Thirty cases of infantile traumatic subdural effusion were investigated to study the factors affecting it's clinical course, pathophysiology and prognosis.
Although the clinical course of traumatic subdural effusion differs from case to case, it seems reasonable to classify it roughly into the following two types: (1) cases showing exacerbation of preceding chronic subdural effusion by head injury; and (2) cases with chronic subdural effusion or cases transformed from acute subdural effusion.
These courses are intermingled with each other in some cases and the effect of treatment differs accordingly.
The determining factors of the response to the treatment are numerous and interrelated. Among the various factors, the existing pathological changes in the cerebral parenchyma have the most serious effects.
It is clinically important to establish the objective index predicting the prognosis before treatment. The accurate assessment of mental and physical development, measurement of cerebral hemodynamics and CT findings provide useful information for this purpose.

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Syngeneic brain tumor cell lines were made from inbred Wistar King Aptekman/HKM (WKA/HKM) rats using ethylnitrosourea in our laboratory. Ethylnitrosourea was injected intravenously at a dose of 50 mg/kg into pregnant rats. Two kinds of tumor cell lines were established from offsprings after cell culture. One was mixed glioma which was named KEG-1, and the other was neurinoma which was named KEN-1.
A immunochemotherapeutic study was attempted using KEG-1 cell lines. ACNU was injected intraperitoneally as chemotherapy. PS-K (protein-bound polysaccharide Kureha isolated from Basidiomycetes) was administered intraperitoneally as immunochemotherapy. Animals were divided into the following four groups.
Group 1 : Five×10⁴ viable cells of KEG-1 were inoculated to the right caudate nucleus on day 0. All rats receiving tumor cells died, with a mean survival time of 19.8 days.
Group 2: ACNU was injected intraperitoneally at a dose of 20 mg/kg on day 3. Mean survival time was 32.6 days, showing a 64 percent increase.
Group 3: PS-K was injected intraperitoneally at a dose of 300 mg/kg, according to the time schedule. PS-K alone did not affect the mean survival time.
Group 4: Five different timings of the combination of chemotherapy and immunotherapy (group (a) to (e)) were investigated in this group.
Group (a) animals received PS-K on days 0, 1 and 2 before ACNU. Mean survival time was 32.6 days showing no increase compared to ACNU alone.
Group (b) animals received PS-K on days 0, 1, 2, 3, 4 and 5 before and after ACNU. Mean survival time was 39.3 days, showing a 97.8% increase compared to controls.
Group (c) animals received PS-K on days 0, 1, 2, 6, 7 and 8 before and after ACNU. Mean survival time was 37.2 days, showing an 87.8% increase.
Group (d) animals received PS-K on days 3, 4 and 5 after ACNU. Mean survival time was 37.3 days, showing an 88.4% increase.
Group (e) animals received PS-K on days 6, 7 and 8 after ACNU. Mean survival time was 38.0 day, showing a 91.9% increase.
A marked effect was obtained when PS-K was injected before and after ACNU or after ACNU. When PS-K was injected before ACNU the mean survival time did not show any increase compared with that for ACNU alone. It appears that PS-K enhanced the rat's immunity which was suppressed by ACNU. The immunity of the rats was not enhanced when PS-K was administered before ACNU since the biological activity of PS-K might be short lasting. It is suggested that therapeutic effects are not always augmented if immunotherapy is combined with chemotherapy at random, but it depends on the timing of the combination.

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Activities of neurons of the thalamic relay nucleus and cortical somatosensory area which are capable of producing excitatory potentials in response to stimulation of the sciatic nerve were recorded, and local cerebral blood flow was measured simultaneously using a double microelectrode under local anesthesia in both non-pretreated cats and cats having undergone chemical denervation of the vasoadrenergic nerves by intraventricular injection of 6-OHDA, to unmask the neural control on the cerebral vessels during increases of local metabolic rate. The results obtained may be summarized as follows:
(1) A positive correlation was found between an increase in firing rate of a single neuron in the thalamic relay nucleus and somatosensory area, and an increase in local cereb al blood flow following stimulation of the sciatic nerve. A distinct spatial and quantitative correlation was thus observed between neural activity and cerebral blood flow.
(2) In 6-OHDA-pretreated cats, an increase in neuronal firing rate was observed following stimulation of the sciatic nerve, as it was in non-pretreated cats, but the concurrent response of local cerebral blood flow was seriously impaired. All these findings indicate that the increase in local cerebral blood flow occurring in association with increased neural activity does not result solely from increased local metabolism and a consequent increase in CO₂ production, but requires that certain basic conditions be satisfied and maintained by the vasoadrenergic innervation.

