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The goal of this study was to investigate the relationship among immunohistochemical expression of epithelial growth factor receptor (EGFR) family proteins, p21, p27 and prognosis in patients with high-grade astrocytoma. Expression of EGFR family proteins (c-erbB-1, c-erbB-2, c-erbB-3, c-erbB-4), p21 and p27 and Ki-67 labeling index (LI) were studied in 59 samples of high-grade astrocytoma. Expression of protein levels was analyzed by immunohistochemical staining of formalin-fixed and paraffin-embedded sections. Results were analyzed in relation to age, gender and survival. Overexpression of c-erbB-1, c-erbB-2, c-erbB-3 and c-erbB-4 was found in 40 (67.8%), 17 (28.8%), 3 (5.1%) and 42 (75.0%) samples, respectively. Similarly, low expression of p21 and p27 was observed in 50 (84.8%) and 27 (45.8%) samples. Mean Ki-67 LI was 17.3 +/- 1.1. Cox multiple regression analysis showed that c-erbB-1 (Hazard rate(HR) 1.57, 95% Confidence interval (CI) 1.08-2.36; p = 0.017), c-erbB-4 (HR 1.79, 95% CI 1.20-2.74; p = 0.004) and p27 (HR 0.50, 95% CI 0.30-0.82; p = 0.006) were significantly associated with survival. High expression of c-erbB-1 and c-erbB-4 and low expression of p27 were associated with poor prognosis in these patients.

The authors report a retrospective review o f 70 patients followed up for the presence of incidental, asymptomatic meningiomas. A survey was conducted of primary intracranial tumors diagnosed in Hiroshima Prefectural Hospital between 1995 and 2004. The neuroradiological imaging and clinical studies for asymptomatic meningiomas were performed during the 57.5-month mean follow-up period. Of the asymptomatic 70 meningiomas, 34 (mean age 58.3yrs) were surgically removed just after diagnosis, whereas 36 (mean age 72.1yrs) were treated conservatively. There was no permanent morbidity. Five patients (13%) had the transient operation-related neurological morbidity, which was caused by venous congestion near eloquent area, or operative manipulation at the craniotomy. The transient morbidity in patients over 70 years was 20%, although it was 12% in patients under 70 years. Eight patients (21%) were complained of chronic pain at the wound and 5 of them had medication. In 11(30.6%) of these 36 cases treated conservatively, the tumor size increased by mean 0.24 cm/year. Three of them had operation. The tumor growth rate was 0.33 cm/year in the operative group, whereas it was 0.09 cm/year in the conservative group. Histological grading of 3 cases revealed WHO grade I meningiomas. The absence of calcification and high intensity on T2 weighted-imaging were significantly associated with the higher growth rate (p<0.05). We should decide the strategy for treatment, paying attention to the radiological features, the tumor growth rate, age and operative difficulty. In addition that, we should keep in mind that over 20% patients were suffered from postoperative painful wound.

The authors evaluated various clinical courses of ruptured infectious cerebral aneurysms associated with infective endocarditis in 4 patients. The first case: A 60-year-old male, who had a large hematoma resulting from rupture of a distal anterior cerebral artery aneurysm at the left frontal lobe co-existing with cerebral infarction at the right temporo-occipital lobe, with complications of renal and liver embolisms and pyogenic spondylitis, was treated with antibiotic therapy. However, he died of rupture of another newly formed aneurysm 29 days after onset. The second case: A 71-year-old female presented cerebral infarction in the right occipital lobe at onset. Two days later, abrupt occurrence of a large hematoma at the left parietal lobe led to deterioration of her consciousness. She underwent emergent evacuation of a large hematoma containing the infectious cerebral aneurysm proven histologically afterwards. The third patient: A 49-year-old female was suffered from a large hematoma and subdural hematoma accompanied distal posterior cerebral artery aneurysm at the right occipital lobe. She was operated by removal of the hematoma and the aneurysm proven as a bacterial infectious aneurysm. The fourth patient: A 71-year-old female had hemiplegia caused by a brain abscess and cerebral hemorrhage in the right temporal lobe and a distal middle cerebral artery aneurysm adjacent to the same region. Trapping of the aneurysm was undertaken and clinical course was uneventful. Attention needs to be paid to the various cerebrovascular condition arising from the bacterial embolus of infective endocarditis.

The authors present a case of a subependymal giant cell astrocytoma (SGCA) not associated with tuberous sclerosis. On admission, a six-year-old boy had obstructive hydrocephalus caused by a huge intraventricular tumor. Preoperative T1-weighted MR images with gadolinium showed heterogeneous enhancement of the lesion. The tumor was totally removed through a right transcortical approach with frontal craniotomy. Immunohistochemical staining for glial fibrillary acidic protein (GFAP) showed a positive reaction in some of the large tumor cells and the labeling index of MIB-1 was < 1.0%. Histological examinations revealed SGCA. He has no other evidence of tuberous sclerosis at present, but the patient in this case is an infant, so there is a possibility of his being diagnosed as tuberous sclerosis in the future. Therefore, systemic regular follow-up is recommended, even when his condition is asymptomatic.