We performed an immunohistochemical analysis on mutant epidermal growth factor receptor (ΔEGFR) expression using an anti-ΔEGFR monoclonal antibody, DH8.3, on seventy-four astrocytic tumors obtained during surgeries at Saitama Medical School. At the same time, expressions of wild-type EGFR, TP53 and CDKN2A were analyzed to recognize their mutual relationships and possible contributions to patients'survival time. Results : 1) ΔEGFR expression was observed in 0/19 (0%) diffuse astrocytoma cases, 3/14 (21.4%) anaplastic astrocytoma cases, and 20/41 (48.8%) glioblastoma cases. 2) EGFR expression was more frequent in TP53-negative cases, and in CDKN2A-negative cases as well, although it did not reach the statistically significant level of p=0.05 by chi-square test. 3) Univariate and multivariate analyses of survival time did not show ΔEGFR being a significant and independent prognostic factor. Conclusion: Although ΔEGFR promotes glioblastoma progression in vivo through several activities such as down-regulating p27(a negative regulator of the cell cycle) and BclX(L) (an inhibitor of apoptosis), and promoting tumor cell invasion, its clinical significance still remains to be elucidated.

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Authors describe a symptomatic case of multiple lumbar spondylolyses without spondylolisthesis. A 31-year-old man was admitted to our hospital with severe low back pain. He had an extension catch with localized tenderness over the L5 vertebra. Lumbar X-rays revealed multiple lumbar spondylolyses at the L2 and L5 levels. He was initially treated with non-operative methods, but the results proved unsuccessful. According to the results of block for pars defects and the findings of three-dimensional CT, we decided that the low back pain might be caused by the pars defect at L5. Then he underwent bilateral pars repair at the L2 and L5 levels using rod-screws and sublaminar hooks with bone grafting for the pars defects. Three months after surgery, the patient was painfree, and was able to return to his previous job. Multiple lumbar spondylolyses are rare and it might be difficult to judge which pars defects cause low back pain. In this case, three-dimensional CT provided us with a more accurate three-dimensional dipiction of the lumbar structures with the instability of pars defect.

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The authors report a case of intrasellar primary malignant lymphoma. A 62-year-old male was admitted with a visual disturbance lasting for one month, which rapidly progressed one week before admission. Neurological examination showed severe bitemporal hemianopsia and deterioration of visual acuity. Magnetic resonance (MR) images revealed an intrasellar mass lesion with a suprasellar extension suggesting mild compression of the chiasma. The tumor was iso-intensity in T1 and T2 weighted images, and enhanced inhomogeneously by gadolinium-DTPA intravenous administration. A transsphenoidal surgery was performed urgently, resulting in significant improvement of the visual disturbance. Histological diagnosis was malignant lymphoma of diffuse large cell type and B cell type. Chemotherapy with high-dose methotrexate followed by irradiation provided a significant reduction in the tumor size as seen on MR images. We discussed the clinical features of primary malignant lymphoma in sellar region.

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A rare case of intracranial neurenteric cyst was reported, and we review the literature about intracranial neurenteric cyst. A 29-year-old man presented with headache. Computed tomography demonstrated cystic lesion in front of the brainstem. Magnetic resonance imaging demonstrated a low intensity lesion on Tl-weighted image and a high intensity lesion on T2-weighted image. The cyst wall was not enhanced after Gd-DTPA administration. Diffusion weighted image (DWI) demonstrated low intensity. Surgery was performed and the cyst was subtotally resected. DWI demonstrated all neurenteric cysts with low intensity, while epidermoid cysts are characterized by high intensity on DWI. We suppose that DWI is useful for differentiating between neurenteric cyst and epidermoid cyst.

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A 74-year-old female presented with painful left oculomotor nerve palsy. A cerebral angiogram suggested a left internal carotid-posterior communicating aneurysm. At surgery, the compression of the oculomotor nerve by the atherosclerotic and tortuous posterior communicating artery was confirmed. Aneurysmal change was not found. After the adhesive arachnoid membrane was removed, the compression was released. Postoperatively, the symptoms disappeared.

