Cell transplantation therapy has been developed recently. To recover the function lost in various neurological disorders, reconstruction of the neural network is crucial. The authors overviewed the present state of cell transplantation therapy and unsolved problems. Parkinson disease is a main target of this transplantation therapy because the background of the disorder is quite simple (loss of mesencephalic dopamine neurons). Various kinds of donor tissue for Parkinson disease are discussed. Recent development of stem cell transplantation is also described. Stems cells have totipotent and self-renewal ability, which are quite important as donor tissue. Critical issues to be solved in stem cell transplantation are described.

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Lumbar stenosis is a very frequent condition among the elderly, which inflicting serious disturbances in locomotion and the general well-being of the patients. From 1992 to 2000, we have performed surgery on 321 cases of lumbar spine diseases, which included 180 lumbar stenosis. Our primary method used in this period was fenestration, which preserves the lamina, spinous process, facets, interspinous and the supraspinous ligaments. The technique allows selective and effective decompression of the common dural sac and the individual root sleeves in the foramen. Long-term outcome was assessed using questionnaires and interview of the patients. One hundred and thirty-five patients had a postoperative follow-up longer than 2 years (2 to 8 years 11 months, with a mean of 3 years and 11 ± 2 months). Seventy-four percent of the patients undergoing fenestration reported markedly improved status of the walking capacity, and 94.1% expressed overall satisfaction with the results. This less invasive method of surgery yields reliable alleviation of the neurological function and ADL. The symptomatology, anatomical concept/classification, radiological findings, indication, techniques and results of surgical treatment are summarized.

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We reviewed 70 arteriovenous malformations (AVMs) treated with embolization over 5 years and investigated the treatment strategies for virtual AVMs simulating various types and situations with a quetionnaire sent to 17 affiliated hospitals. Of 70 patients with AVMs, 14 underwent postembolization surgical removal, and 47 underwent radiosurgery. Four patients were cured with total occlusion of their AVM by embolization alone. 61 patients achieved a more than 70% occlusion of the nidus. We observed 12 complications including 3 permanent and 9 temporary. Based on these data, we created the chart of treatment strategy for AVMs. There is an absolute indication of embolization for large, high flow AVMs as well as possible bleeding sourses such as intranidal or feeder aneurysms. Deep-seated feeders must be embolized presurgically along with fistulous or high-flow feeders, and fistulous and meningeal feeders should be treated before radiosurgery. The nidus must be packed with embolic materials with no risk of recanalization. The responses to a questionnaire revealed the tendency of less aggressive surgical extirpation for difficult AVMs, and more dependence on radiosurgery with or without embolization. The general strategy with more than 70% of consensus was following three: 1) radiosurgery for small AVM without bleeding, 2) embolization plus radiosurgery for large AVM with ischemic events, and for large, eloquent one and deep-seated one with minor hemorrhage, 3) surgical removal for small, middle-sized AVM with large hematoma except for middle-sized eloquent and deep-seated ones. Although the improvements in radiosurgery may narrow the indication of embolization, it still plays an important role for high grade AVMs by enhancing the effectiveness of the secondary treatment. The inidicaiton of embolization should be decided taking various factors about the angioarchitecture of AVMs as well as the patients' situations into considerations. The safest multi-axial method should be used for the benefit of patients with AVMs.

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A correct medical treatment is carried out with a correct purpose, using a correct means, after a patient's consent is obtained. Informed consent (IC) is to explain exactly medical condition and obtain a patient's consent. In the emergency spot, a medical behavior is started also under the situation of not fulfilling the above-mentioned conditions. It is not always to perform IC with sure legal responsibility and sure duty in that case. In this paper, relation of emergency medical treatment and IC was discussed legally with review of the literatures. A doctor should perform IC in emergency medical treatment, but some defects may arise. Therefore, enrollment of a lawyer should also be taken into consideration. If IC can build the good confidential relation of medical professions and patients, we believe that it leads also to improvement in medical treatment results.

