In skull fracture it is clinically important that the mechanical force which produce skull fracture might also produce brain injury, that cosmetic outlook is important, and that above all there are many complications. In the diagnosis of complications of skull fracture it will be useful to know the mechanical background.
Skull fracture occurs at the compression load of about 500 kg or load factor of about 100. Fracture may occur experimentally when the head dropped from the height of 100 cm onto the hard impact surface and from accident surveys when the impact speed exceeds 10 to 15 km/hr.
Skull fracture begins at the impact point and the fracture lines run along the direction of mechanical force. The fracture in the skull base follows the same principle with some variations according to the structural weakness. Therefore, there are particular symptoms and signs according to the relationship between impact points and the anatomy. For the convenience of the diagnosis the site of blow are divided into facial, mid frontal, lateral frontal, lateral, posterior lateral, occipital, and vertex blow.
Considering the direction of mechanical force, it is possible to recognize symptoms and signs as a pattern in the diagnosis of skull fracture and its complications.

View full abstract

Clinical experiences of the transcutaneous afferent electrical stimulation therapy for various types of intractable pain are reported. A total of 29 pain patients included 9 residual or recurrent chronic pain patients who had had various destructive pain treatment, 15 non-malignant chronic pain patients and 5 patients with pain due to malignant tumors. In 93% of the patients complete or partial relief of pain was observed. After the subsequent successive stimulation therapy from a week to two years and ten months 86% of the 22 patients who could use the stimulator by themselves in free of charge got pain relief in more or less degree. Only 42% of these patients, however, wished to continue this therapy for their pain relief. All the malignant tumor patients and many posttraumatic chronic headache patients with Barre-Lieou syndrome discontinued electrical stimulation. Good benefits are to be expected from this non-destructive treatment for chronic pain in combination with medication and/or destructive treatment.

View full abstract

About 150 cases of supratentorial glioma were treated during the past 17 years. Based on functional status, 15 were judged to be cases of silent glioma (synonymous with Norman's inactive glioma). They were silent for from 5 to 17 years, for an average of 8.5 years.
Histologically, they included: Astrocytoma Grade I, 6 cases; Astrocytoma Grade II, 7 cases; Astrocytoma Grade III, 1 case, and Ependymoma, 1 case. Most of these silent gliomas were fibrillary or gemistocytic astrocytoma. Cystic formation was seen in 10 of the 15 tumors, and calcification in 7 of the 15 (46%). In other words, there were only 2 of 15 cases of silent glioma without either cystic formation or calcification.

View full abstract

The purpose of this study is to evaluate the results of 150 transsphenoidal pituitary operations in light of the clinical, endocrinological and neuroradiological findings obtained preoperatively in these patients. There were 63 cases of pituitary adenomas, 68 cases of hypophysectomies, 9 arachnoid cysts (“empty sella”) and 10 other cases in this series. The mortality was 2 percent, occurring only in patients undergoing transsphenoidal hypophysectomies for metastatic breast cancer. The cumulative morbidity, including three cases each of CSF rhinorrhea and meningitis, two cases of rhinorrhagia and a single case of a temporary sixth nerve palsy, was 6 percent. The combined recurrence rate for both nonfunctioning and functioning adenomas was 9.5 percent. Improvement of visual field defects was observed in 92.3 percent of cases who preoperatively exhibited visual field loss. Improvement of endocrinological findings in functioning adenomas was also discussed. Postoperative change of water and sodium metabolism were carefully studied in 49 patients harboring pituitary adenomas and in 36 patients undergoing transsphenoidal hypophysectomy. Diabetes insipidus was seen more frequently following transsphenoidal hypophysectomies than after removal of pituitary tumors. In 85 cases of transsphenoidal pituitary operations studied in relationship to the developement of diabetes insipidus, a permanent diabetes insipidus lasting over a month (Grade III) occurred only in 8 patients following transsphenoidal hypophysectomy. Temporary diabetes insipidus, on the other hand, lasting less than a month (Grade II and I) could be observed following 20 operations for a pituitary tumor and in 17 hypophysectomized patients. Recurrence of the pituitary adenoma was observed in 6 out of 63 cases. All cases had large mass radiologically demonstrating destruction of the sella turcica and suprasellar extension of the tumor. Operative results by transcranical operation were also discussed reviewing literatures. The attempt will be made to define the indications for transsphenoidal approach in the light of the neuroradiological findings and to summarize our experiences with the postoperative management of these patient in part—2 and 3.

