Hereditary asplenic-athymic (lasat) mice were used in a study of heterotransplantation of an established human glioma cell line designated KNS-42 derived from a glioblastoma located in the right posterior frontal and parietal lobes of a 16-year-old boy. All six lasat mice, inoculated with 6×10⁶ to 1×10⁷ cells subcutaneously, developed permanently growing tumors which were strikingly similar to the parent tumor. In paraffin sections the transplanted tumor tissue was of high cellularity and showed perivascular arrangement of tumor cells with marked endothelial proliferation, mitotic figures, and small necrotic foci. Invasive proliferation of the tumor cells beyond the proper connective tissue capsule of the mouse was also noted. Under electron microscopy tumor cells in the mice, similar to the cell line, retained a large amount of glial filaments measuring 9-10 nm in diameter. In an immunodiffusion study, the cell line and the tumors in mice showed a precipitation line with rabbit immune serum against purified glial fibrillary acidic protein.

抄録全体を表示

Cross-reactivities between chemically induced rat tumors and fetal tissues were examined by the migration inhibition test. Wistar/Fib adult rats were immunized by intracutaneous injection of Freund incomplete adjuvant with or without the extracts of various fetal tissues (one-week whole fetal tissue, two-week fetus without brain and spinal cord, and two-week fetal brain). A mixture of thymic and lymph-node cells was used as migration cells. Peripheral neurinomas (T1 and T3) and oligodendroglioma (T2) were induced by ethylnitrosourea with single intraperitoneal injection in pregnant rats in the third week of gestation; 3M KCl extracts of these tumors served as antigens. The animals sensitized by two-week fetus reacted with all neurogenic tumors although in half of them (4/8) no significant differences from the reaction of the lymphoid cells sensitized by Freund incomplete adjuvant alone were demonstrated. The lymphoid cells sensitized by one-week fetus showed the weakest responses (especially in the reaction with T3 tumor) among all fetal extracts.
The T1 tumor was also suggested to have brain specific antigens. When the lymphnode cells served independently as the migration cells, it was very difficult to obtain positive results which were easily obtained by a mixture of lymph-node cells and thymic cells. However, the lymph-node cells sensitized by one-week fetus reacted much more strongly than the mixture of thymic and lymph-node cells.
In vivo tumor rejection studies on the embryonic tissue of immunized rats are now in progress.

抄録全体を表示

Immunological cross-reactivities between rat spontaneous mammary carcinoma or ethylnitrosourea (ENU)-induced neurogenic tumors and various fetal and adult tissues were tested in vitro by the migration inhibition test (MIT).
Wistar/Fib rats were immunized with either live cells or radiation-killed tumor cells of over 37 transplant generations. ENU-induced neurinomas of the peripheral nerve (T1, T3) lost some of their antigenicities in the later transplantation generations, and failed to react with fetal or brain tissues. On the other hand, ENU-induced oligodendroglioma (T5) retained strong antigenicities at least up to the 10th passage. In addition, T5 and syngeneic spontaneous mammary carcinoma (T9) showed similar responses to fetal extracts.
Among the tissues examined, two-week fetal tissues showed the highest expression of fetal antigens detected by cross-reaction with these tumor cells.
MIT with 3M KG extracts of fetal tissues demonstrated that sensitization with live tumor cells elicited stronger immunological responses than that with radiationkilled cells.

抄録全体を表示

The cytogenesis of BK virus-transformed hamster brain cells (HBBK cells) was studied. HBBK cells with indistinct processes showed a tendency to epithelial arrangement as well as characteristics of malignant or immature tumor cells in vitro. They developed long, delicate processes forming tree-like networks and were transformed into mature glia-like cells by the addition of c-AMP into the culture medium. Glial fibrillary acidic protein was demonstrated by immunofluorescent staining in the cytoplasm of almost all HBBK cells. The tumors arising in hamsters after subcutaneous inoculation of HBBK cells resembled human immature neuroectodermal tumors such as medulloblastoma, ependymoblastoma or glioblastoma, and were classified as poorly differentiated gliomas from their cytomorphological characteristics.
This study suggested a selective transformation of glial cells in hamster brain cell cultures by BK virus or an affinity of BK virus for glial cells.