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In this study, the efficacy of percutaneous transluminal angioplasty (PTA) and intra-arterial infusion of fasudil hydrochloride (FH) on cerebral vasospasm after subarachnoid hemorrhage were reviewed. Twenty-two arterial territories in 15 patients were treated according to the following strategy. Vasospasm located on the proximal intracranial vessels (ICA and M1) was treated with PTA and intra-arterial infusion of FH was selected for vasospasm at more distal locations. Angiographic improvement of vasospasm was demonstrated in 19 territories (86%) and 9 of 11 symptomatic patients (82%) showed neurological improvement after the procedure. Angiographic vasoconstriction recurred in 7 territories (43%), and neurological deficits recurred in 3 patients (33%). Recurrence of vasoconstriction was seen only after intra-arterial infusion of FH. After treating the 22 vascular territories, 16 (73%) were prevented from large ischemic change on post-procedural computed tomographies. There were no episodes of systemic hypotension and no severe adverse effects were encountered. We concluded that the combined use of PTA and intra-arterial infusion of FH was useful for cerebral vasospasm following subarachnoid hemorrhage.

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Middle meningeal arteries (MMA) are usually found and hemorrhage on the surface of the dura mater occurs after completion of craniotomy in vascular reconstruction for cerebral ischemia in the territory of the middle cerebral artery in moyamoya disease. The hemostatic procedure is usually performed macroscopically. Macroscopically-performed electrocoagulation may cause stenosis or occlusion of the MMA and its branches, and spontaneously developed collaterals to the brain via the MMA may decrease or stop, abruptly. Cerebral ischemia can be aggravated. In the present report, the importance of the hemostatic procedure under surgical microscopy was investigated in a consecutive series of sixteen patients with moyamoya disease. Hemorrhage usually occurred from the fine branches between the MMA and vessels through the cranium. Those branches were left adjacent to the MMA. Electrocoagulation of the branches under the microscope effectively stopped hemorrhage on the dura mater. The microscopically-performed hemostatic procedure could preserve the MMA and did not disturb collateral pathways via the MMA.

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Arachnoid cysts of the quadrigeminal cistern have been managed by craniotomy with cyst fenestration and cystoperitoneal shunting and ventriculoperitoneal shunting. A 6-year-old girl with symptoms of increased intracranial pressure was treated by endoscopic cyst opening. Third ventriculostomy was performed simultaneously. The postoperative course was excellent. Obstructive hydrocephalus caused by arachnoid cyst of the quadrigeminal cistern seems a good indication for endoscopic surgery. Neuroendoscopic management of arachnoid cysts of quadrigeminal cistern is described.

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Superior canal dehiscence syndrome (SCDS) involves of sound- or pressure-induced vertigo caused by a defect in bone overlying the superior semicircular canal (SSC). A 42-year-old woman had experienced vertigo for nearly 25 years. She began to experience severe vertigo induced by loud noises about 4 months ago. Ultra-high-resolution computed tomography of the temporal bone revealed dehiscence of the bone overlying the SSC at the superior petrosal sinus. In Japan, to the best of our knowledge, this is the first reported case of SCDS revealing a defect of the bone overlying the SSC.

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A fibrinogen-based collagen fleece (TachoComb^[○!R]), was used in 21 cases during operations to assess its properties as a hemostatic modality in neurosurgical procedures and prevention of cerebrospinal fluid (CSF) leakage after duraplasty. Our clinical experience shows the efficacy of this material to control oozing hemorrhage from dural sinuses not controlled by primary hemostatic procedures. Postoperative CSF leaks developed in only one case among 16 cases that did not require operations such as lumbar CSF drainage. TachoComb^[○!R] is available to prevent CSF leaking after duraplasty.

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We report a case of metastatic brain tumor which showed hypointense on a T2-weighted MR image. A 69-year-old man was hospitalized because of sensory aphasia and right hemiparesis. He had a history of sigmoid colon cancer at 68 years old. CT scans revealed a high density tumor on the left temporal lobe. The tumor exhibited iso- and low-intensity signals on T1- and T2-weighted MR images, respectively. The marginal portion of the tumor showed an irregular enhancement upon Gd-DTPA administration. Fronto-temporal craniotomy was performed and the tumor was totally removed. In the pathological findings, it was found that the tumor was composed of relatively differentiated adenocarcinoma cells, indicating a metastatic brain tumor from sigmoid colon cancer. No evidence of acute hemorrhage or calcification was identified. We also confirmed the presense of mucin in the ducts of gland epithelium using PAS and alcian blue stain. The binding of mucin to water results in an increase in the amount of bound water, thereby slowing the tumbling rate of protons in the tissue, and causing the subsequent preferntial T2 shortening. Among lesions showing hypointensity on T2-weighted MR images, we have to be aware of the possibility of metastatic adenocarcinomas from the digestive system, besides melanoma, hemorrhage and calcification.

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