Three-dimensional CT angiography(3D-CTA)was used to investigate the variations in the venous system of the cerebellar tentorium in the 408 hemispheres of 204 patients with cerebrovascular diseases, brain tumors, and other intracranial pathologies. 3D-CTA could provide useful information about the presence and course of the vein of Labbe(VL)and other bridging veins. The VL was found in 382 of the hemispheres examined. The VL flowed into the transverse sinus(TS)in 300 of the 382 sides at various inflow points(Ts-sigmoid sinus[SS] junction in 50 sides, TS within 3 cm from the TS-SS junction in 200, and TS over 3 cm from the TS-SS junction in 50). The VL also flowed into the lateral tentorial sinus(LTS)in 79 sides. The temporobasal vein(TBV)was found in 219 sides. The TBV flowed into the LTS in 103 of the 219 sides, and into the TS in 63 sides. Furthermore, variants of the superficial sylvian vein were distinctly delineated in 27 sides. 3D-CTA could also demonstrate the pattern of the tentorial sinus and bridging veins in the occipital lobe. Bridging veins running on the interhemispheric or inferior medial side of the occipital lobe were found 1.84 vessels on the average for each side, and the medial tentorial sinuses around the tentorial edge were found in 102 sides. 3D-CTA provided practical images of the deep veins of the skull base venous system and showed the relative anatomical relationships with the arteries and bony structures.

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It has been reported that fasudil hydrochroride, which is an inhibitor of protein kinases such as myosine light chain kinase, has a vasodilating effect on cerebral arteries and a preventive effect for cerebral vasospasm after subarachnoid hemorrhage. However, its half life in blood is very short. Therefore, it is not clear whether it maintains an effective blood concentration in clinical cases. On the other hand, hydroxy fasudil(M3), which is metabolite of fasudil hydrochloride, has a brain protective effect and its half life in blood is very long. The authors investigated the time course of the blood concentration of fasudil hydrochloride and hydroxy fasudil, and evaluated their preventive effect for cerebral vasospasm.

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A54-year-old man noted a burning sensation of the left shoulder and cold sensation of the left hand for about 4 years before admission. Stiffness in the occipital region, weakness of the right side of his body and left sensory disturbance gradually developed. We obtained new images reconstructed from 3D-FSE(TR/TE 4000/136). Raw images of 3D-FSE demonstrated the spinal cord, tumor, vertebral arteries and dura mater. Preoperative simulated images visualized a compressed spinal cord dorsally on the left and the whole body of the tumor through the virtual image of hemilaminectomy. The relationship between the tumor and the right vertebral artery was clearly shown. The tumor was totally removed by right suboccipital craniectomy and C1-2 hemi-laminectomy. Histological examination revealed meningothelial meningioma. In this case, virtual images simulated from MR images were closely correlated with intraoperative findings and preoperative evaluation with 3D-FSE was helpful to predict the course of the right vertebral artery contacting the tumor. Preoperative evaluation with 3D-FSE is a very useful method for pathological lesions in the craniovertebral junction and spinal canal.

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Recently the case of an intracranial arterial dissection has been reported in some papers. It is generally considered that the dissection of the internal carotid artery system was predominately performed in Europe and America, while in Japan on the other hand, most of the intracranial dissections were perforrmed in the posterior circulatory system. The arterial dissection of the anterior cerebral artery(ACA)was very rare and only 22 cases were reported previously. They were young adults, mean age 36 years(range 5-62), more often male(17 males, 6 females), and usually presented with ischemia due to occlusion distal to the dissection. In the past, only one case of subarachnoid hemorrhage and cerebral infarction simultaneously, occurring, had ever been reported. We describe a rare case of ACA dissection with a subarachnoid hemorrhage and cerebral infarction.

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A 37-year-old man with no history of trauma experienced sudden, massive epistaxis. Epitaxis was intractable for various treatment, including Bellocq's tamponade. After entering hypotensive shock, bleeding finally stopped. Computed tomography, magnetic resonance imaging, and angiography demonstrated a cavernous left carotid artery giant aneurysm extending into the sphenoid sinus. After the left superficial temporal artery-middle cerebral artery double anastomosis and ligation of cervical internal carotid artery, the aneurysm was completely thrombosed without any neurological deficit. Rupture of a cavernous carotid aneurysm can cause severe, sometimes fatal, epistaxis via the sphenoid sinus. In most of those cases, epistaxis followed a head injury. In our case, the patient had no history of head trauma, and it was supposed that a nontraumatic cavernous carotid artery giant aneurysm caused severe epistaxis. We should keep in mind that a cavernous carotid artery aneurysm can be the cause of intractable massive epistaxis without any traumatic history.

