system. 6) Siphon effect might be minimal, if present. 7) As compared to V-A shunt, severe complication like septicemia will not occur in the L-P shunt. With this simple method and good material, we hope that this L-P shunt is employed more widely for the patients with communicating hydrocephalus.

The authors reported a case with unilateral proptosis of over ten years' duration due to organized hematoma of the orbit. It has generally been accepted that any given hemorrhage within the orbit can be resolved in a relatively short period of time. Persistent intraorbital hematoma, therefore, in the form of organized hematoma is very unusual in incidence and has been reported very few in the literature. Our patient presented himself with a ten-and-several-year history of unilateral exophthalmos, limited ocular movement and decreased visual acuity on the involved side. There was no specific symptom when compared with the other intraorbital tumors. Total resection of the tumor was performed through transcranial frontozygomatic approach. Histopathologic examination revealed evidence of organized hematoma without definite sources of bleeding such as microangioma, microaneurysm or arteriovenous malformation. Retrospective review of history failed to uncover episodes of hemorrhagic tendency or direct trauma to the head or the orbit. Subsequently a diagnosis of spontaneous organized hematoma was made. Great emphasis was laid on the fact that CT-scan was one of the most useful diagnostic tools. Our surgical approach was introduced and discussed.

Chemotherapy was applied for experimental subarachnoid dissemination model of brain tumor which was established in male Wister-SPF (SLC) rats inoculated intracisternally with 2 X 10(5) C6 rat glioma cells. Nontreated animals died about 24 days after inoculation. Autopsy findings of the animals showed localized or multifocal invasion of the tumor on leptomeninges in cisterna magna, and partially infiltration into the parenchyma of the cerebellum and medulla oblongata. Three days after inoculation, the tumor deposition and proliferation already occurred. Several tumor cell layers were found in the subarachnoid space over the cerebellomedullary surface. Tumor bearing animals were at first treated by single agent. These are ACNU administered intraperitoneally, methotrexate administered intracisternally, and OK-432 administered intraperitoneally. In the next stage, combination of these drugs was applied. ACNU, 3 mg/kg i. p., on Day 3, was effective in elongation of median survival time by 23.6%, statistically significant (P less than 0.02). Methotrexate, 0.25 mg/kg i.th., on Day 3, was also effective in elongation of median survival time by 8.4%, statistically significant (P less than 0.05). OK-432, 0.1 KE/kg i. p., daily, 14 times, from Day 3 to Day 16, was ineffective in elongation of median survival time. Combination of ACNU, methotrexate and OK-432, in the same schedule as described above, produced the longest median survival time of 42.4%, statistically significant (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

We have established the rabbit brain tumor model. The domestic rabbits (Japanese White) inplanted the VX2 rabbit epidermoid carcinoma cell were died within three weeks after the inplantation. These brains showed massive brain tumor remarkably infiltrating into the surrounding brain. The flowcytometry of intracerebral VX2 tumor revealed a monopeak at the 2C and relatively large amount of S-phase cells. We think that this brain tumor model is more convenient for the combination treatment with operation and chemotherapy, because the rabbit brain is larger and intravenous injection is more easy than the rat or mouse.

A case of astroblastoma in a male newborn baby was reported. He has been suffered from convulsive seizures from six hours later after the birth, not controlled by the anticonvulsants, and lumbar tap revealed bloody cerebrospinal fluid. He had no response against the noxious stimuli and left clonic hemiconvulsion, and showed anisocoria, left pupil was dilated. Right BAG showed a large space occupying lesion in the right frontal lobe. Operation was performed eighteen hours after the birth. Right frontotemporal craniotomy revealed reddish-grey, soft tumor in the right frontal lobe infiltrating into the parietal and temporal lobe of the same side and frontal lobe of the left side. Right frontal lobectomy was performed. He had cardiac arrhythmia after the operation and died next day. Autopsy was not permitted. Histologically tumor tissue showed abundant vessels and perivascular pseudorosettes, and electron micrograph revealed glial filaments in the tumor cells. Histological diagnosis was astroblastoma.

Permeability of the blood-brain barrier (BBB) of methylmercury chloride (MMC) intoxicated rat brain was studied in vivo by gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) enhanced magnetic resonance imaging (MRI), measuring the longitudinal relaxation time (T1) and the transverse relaxation time (T2). MMC intoxicated rat brain showed the prolonged T1 in the cerebral white matter and prolonged T2 in the cerebellar cortex. After Gd-DTPA administration, T1 of cerebral and cerebellar white matter shortened from 1.647 to 1.344 sec., and 1.290 to 1.223 sec. respectively. On the contrary, T2 showed no change after Gd-DTPA injection. It was concluded that, although the shortening of T1 after Gd-DTPA enhancement was rather little when compared with experimental brain ischemia, the shortening of the relaxation time of the MMC intoxicated rat brain was caused by the increased permeability of BBB.

A case of alpha-fetoprotein (AFP) producing primary intracranial embryonal carcinoma was reported with special reference to the chemotherapy. The patient was a 14-year-old male who had suffered from vomiting and disturbance of consciousness. CT scan revealed a tumor originating in the anterior part of the third ventricle and expanding into both lateral ventricles. Right frontotemporal craniotomy was performed and the tumor was totally removed under the microscope. The histological diagnosis was embryonal carcinoma. Inspite of the elevated amount of AFP in the serum, we could not verify the yolk sac element in the surgical specimen. Three months later, he became drowsy and another CT scan revealed recurrence of the tumor. Ommaya's reservoir was placed and CSF was drained to control the intracranial hypertension. But the disturbance of consciousness did not improve. We then started a combination chemotherapy with cis-platinum, vinblastine and bleomycin. Cis-platinum was given in a dosage of 20 mg/m2 body surface area as a 15 min. intravenous infusion for 5 consecutive days every 3 weeks for three courses. Vinblastine was given in a dosage of 0.4 mg/kg body weight intravenously for 2 consecutive days every 3 weeks for three courses. Bleomycin was given in a dosage of 30 mg intravenously 6 hours after vinblastine weekly for a total of 12 weeks. The AFP level of the serum and CSF was monitored every several days. After the chemotherapy, the AFP level of the serum and CSF decreased. Repeated CT scan revealed no evidence of tumor. His clinical condition improved remarkably. Toxicity was vomiting, proteinuria and leukopenia, but not so severe. Proteinuria continued after the chemotherapy, but BUN and creatinine did not elevate. It was emphasized that the combination chemotherapy with cis-platinum, vinblastine and bleomycin is effective remission-induction treatment for AFP producing primary intracranial embryonal carcinoma.