View full abstract

Nitrosourea derivatives are widely used for the treatment of malignant brain tumors. ACNU [1-(4-amino-2-methyl-5-pyrimidinyl) methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride] was used for the present experiment. The experimental brain tumor used was 20-methylcholanthrene induced malignant glioma of C57BL mice. 1) The growth of subcutaneously transplanted glioma was markedly inhibited with 10 mg/kg of ACNU and mostly disappeared with 10 mg/kg ACNU plus 1, 240 rads of X-ray irradiation. 2) The intracerebrally transplanted glioma mice survived 180% longer than control mice with 10 mg/kg of ACNU or 1, 240 rads of X-ray irradiation and 380% longer with 10 mg/kg ACNU plus 1, 240 rads X-ray irradiation. 3) Nitrosourea derivatives (ACNU or Me-CCNU) were used in the treatment of 50 patients with malignant glioma. The result of chemotherapy was evaluated by neurological examinations and CT-scan findings. The effect of nitrosourea derivatives were as follows: responders 10%, probable responders 30%, non-responders 60%. ACNU showed almost the same in effect to malignant glioma as Me-CCNU.
The chemotherapy combined with 5, 000 ?? 6, 000 rads of irradiation was more effective than chemotherapy alone, namely, responders 27.5%, probable responders 35%, non-responders 37.5%. The toxicity of ACNU was delayed reversible thrombocytopenia and leucopenia as other nitrosourea derivatives.

View full abstract

The cerebral blood volume (CBV) is considered to be an important parameter in the regulation of the cerebral hemodynamics. However, methodological difficulty in measurement of CBV has not clarified how CBV is changed in pathological condition of the brain. We have devised photoelectric method to measure regional CBV. The sensor of the apparatus consists of three gadgets; microlamp, photodiode to which infra-red filter is attached, and polyethylene catheter with its tip open for intracranial pressure (ICP) measurement. They are pasted with silicon rubber. The sensor is applied on the brain surface to measure the intensity of the optical absorption (OA) of hemoglobin in the brain tissue. OA remained nearly constant despite various degrees of change of cerebral blood flow (CBF) and blood gases.
Both OA and ICP increased during vasodilatation induced either by CO₂ inhalation, compression of jugular vein, or intravenous injection of papaverine. In contrast, both of them decreased during vasoconstriction induced either by hyperventilation or severe arterial hypotension.
From these results we can conclude that OA may demonstrate changes of CBV.
Disadvantages of this method are that absolute CBV and CBV in the depth of the brain tissue are not measured and that the operative field should be kept dark. However, this method has several advantages as the following;
1) Regional CBV is continuously measured without radionuclide or specific indicators.
2) This method does not require skilled technique.
3) This sensor also measured ICP simultaneously.
4) The cerebral transit time is measurable by injection of saline or indicators into the right brachial artery.
This method will be useful in measurement of CBV which is one of the important factors in pathological condition.
By increasing ICP stepwisely on six dogs, CBV was measured continuously by the photoelectric method and CBF by the heat clearance method. CO₂ reactivity was also obtained from changing of CBV following inhalation of 10% CO₂. ICP was gradually elevated up to 130 mmHg by saline infusion through a tube introduced into the cisterna magna.
While ICP was below 50 mmHg, neither CBV nor CBF showed any changes. However, when ICP was increased from 50 mmHg to 130 mmHg, CBV showed continuous increase while CBF showed continuous decrease. On the other hand, CO₂ reactivity was completely lost when ICP was more than 110 mmHg, which was thought to be due to vasoparalysis.

View full abstract

It is already shown that the edema fluid propagates through the expanded extracellular space by bulk-flow and drained into the ventricular CSF. It is, however, not yet quantitatively measured how much edema fluid is drained into the ventricle per time. In order to determine the minute amounts of edema fluid resolution into ventricular CSF, the edema fluid was labeled with a high concentration of a extracellular marker, ³⁵S-sodium thiosulfate. Ventriculo-cisternal perfusion was made during 21-24 hrs. after the cold lesion was made and the activities in the cisternal outflow were measured during each 15 minutes and corrected through control series without cold lesion.
Maximal increase in water content and space was observed in the tissue samples adjacent to the cold lesion and these values declined progressively with distance from the lesion towards the ventricle. The measurements of edema clearance yielded that 0.5-1.2 μl/min. of edema fluid is drained from the edematous white matter. The data confirmed the evidence that the removal of the edema fluid into the CSF is the main mechanism of resolution of vasogenic brain edema. The measurement of the fluid removal could be an useful aid in assessing the effect of drugs to facilitate the movement of edema fluid into the CSF.

View full abstract

Experimental hydrocephalus of the rat was produced by cisternal injection of Kaolin-solution. Intraventricular injection of India ink disclosed obstruction of cerebrospinal fluid pathways at the tentorial incisura in the hydrocephalic rat, while the same injection to the normal rat showed diffuse spreading of the dye over whole subarachnoid space of the brain. The injection of the dye into the cerebral subarachnoid space showed obstruction of the dye at the tentorial incisura in the hydrocephalic rat, while sufficient communication was observed between supratentorial and infratentorial subarachnoid spaces in the normal rat. There were however no remarkable differences between the normal and the abnormal rats about distribution of India ink over the cerebrum under macroscopic and microscopic observations.
Obstruction at the tentorial incisura was caused by arachnoid fibrosis and granulation and not by tentorial herniation. Considering experimental findings of paucity of adhesive arachnoiditis over the cerebrum and clinical reports of reversibility of the cerebral subarachnoid space, much effort should be made to promote CSF absorption over the cerebrum, instead of external drainage.

View full abstract