Our goal is to determine the molecular pathogenesis of pituitary tumors. We have identified new molecular targets and have developed a novel molecular-targeted imaging agent for non-functional pituitary adenomas. Tumor specimens from surgery were used in these studies. Microarray analyses, RT-qPCR, Western blotting analysis, immunochemistry and folate-binding studies were performed to determine folate receptor expression. Primary cell culture, folate-PEG-liposome uptake, folate-PEG-liposome-DOX (doxorubicin) uptake and cytotoxicity studies were performed. In vivo imaging was performed by injection of FolateScan followed by planar and SPECT/CT imaging in patients with clinically non-functional pituitary tumors prior to pituitary surgery. All the analyses indicated that the folate-receptor was significantly and uniquely upregulated in non-functional pituitary adenomas. Folate-PEG-liposomes carrying the antineoplastic drug doxorubicin induced cell-death in folate-receptor α expressing pituitary tumors in vitro, as measured by MTT assays. Using a folate-receptor targeted technetium-99 labeled radionuclide imaging molecule imaged, FolateScan successfully folate-receptor expressing tumors. Non-folate-receptor expressing tumors were not imaged by FolateScan. Folate-receptor positive and negative tumors were validated by Western blotting analysis. These preliminary results support the concept of FolateScan as a novel diagnostic imaging tool for clinically non-functional tumors, and folate receptor targeted therapy as a medical treatment for these tumors, options which currently do not exist.

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【Object】This review addreses the transthoracic antero-lateral approach to thoracic disc disease.【Methods】Three patients were operated upon for thoracic disc disease between 2002 and 2003. One patient had thoracic spon-dylosis and two patients had intervertebral disc herniations. The transthoracic antero-lateral approach was used performing the work on the spine under the surgical microscope. The approach was on the left in two and on the right in one patient.【Results】The results were very good and the postoperative course was uneventful in all cases.【Conclusion】This approach can be an effective and safe method for the treatment of thoracic disc disease.

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Efficacies of NIHSS in the evaluation of severity of symptomatic vasospasm (SVS) and in the selection of proper candidates for endovascular treatments (EVTs) against SVS were assessed. From 94 patients who developed SVS after the obliteration of a ruptured aneurysm in the acute periods during the past 8 years, outcomes and incidence of cerebral infarction were compared with the NIHSS scores before SVS and at the time of diagnosis of SVS between 28 cases treated before introduction of EVTs as standard therapeutic protocols and 46 cases that actually underwent EVTs. Furthermore, the efficacy of EVTs was examined between cases before (28 cases) and after (66 cases) introduction of EVTs, and the timing of EVTs were also assessed. The NIHSS before SVS tended to correlate with the development of cerebral infarction and with outcome in both groups, and NIHSS at the diagnosis correlated with both significantly. Patients after introduction of EVTs tended to have good outcomes, and patients who underwent EVTs within 6 hours from the diagnosis of SVS had better outcomes. From our results, sequential NIHSS scoring was useful in evaluating the severity of SVS and in selecting candidates for EVTs.

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A 65-year-old male with a past history of superior sagittal sinus thrombosis, presented 6 years later with general convulsions. On admission, he displayed dementia (HDS-R score of 13) and left hemiparesis. A computed tomography (CT) scan revealed a subcortical hemorrhage at the right temporal lobe. Angiography revealed a dural arteriovenous fistula (DAVF) at the torcular herophili. The bilateral transverse sinus and superior sagittal sinus distal to the fistula were occluded and there was retrograde venous drainage through the straight sinus to the basal vein of Rosenthal. Transarterial embolization (TAE) was performed for the bilateral middle meningeal artery and occipital artery. After the TAE, general anesthesia was induced in the patient and direct sinus packing using portable digital subtraction angiography (DSA) was performed successfully. Postoperative angiography showed the complete obliteration of the DAVF and the HDS-R score improved to 28. Direct sinus packing is a significant and effective treatment for DAVF's that empty into the isolated sinus.

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A case of intraventricular hemorrhage caused by an A1 perforating artery aneurysm was reported. A fifty-five year-old female without any hereditary background or infections had collapsed at work, become comatose, and was transferred to our hospital. Computed tomography showed a massive intraventricular hematoma, and subsequent angiography revealed an aneurysm arising from an A1 perforating artery at the right lateral ventricular wall. The aneurysm was successfully removed by a transcortical-transventricular approach, and the patient regained consciousness after two weeks. To the best of our knowledge, this is the first report of an intraventricular aneurysm arising from an A1 perforating artery.

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We report a case of recurrent schwannoma originating from the jugular foramen presenting with hypoglossal nerve palsy due to the extracranial extension of the tumor. Extensive resection of the bone around the jugular foramen was deemed disadvantageous for this patient, thus we planed an image-based palliation by gross total resection of the tumor in the jugular foramen and unroofing of the hypoglossal canal with assistance of MRI/CT fusion image processing, surgical navigation and endoscope assistance. Stereotactic radiotherapy to the residual extracranial tumor followed postoperatively. The patient's neurological deficits ameliorated rapidly after the operation without any additional complications. Our minimally invasive technique that fully utilizing image-based preoperative planning and surgical navigator and endoscope assistance would be advantageous for future tailor-made skull base surgeries.

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We examined glucose metabolism using positron emission tomography (PET) in 2 patients with acute carbon monoxide (CO) poisoning. In the first case, a 15-year-old woman suffering from acute and moderate CO poisoning was treated with hyperbaric oxygen (HBO) therapy and underwent PET scan examinations using <15>O-labeled gas and <18>F-fluorodeoxyglucose (FDG). Although hypoperfusion was not apparent, reduced glucose metabolism in the bilateral globus pallidus and thalamus and frontal cortex was observed on the FDG-PET scan that was examined immediately after the first HBO therapy. MRI revealed high-signal intensity in the left globus pallidus on the diffusion-weighted image, the patient, however, did not develop any delayed neuropsychiatric complications. In the second case, a 19-year-old man suffering from acute and moderate CO poisoning underwent FDG-PET examination 8 days after the CO poisoning. Reduced glucose metabolism in the bilateral globus pallidus and thalamus and frontal cortex was observed on the FDG-PET image. MRI revealed high-signal intensities in the bilateral globus pallidus and frontal and parietal white matter on the diffusion-weighted image and the patient resulted in chronic unresponsiveness. Reduced glucose metabolism in the bilateral globus pallidus and thalamus and frontal cortex might be a common finding in patients with acute CO poisoning. Evaluation in two patients does not validate the usefulness of FDG-PET examination in the determination of neuropsychiatric prognosis in patients with CO poisoning, however, PET has possible utility in gaining further understanding of the pathophysiological characteristics of human CO poisoning.

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