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We wish to report the case of a 12-year-old boy with brain metastasis 12 years after the resection of Wilms'tumor(stage I, favorable histology)of the left kidney as a 5-month-old. He had a history of right retroorbital metastasis as a 7-year-old. He was treated by the total removal of a right cerebellar tumor and post-operative radiotherapy and chemotherapy. He is still disease-free 3 years after surgery. The tumor was poorly differentiated and was composed of nephroblastic blastema. Abnormalitites on chromosomes 1q, 9q, 18q and trisomy 8, 15 were seen in his blood sample. Abnormalities on chromosomes 1p and trisomy 3, 7, 8, 19 were also found in the tumor. To the best of our knowledge, no late brain metastasis of Wilms' tumor has ever been described. Multimodal treatment was effective in this case and we discussed this case based on the literature.

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We experienced a case with a ruptured anterior cerebral artery aneurysm encased in the tuberculum sellae meningioma, which we treated successfully. Although several cases of coexistent of cerebral aneurysms and a meningiomas have been reported, encasement of an aneurysm in a meningioma is extremely rare. There has been only one report so far. The patho mechanism of the coexistent of these two lesions is still an unsolved problem. Several ideas have been proffered to explain the mechanism. In our case, the meningioma may highly contribute to cause aneurysmal development. Usually, a ruptured aneurysm case is diagnosed with CT and angiography preoperatively. In this situation, the anatomical relation of tumor and aneurysm may not be demonstrated in detail. Therefore, careful microsurgical resection is be required.

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A case of xanthogranuloma of the choroid plexus diagnosed by neuroendoscopic biopsy is reported. A 65-year-old woman visited our hospital with tension headache. CT scans showed a high density mass in the bilateral trigone of the lateral ventricles. Bilateral intraventricular tumors 20 mm in diameter were recognized in MR images. Gd-DTPA images revealed ring-like enhancement. To differentiate from metastatic tumor, a neuroendoscopoic biopsy was performed by transcortical approach of the left parietooccipital lobe. An encapsulated yellowish gray tumor neighboring the choroid plexus was seen under neuroendoscopic view. The capsule was torn by a sharp tip forceps and the included yellowish grumous material was fragmented and removed with KTP laser and blunt tip forceps. No neurologic deficits were seen postoperatively. This suggests that neuroendoscopic surgery is another method for obtaining histological specimen from an intraventricular tumor.

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A 81-year-old female with a calcified metastatic brain tumor, histologically confirmed to be an adenocarcinoma, is reported. In our case, the primary lesion was detected in the lung and was histologically confirmed as a moderately differenciated adenocarcinoma. It took 90 months from the treatment of the primary lesion to the identification of the brain metastasis. She died of cachexia 18 months following the treatment of the metastatic brain tumor. Calcification in metastatic brain lesions are very rare. We can find only 19 cases reported in the literature. Primary lesions were derived from various organs and the histopathological diagnosis was mainly adenocarcinoma. It had taken a relatively longer interval(mean 42 months)from treatment of the primary lesion to the occurrence of brain metastasis. It had also taken a long interval(mean 21 months or more)from the identification of the brain metastasis to the patient's death, in the supporting literature. Characteristic findings on the CT scan are slight mass effect and slight enhancement.

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A cerebellar tumor was incidentally discovered on a CT scan of a 14-year-old boy, which was taken after a minor head trauma. The tumor had a large and thick-wall lining cyst, and was not enhanced with a contrast medium. Therefore, it was considered a ganglioglioma rather than a pilocytic astrocytoma. During surgery, the cerebellar cortex surrounding the tumor was found to be swollen. The tumor and the swollen cortex were removed en block. Histological examinations proved it to be a pilocytic astrocytoma associated with an extension to the surrounding leptomeninges. Radiological diagnosis, therapeutic strategy and prognosis of pilocytic astrocytomas with such an extension or dissemination into the subarachnoid space are discussed.

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Gangliocytomas are noteworthy in view of their content of neurons and ganglion cells and their common clinical manifestation include medically intractable epilepsy. It is still debatable whether lesionectomy alone is sufficient for seizure control in treatment of seizures in patient with gangliocytoma. We report a case of gangliocytoma causing epileptic seizures, which was treated successfully by resection of both the tumor and the adjacent epileptogenic cortex. The patient, a 18-year-old man, had suffered from intractable complex partial seizures(once or twice per week)manifested as motionless staring or automatism since the age of 15. A small lesion with a calcified mass was detected in the left parahippocampal gyrus. Intracranial EEG recording with subdural electrodes demonstrated an epileptogenic focus in the fusiform and parahippocampal cortices of the left temporal lobe adjacent to the tumor. The tumor and the adjacent epileptogenic cortex were removed. Before surgery, functional mapping by cortical stimulation was performed. Pathological specimen disclosed gangliocytoma. The patient became seizure-free after surgery and was able to enjoy college life during 2-year follow-up period. This case indicates that patients with benign tumors and intractable epileptic seizures may require additional resection of the adjacent epileptogenic cortical tissue in stead of lesionectomy alone. For presurgical evaluation, both intracranial EEG recording and functional mapping is essential for obtaining a good surgical outcome.

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