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Pineal parenchymal cell tumors (PPCTs) with or without metastasis into the lumbar region by way of the cerebrospinal fluid were treated successfully with combination chemotherapy using cisplatin, vinblastin, and bleomycin (PVB) or cisplatin and vinblastin (PV) and low-dose irradiation (25 approximately 30 Gy). Our series included a case of pineoblastoma, two cases of mixed pinocytoma/pineoblastoma, and a case of pineocytoma, compared to which the data held by the All Japan Brain Tumor Registry (AJBTR) included information on 47 cases pineocytoma and 20 of pineoblastoma. All our patients have survived, with scores of 90% or over on Karnofsky's performance scale, for 2-12 years of follow-up so far; however, the 5-year survival rates of the patients recorded by AJBTR were 83% for pineocytoma treated with radiation and 43% without radiation; and 42% for pineoblastoma treated with radiation and 50% without radiation. Incomplete or varied chemotherapeutic regimens used in different medical centers to treat PPCTs precluded an evaluation such as was made by AJBTR. Our results suggested that combination chemotherapy with low-dose back-up radiotherapy may be the treatment of choice for primary or recurrent disease with or without dissemination in PPCTs.

Congenital hydrocephalus was induced by intraperitoneal administration of antipregnant rat kidney serum (APRKS) into rats at 9 days of pregnancy. To clarify a correlation between the oncogenes and expression of hydrocephalus, immunostaining of the fetal rat nervous system for p53 was carried out using Ab-1, a pantropic antirat p53 antibody, and Ab-3, raised against a mutant form of rat p53, Ab-1 staining was observed in cells of the neural plate of the fetus, the yolk sac, and the placenta. Because no staining occurred with Ab-3, it was likely that the p53 induced by antiserum injection was the wild-type protein. This result indicated that p53 may represent a reparative reaction to DNA damage from the APRKS; also, when DNA is irreparably damaged, p53 could induce apoptosis by favoring transcription of a gene encoding an inducet of apoptosis. Insufficient apoptosis, on the other hand, may induce failure of fetal development, contributing in particular to congenital hydrocephalus and other central nervous system anomalies.

We report a case of Rathke's cleft cyst associated with cholesterin granuloma in an 8-year-old girl with apoplexy. She was admitted to our hospital in April 1996 because of repeated headache and deep ophthalmic pain, without any visual disturbance. Computed tomography (CT) of the pituitary demonstrated an intrasellar isodense mass extending to the suprasellar cistern. Magnetic resonance imaging (MRI) showed a high-intensity mass on both T1- and T2-weighted images. The preoperative diagnosis of this lesion was Rathke's cleft cyst associated with a craniopharyngioma and/or hemorrhage. Transsphenoidal microsurgery was performed, and a bloody coffee-like serous and mucinous-yellowish substance was evacuated. Curettage of the wall removed the yellowish hard mass and soft membranous tissue. Histological examination of this tumor revealed a Rathke's cleft cyst with cholesterin granuloma.

The career of one neurosurgeon interested in pediatric neurosurgery is described, with reference to the people who influenced him and his own publications.

Since hydrocephalus is a multifactorial disease with a diverse pathogenesis, no single, truly ideal classification of its exists. Hydrocephalus has been classified from various standpoints, each classification reflecting the current level of knowledge about hydrocephalus. Hydrocephalus needs to be classified according to the purpose of the study. There are two major categories of classification of hydrocephalus: academic and practical. Untreatable hydrocephalus still occurs. We propose a practical clinical classification based on the time of onset and the etiology for use in the clinico-epidemiologic study of intractable hydrocephalus and its future management.

Venous malformations in the posterior fossa are relatively rare. Although the introduction of CT and MRI has made them easier to detect, their treatment is still controversial. Based on our experience with six patients and a review of the literature, we have tried to establish guidelines for their treatment. Since they have a benign natural course and may provide venous drainage in the posterior fossa, venous malformation found incidentally, unruptured venous malformation with nonhaemorrhagic complications, and those accompanied by small intracerebellar haematoma of less than 2 cm in diameter due to their rupture, should be treated conservatively unless they are associated with a coexistent malformation. Venous malformation with intracerebellar haematoma larger than 3 cm or reexpansion of the haematoma due to rebleeding should be treated surgically by evacuation of the haematoma. Resection of venous malformations in the posterior fossa should be restricted to cases in which the malformation is small and does not serve as a functional venous drainage route. Radiation therapy, including the "gamma-knife", may be a treatment of choice in the future.

