We evaluated the reproducibility and predictability of tumor growth by counts of MIB-1 positive cells in meningiomas. Sixteen meningiomas whose tumor doubling time (Td) could be calculated from serial radiological examinations were used in this stydy. MIB-1 positive cells were counted : (1)in at least 1×10^3 tumor cells which were located in the area of the highest MIB-1 staining ; (2) in at least 1×10^3 cells in randomly selected fields ; and (3)in at least 2×10^3 cells in randomly selected fields. The staining indices (SI's) determined by the first method were about twice as high as those by the other two methods, and the correlation values were high. The third method gave the highest correlation coefficient for Td and SI, and the reproduciblity was worst for the second method. The advantages and disadvantages of the methods were discussed.

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To evaluate the influence of genetic factors, life style and medical history on the occurrence of cerebrovascular diseases, a multicenter case-control study was performed. In this report the authors have analyzed risk factors for spontaneus intracerebral hemorrhage (ICH). A medical history of systemic hypertension was the most powerful risk factor for ICH [odds ratio (OR)12.78, contributory rate (CR) 38.5%], followed by chronic alcohol consumption (≥ 250g/week ; OR2.31, CR16.4%). Treatment of hypertension reduced the risk of an ICH. A family history of ICH was a significant risk factor in univariate analysis, but it was not independent after adjustment for hypertension and alcohol consumption. Physically active persons had a lower risk of an ICH only in a univariate analysis (OR 0.41). 'Stress control'was another important preventative factor, and remained independent after a multivariate analysis(OR 0.54, CR 15.2%).

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We report excellent initial results of stenting for cervical carotid artery stenosis. Patients demonstrated three lesions that met the criteria used by the studies of the North American Symptomatic Carotid Endarterectomy Trial Collaborators (NASCET) or the Committee for the Asymptomatic Carotid Atherosclerosis Study (ACAS) for carotid endarterectomy (CEA). Stenting was performed for restenosis after CEA in one patient, and as an initial treatment in two patients. Stents utilized in these patients were Palmaz stents, the balloon expandable type orginally developed for peripheral arteries. Stents were placed at the lesion after predilatation in one patient and primarily in two patients. Additional protective balloon cathere was employed in one patient. Complete dilatation was obtained in every patient without any adverse event. Several techniques are needed, particularly in postdilatation, to fit stent to arterial wall and to obtain a smooth vascular lumen in cervical carotid artery where the diameter changes naturally from proximal to distal portion. Further considerations of the necessity of protective balloon and degree of perioperative anticoagulation therapy will require more experience. Usefulness of stenting for cervical carotid artery stenosis was indicated by our initial results, but the development of a better stent for the cervical carotid artery and long-term follow-up are mandatory.

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The authors report a race case of glioblastoma in which the patient's condition rapidly deteriorated due to a massive leptomeningeal gliomatosis without definite growth of the primary lesion. A 48-year-old man was hospitalized with complaints of occipital and nuchal pains. CT and MRI on admission showed a small tumor in the lateral wall of the right trigone partially projecting into the ventricle without any finding of leptomeningeal gliomatosis. Subsequently, his consciousness level worsened gradually with rapidly developed leptomeningeal gliomatosis which was demonstrated on enhanced MRI. He received intrathecal chemotherapy through an Ommaya catheter and by lumbar puncture, without any effects on gliomatosis. He died 7 weeks after admission. At autopsy, an intraparenchymal tumor, 5×10×15mm in diameter, was found in the deep white matter of the right parietal lobe facing and extending into the right lateral ventricle. The ependymal layer in the region of the tumor had been destroyed. Infiltration of tumor cells was seen diffusely in the leptomeninges of the surface of the brain and spinal cord, but not in the ventricular walls. Histopathological patterns of the intraparenchymal and leptomeningeal tumors were similar and compatible with the typical features of glioblastoma. However, immunohistological study demonstrated different findings for both lesion ; the leptomeningeal tumor was more poorly differentiated (GFAP(-), PCNA 94%) than the intraparenchymal tumor (GFAP(+), PCNA 42%). It is suggested that the biological characteristics may play a part in the development leptomeningeal gliomatosis in addition to the anatomical characteristics.