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We present a surgical case of a combination of autosomal dominant poly cystic kidney disease (ADPKD) and internal carotid-posterior communicating artery (IC-PC) aneurysm presenting with oculomotor nerve palsy. A 57-year-old man suddenly developed left ptosis and double vision. After 6 days from the onset of symptoms, the patient was referred to our hospital. He had mild headache and partial oculomotor palsy. CT scan revealed no subarachnoid hemorrhage. Magnetic resonance angiography (MRA) revealed a left IC-PC aneurysm. The following day, the aneurysm was clipped under a microscope without a dome puncture. The recovery from the oculomotor palsy started with pupillary function. Improvement was next noted in the levator palpebrae muscle, followed by the medial rectus muscle and then the inferior and upper rectus muscles. The patient was discharged without neurological deficits. The most important factor influencing the prognosis of oculomotor palsy is the interval between the onset of the palsy and the time of surgery. If renal dysfunction is mild, early surgery should be performed. We presented this case with a review of the literature.

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The authors describe a case of a twentyone-month-old moyamoya disease patient with severe brain atrophy in the right cerebral hemisphere. The patient had fixed left hemiparesis. Superficial temporal artery-middle cerebral artery anastomosis on the right side was performed in order to prevent cerebral ischemia development. Intraoperatively, making a distinction between the cortical artery and vein was difficult under the surgical microscope due to a marked decrease in oxygen consumption on the right side. Then, flow velocity was measured in the cortical artery and superficial veins using Doppler flowmetry, and this disclosed that a flow velocity wave could be detected in the artery but not in the veins, i. e. it could distinguish artery from vein. In summary, intraoperative measurement of flow velocity was useful for distinguishing between cortical arteries and veins in the surgical management of moyamoya disease with severe brain atrophy.

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Intracranial schwannomas commonly arise from the sensory nerve, and they rarely affect the pure motor nerve (fflrd, IVth, Vlth). Schwannomas of the VIth cranial nerve are exceptionally rare and only 10 cases have been previously reported in the literature. We report a case of a 60-year-old male who presented with diplopia. On neurological examination, only a left abducens nerve palsy could be demonstrated. Magnetic resonance imaging showed a 1.5 cm mass with cyst formation in the lateral side of the left cavernous sinus. Surgery was performed using the Dolenc epidural approach. Partial removal of the tumor was performed. Postoperative histopathological examination confirmed the diagnosis of schwannoma. One week after the surgery, the patients' symptoms started to improve. Ultimately, the symptoms were completely resolved during only a month after the surgery.

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We report a case of a spontaneous vertebral arteriovenous fistula (AVF) . A 38-year-old man developed the numbness and the weakness of the left upper limb 2 months ago. MRI showed an expanded anterior spinal dural venous plexus, which was located in the left spinal canal at the levels of C3 to C7. Angiography showed an arteriovenous shunt from the radicular artery of the proximally dilated left vertebral artery. The AVF drained into the anterior internal vertebral venous plexus at the level of C7. Embolization of the shunt point via vertebral artery was successfully performed with coils and a detachable balloon. After the endovascular obliteration of the fistula, he demonstrated the remarkable improvement of the numbness and the weakness of the left upper extremity. In a case of a spinal AVF, the endovascular treatment was recommended as a first choice of the treatment.

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We attempted intraoperative fluorescence diagnosis in a brain tumor patient who was given 5-aminolevulinic acid using a purple semiconductor laser device as part of a photodynamic diagnosis (PDD) study. The light output was able to be powerfully applied by adjusting the wavelength to 405 ± 1 nm. It was useful to be able to perform a fluorescence assisted diagnosis of his brain tumor using an optic fiber under a microscope for irradiation.

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