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Eighty-four patients with ruptured intracranial aneurysms were analyzed to investigate relationship of cerebral vasospasms to subarachnoid clots and to cerebral circulation and the effect of vasospasms upon the development of cerebral infarction.
The extent of vasospasms was classified into four types: diffuse (narrowing over 2 cm in length in at least one of the C₁, A₂ and M₁ portions), peripheral (narrowing over 2 cm in length in the distal portions), multi-local (multiple localized narrowing) and local (single localized narrowing). The diffuse type of vasospasm was further divided into two grades of severity: diffuse severe (reduction of the caliber by more than 50%) and diffuse mild (reduction of the caliber by 25 to 50%). As an indicator of objective estimation of vasospasms, the ratio of the diameter of the arteries at the C₁, A₂ and M₁ portions to that of the canalicular portion of ICA was calculated from 32 normal angiograms. Measurement of the rCBF was undertaken by the intra-arterial xenon-133 injection method. The degree of subarachnoid clot was graded according to the high density area in the CT from 0 (no clot) to II (diffuse and severe clot in the basal cisterns, especially around the midbrain). The extent of the vasospasm was estimated by angiography performed 4 to 20 days after the subarachnoid hemorrhage.
The results were as follows: 1) There was a good correlation between the degree of subarachnoid clot within 3 days after the subarachnoid hemorrhage and the types and the severity of the vasospasm. Fifteen out of 18 patients with grade I or II subarachnoid clot developed the diffuse type of vasospasm (nine severe and six mild), while only three cases developed the diffuse type of vasospasm (one severe and two mild) out of eight patients with grade 0 or I. 2) Most of the patients with the diffuse type of vasospasm, especially with the diffuse severe type, showed decreases of mean CBF and impaired CO₂ response, while mean CBF of the patients with the multi-local or the local type ofvasospasm showed no meaningful decrease when compared to the patients without vasospasms. Focal ischemia was frequently shown in regions supplied by the involved arteries in the patients with vasospasms. Increase of cerebrovascular resistance was seen in patients with the diffuse-severe type of vasospasm. 3) Twenty out of 38 patients with the diffuse type of vasospasms developed cerebral infarctions (12/20 severe, 4/14 mild and 4/4 peripheral), while none of the 14 patients with no, vasospasm or local and multi-local type of vasospasm developed cerebral infarctions. 4) Development of cerebral infarctions after subarachnoid hemorrhages depended not only on the severity of vasospasms but also on the duration of the vasospasm and interval between onset of the vasospasm and the subarachnoid hemorrhage.

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Results of aneurysm operations are unsatisfactory when they are performed within one week after the subarachnoid hemorrhage. The major cause of the poor results is vasospasms in the postoperative period. The authors propose prophylactic administration of isoproterenol and aminophylline in the postoperative period before actual signs of vasospasms appear. The treatment lasts two weeks after a subarachnoid hemorrhage. In eighteen cases in which this scheduled treatment was completed, seventeen showed full recovery and one had permanent hemiparesis. In the course of treatment, however, various side effects were encountered such as polyuria, convulsive seizure, abnormal psychiatric condition, nausea, vomiting, hiccup and hypotension. In three cases, hemiparesis and deteriorated sensorium level developed during interruption of infusion of the drugs. Angiography revealed vasospasms and a prolonged circulation time. These signs disappeared shortly after re-starting the regimen. In the other two cases, signs of vasospasms appeared in the course of treatment. These cases were handled by increasing the circulating volume using 5% albumin fluid and i.v. hydrocortisone. They showed excellent recovery. Postoperative angiography showed vasospasms in ten cases out of eighteen without signs of vasospasms. The authors concluded that prophylactic administration of these drugs is indispensable when operations are performed on intracranial ruptured aneurysms in the acute stage, despite of the numerous side effects and large amount of labor required for precise observations and for maintaining a constant blood level of drugs for two weeks.