The effects of active oxygen species in the development of congenital hydrocephalus have been investigated. Superoxide dismutase (SOD) is one of the scavengers of active oxygen species and there have been many recent reports on the relationship between neurological disorders by active oxygen species following reperfusion for ischemic brain and SOD. In this study, the localization of Cu-SOD and Zn-SOD in WIC-Hyd congenitally hydrocephalic rat brains was identified by the enzyme unlabeled antibody method. We examined the localization of SOD in the choroid plexus, hippocampus, and ependymal cells of the lateral ventricle and aqueduct of WIC-Hyd rats. SOD was hardly observed in the choroid plexus and faintly localized in the hippocampus and ependymal cells of the congenitally hydrocephalic brain, but was observed equally in the cytoplasm of the choroid plexus, hippocampus, and ependymal cells in control animals. In the hippocampus, less SOD was found in hydrocephalic rats than in controls. The SOD was slightly observed in the CA1 pyramidal cells in hydrocephalic rats. In the lateral ventricle and aqueductal ependyma, less SOD was found in hydrocephalic than in controls rats. The amount of Cu, Zn-SOD in the congenitally hydrocephalic rat brain was less than in the control, especially in the choroid plexus. Therefore, we suspect that the production of SOD is congenitally reduced in the congenitally hydrocephalic rat brain, and this may promote the impairment of the function of choroid plexus and cilia due to increased active oxygen species. The reduction of SOD in the choroid plexus, hippocampus and ependymal cells of ventricles or aqueduct may promote the development of hydrocephalus in the congenitally hydrocephalic rat.

In the natural history of infantile extracerebral fluid collections, subarachnoid fluid collection itself is regarded as a benign lesion, and surgical treatment is not indicated. As this condition is age-related and self-limiting, spontaneous resolution can be expected in most cases by 2-3 years of age. However, out of 20 cases of infantile subarachnoid fluid collection in an 8-year period, 3 infants developed subdural hematoma. Infantile subarachnoid fluid collection seems to be prone to complicate subdural hematoma. Surgical treatment should be considered when subarachnoid fluid collection is complicated by subdural hematoma due to arachnoid ruptures or tearing of the bridging veins. Therefore, all patients should be observed closely and measures should be taken to prevent head trauma since it may precipitate subdural hematoma.

A rare case of multiple cavernous angiomas with repeated hemorrhages in a 9-month-old male infant is presented, together with sequential computed tomography (CT) and magnetic resonance (MR) images. The infant underwent hematoma evacuation for left cerebellar hemorrhage, and his postoperative course was uneventful. The multiple cavernous angiomas receded gradually without any treatment except the hematoma evacuation. Two years following presentation, he continues to do well. To the authors' knowledge, this is the first report of multiple cavernous angiomas with brain stem involvement in an infant.

This paper attempts to summarize and statistically analyze 2,361 pediatric brain tumors out of a total of 20,192 human brain tumors from about 250 institutes in Japan during the period 1969-1978 in order to obtain an idea of their incidence and results of treatment. This report uses the classification and nomenclature adopted by UICC (Unio Internationalis Contra Cancrum) in 1965. Survival rate was computed as relative survival rate by the method reported by Cutler in 1964 [3]. Interestingly, germinomas (7.8%) are still frequent tumors in Japan. Astrocytoma (19.7%), medulloblastoma (16.6%), craniopharyngioma (12.5%), germinoma (7.8%) and ependymoma (6.6%) occurred in that order of frequency. Five-year survival rate of medulloblastoma was 35.7% in subtotal and 55.3% in "total" removal. Radiotherapy was an effective therapeutic adjunct for the treatment of medulloblastoma. The germinoma prognosis was good, with a 5-year survival rate of 42.4% without and 69.1% with radiation therapy, revealing radiotherapy as a statistically significant treatment. Radiotherapy, with or without shunt, is thus the treatment of choice. The survival rate of patients with craniopharyngiomas was also high, with a 5-year survival of approximately 75% in partial and 76.3% in total removal. Most of the craniopharyngiomas were treated by partial removal of the tumor, with or without radiotherapy. Patients treated with radiotherapy survived a little longer than patients without.

The occurrence of a post-traumatic epidural hematoma in two patients with long-standing "arrested" hydrocephalus is reported. There was a relatively long interval between the head injury and the onset of symptoms. The large hematoma was accommodated by the decrease in size of the markedly dilated ventricles. This report stresses the possibility of the presence of an epidural hematoma in the management of head injury in patients with long-standing "arrested" hydrocephalus.