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We report an adult patient with moyamoya disease which progressed from unilateral to bilateral involvement. The disease was detected with magnetic resonance angiography (MRA) and treated with a prophylactic direct revascularization. A 37-year-old female developed a cerebral infarction in the left frontal lobe. A MRA showed absence of a signal from the proximal portion of the left middle cerebral artery (MCA). A cerebral angiogram revealed obstruction of the terminal portion of the left middle cerebral artery(MCA). A cerebral angiogram revealed obstruction of the terminal portion of the left internal carotid artery (ICA) and basal moyamoya vessels. The right ICA did not have a steno-occlusive lesion. Because the diagnosis was 'probably'moyamoya disease, we performed direct bypass surgery on the affected left side. The result was an uneventful postoperative course. Follow-up MRA obtained 5 years after the first surgery showed the absence of a right MCA signal, although the patient did not have new symptoms. A cerebral angiogram demonstrated a steno-occlusive change at the terminal portion of the right ICA. Futhermore, a measurement of cerebral blood flow (CBF) gave a normal value at rest but a negative response to acetazolamide loading in the region of the right MCA. Direct bypass surgery was then performed on the right hemisphere to protect it from ischemic insult caused by a further progression of the moyamoya disease. A follow-up study revealed a rich revasculatization from the right external carotid artery, regression of the moyamoya vessels and an improvement of vascular reactivity. This case reinforces the necessity and usefulness of a follow-up MRA of adult patients with unilateral moyamoya disease. In cases where an impaired vascular reactivity is demonstrted in a CBF study, prophylactic revascularization may be considered.

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A 43-year-old male was admitted to our hospital in a semicomatose state. A plain head CT scan revealed a diffuse subarachnoid hemorrhage. On a carotid angiogram a saccular aneurysm was absent, but there were findings of extravasation, irregular narrowing and dilatation of the left A1. During surgery a dissecting aneurysm of the left A1 portion with a focal stenosis, dilatation, and a small aneurysmal change were discovered and treated by the trapping method. Histological examination of the resected artery revealed a ruptured arterial wall associated with an intra-wall dissecting hemorrhage. We discuss clinical and pathological characteristics of an anterior cerebral artery dissecting aneurysm.

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A case of unilateral acoustic neurinoma in a 10 year old boy is presented here. He has a cafe-au-lait spot in his chest, but has no other sigma or family history of von Recklinghausen's neurofibromatosis. Despite the relatively large size of the tumor, a complete removal was achieved and the facial nerve function was preserved. Acoustic neurinomas in childhood have rarely been reported. It has always been a worry to know if the tumor is a stigma of neurofibromatosis type 2. Recent progress in genetics found both the responsible genes in neurofibromatosis type 1 and 2. Clinical applications of genetic examination for these syndromes will resolve these apprehensions.

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The authors report two cases of subdural empyema treated successfully with burr holes & drainage operation. A 10-month-old boy suffered from subdural empyema secondary to infected congenital dermal sinus and a 45-year-old man secondary to frontal sinusitis. Continuous irrigation of the subdural space was also effective in the latter case. The literatures are reviewed about the changes in management of subdural empyema and an improvement in mortality was found from about 30% in the pre-CT ear to about 10% in the post-CT era. Particularly, the results of burr hole operation improved as favorable as those of craniotomy. With the CT scan provision of early and accurate localization and easier follow-up, burr hole & drainage operation became more improtant as a less invasive and effective management for subdural empyema.

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A fusiform aneurysm of the distal A1 segment of the right anterior cerebral artery (ACA) is an uncommon clinical observation. This case was a 59-year-old woman who presented with a subarachnoid hemorrhage caused by the rupture of an aneurysm of this type. The aneurysm was treated successfully by using fenestrated clips. The surgical treatment for aneurysms of this type is discussed.

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A 64-year-old man was treated for angina pectoris. An ultrasonic study for carotid artery demonstrated stenosis of bilateral carotid artery. Right carotid angiogram showed a stenosis at the bifurcation of the common carotid artery and left carotid angiogram disclosed and occlusion of the internal carotid artery. Angiogram showed 60% stenosis at the proximal portion of subclavian artery. As informed consent was obtained from the patient and his family, angioplasty and stenting were performed. A Palmatz stent was placed across the stenosis and successfully dilated. Subclavian angiogram 3 months after stent placement disclosed no restenosis. The stenting for subclavian artery stenosis of the present case was briefly discussed.

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