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The colloid cyst of the third ventricle is a rare and unique tumor located in the anterior part of the third ventricle, just below the foramen of Monro. Since the lesion presents a great variety of signs and symptoms, the diagnosis is notoriously difficult if ventriculography or computed tomography is not performed. In the present article, one case is reported and 350 cases in previous publications are reviewed.
A 45-year-old male developed a transient loss of consciousness followed by nausea and vomiting. He had two similar episodes in the previous 15 years. Computed tomography disclosed marked enlargement of lateral ventricles and a small round lesion in the anterior third ventricle. The cystic tumor, 9mm in diameter, was successfully removed by the trans-lateral ventricular approach with microsurgical techniques.
A review of previous cases showed diverse clinical manifestations of the cyst. The signs and symptoms were classified into the following groups.
(1) Due to moderate and/or intermittent disturbance of cerebrospinal fluid (CSF) flow: headache(82%), nausea and vomiting(53%).
(2) Due to sudden, severe obstruction of the CSF pathway: acute deterioration, often fatal(19%).
(3) Due to chronic, mild disturbance of CSF flow: progressive dementia(16%), disturbance of gait(15%) and urinary incontinence (9 %).
(4) Miscellaneous: false localizing signs etc.
The “classical story” of the cyst, which is characterized by intermittent attacks of headache related to abrupt movements of the head, was noted only on a few occasions(7%).
The diagnosis is readily made by computed tomography. Good results can be expected in surgical cases.

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A case of craniopharyngioma confined in the third ventricle is reported.
A 53-year old man was admitted because of headache, nausea, vomiting and general malaise lasting for one year and a half before admission. Neurological examinations showed no significant abnormalities except for a slight degree of papilledema. Lumbar cerebrospinal fluid contained 200 mg/dl of protein and other laboratory tests were normal. Plain skull films were normal. A static technetium 99m brain scan showed no increased uptake. Angiography demonstrated only symmetrical dilatation of the lateral ventricle. Conray ventriculography outlined an irregular mass almost completely filling the anterior third ventricle. Pneumoencephalography showed no abnormality in the suprasellar cistern. Biplane CT scans showed a homogeneously highly enhanced tumor located precisely above the sella turcica and in the third ventricle. A right frontal craniotomy was performed and the transcallosal approach to the lateral ventricle was made. A part of the tumor protruded through the left dilated foramen of Monro into the lateral ventricle. The tumor was reddish, solid, soft and densely adherent to the right wall of the third ventricle. The tumor was subtotally removed under an operating microscope. Histopathological examination of this tumor revealed squamous cell type craniopharyngioma. The patient made an uneventful postoperative recovery, but 2 months after the first operation. a V-P shunt was performed because of gradually developing normal pressure hydrocephalus. Although he recovered after the shunt operation, he died of pneumonia 2 months after the shunt operation. No autopsy was performed. Craniopharyngioma located entirely in the third ventricle has, to our knowledge, been reported in only six cases previously. These reports were reviewed and the condition is discussed in terms of etiology, diagnosis, clinical course and treatment.

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A case of heterotopic gray matter in the left subependymal region is reported.
The patient was a 16 year-old female who was admitted to the Department of Neurosurgery on March 10, 1978 with chief complaints of syncope and generalized convulsion.
Neurological examination on admission revealed no abnormalities. CT scan showed a broad-based isodense mass in the dilated left lateral ventricle, which was not enhanced by contrast media. Pneumoencephalography revealed a round defect in the center of the left lateral ventricle.
On April 12, 1978, the left lateral ventricle was entered through a corticotomy, and a round lump covered by ependymal wall was discovered at the posterior part of the foramen of Monro. This bulging mass was completely removed. CT Scan after surgery showed that no mass remained.
Histopathologically, cells were noted and mild gliosis and some scattered neuron. This specimen was regarded as a gray matter. No malignancy was identified.
Postoperatively, she was free from any convulsions or syncope.
In this case, CT scan was a useful diagnostic procedure among other neuroradiological studies for differential diagnosis.

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A case of giant meningioma in the third ventricle in a 48-year-old woman is reported with discussion of the CT findings and the operative approaches.
She was admitted complaining headache and ataxic gait.
Vertebral angiography showed a large, cleary outlined homogeneous tumor stain and a feeder from the anteriorly and superiorly-displaced medial posterior choroidal artery.
CT-scan showed a markedly enhanced high density mass without peritumoral low density and symmetrical enlargement of the lateral ventricle.
An operation was performed through the transcallosal approach following bifrontal craniotomy. The greatest advantage of this approach is that it permits entry into both lateral ventricles and provides direct access to deep regions of the third ventricle through the foramen of Monro.

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