抄録全体を表示

The effects of retinoids on the growth of murine and human gliomas and on the antineoplastic activities of 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) and vincristine were studied. No significant inhibitory effect on proliferation of human glioblastoma (GB) cells in vitro was found 48 hours after administration of 0.003 mg/ml of retinol acetate. No significant inhibition of murine glioma growth nor significant prolongation of median survival was observed when 70 mg/kg of retinol palmitate was given every other day 5 times from day 7 after the subcutaneous inoculation of glioma. Significant inhibition of GB cell proliferation by ACNU and vincristine in vitro was dose-dependent. The antitumor effects of ACNU and vincristine in vitro were usually enhanced by 0.003 mg/ml of retinol acetate and a statistically significant enhancing effect was found in 10^-6 g/ml of ACNU. The inhibition of tumor growth in vivo induced by ACNU given every other day 5 times was usually enhanced by the addition of 70 mg/kg of retinol palmitate given 4 hours prior to each ACNU administration, and its statistical significance was found on day 21 in treatment with 1 mg/kg of ACNU and on days 21 and 28 in treatment with 10 mg/kg of ACNU. The increase in median survival induced by ACNU administration was also enhanced by treatment with retinol palmitate, but no statistical significance of enhancement was found. In addition, the percentage cure of subcutaneous glioma was higher in treatment with ACNU plus retinol palmitate than with ACNU alone.

抄録全体を表示

Four cases of choroid plexus papilloma in children are presented with special references to the radiological findings. Two occurred in the third ventricle and one each in the lateral and the fourth ventricles. There are few reports in the literature about third ventricle papillomas. Angiography is one of the important radiological means for demonstrating them when they cause dilatation of the choroidal arteries, tumor stains, and hydrocephalus. Difficulties encountered in differentiating choroid plexus papillomas from other ventricular tumors are discussed.

抄録全体を表示

As models of clinical hypertensive intracerebral hematomas, intracerebral hematomas were induced experimentally in 26 mongrel dogs. The CT images of the hematomas during healing were compared with histological findings to determine the cause of ring enhancement in contrast enhanced CT.
The ring enhancement appeared at almost the same time in all dogs, 9 days after formation of the hematomas. Formation of many new capillaries in the peripheral region of the hematomas was seen from day 9 and the ring enhancement was found to be closely associated with these new capillaries. Electron microscopy showed that these newly formed capillary vessels had a similar ultrastructure to those of the muscle. These vessels seemed to have no blood brain barrier. Thus the ring enhancement was attributed to the accumulation of contrast medium in these newly formed vessels and its leakage from the vessels owing to their increased permeability.

抄録全体を表示

Two representative cases of anastomosis of the superficial temporary artery (STA) to the middle cerebral artery (MCA) for the treatment of focal cerebral ischemia are presented and the changes in collateral circulation following the surgery are discussed based on twenty cases treated in this way.
Redistribution of cerebral circulation took place following the surgery. Although the collateral pathway constructed microsurgically was narrow and slender in the early postoperative period, it dilated with time in a majority of the cases. On the other hand, some of preexisting extra to intracranial collateral channels atrophied and narrowed following the surgery.
The role of the microsurgically constructed bypass might be of limited value in the early postoperative period. Spontaneously developed collateral channels must, therefore, be preserved to operate safely for prevention of cerebral ischemic attacks particularly in this period.
Our findings indicate that sacrificing the anterior branch of the STA for STA-MCA anastomosis might be risky in certain cases in which the anterior branch was functioning as one of the main preexisting extra to intracranial collateral routes. In such cases only the posterior branch of STA should be used as a donor artery.

抄録全体を表示

The statistical data in this paper suggest that the number of neurosurgical operations on elderly patients will further increase and halothane anesthesia will maintain its popularity until the advent of a better anesthetic agent. The specificity of elderly patients and important preoperative preparations are discussed. Pre and postoperative complications were most frequently found in the cardiorespiratory system. PaO₂ decreased postoperatively, whereas PaCO₂ was often lower than normal. Good communication between the anesthesiologist and the neurosurgeon is fundamental for safe neuroanesthesia on problematic elderly patients.

抄録全体を表示

During the five years between 1973 and 1978, 494 patients with intracranial aneurysms were operated on using a microsurgical procedure. One hundred forty-eight patients over 60 years of age were clinically analysed and were compared with those under 60 years of age.
1. In grade 1 and 2 of Hunt's classification, the patients over 60 had the same mortality rate (about 7 %) as the younger patients. The over-all success rate of 89.9 in the elderly group was similar to that in the younger group.
2. Following early operation, the mortality rate was 13.3 % for the elderly patients of grade 1 and 2, and 15.5 % for the younger ones. In the delayed operation, it was 4.3 % for the elderly patients, and 1.9 % for the younger ones.
3. The elderly patients with grade I and 2 had a lower morbidity rate in the early operation (30 %) than in the delayed operation (62.3 %), whereas the younger group showed no such difference. Mental symptoms such as disorientation were more common in the aged patients.
4. Surgical mortality was much higher in the elderly patients of grade 3, especially in those who underwent an operation within 2 weeks after hemorrhaging. Postoperative complications occurred more frequently in the elderly patients, especially in grade 3.
5. In patients of grade 4 and 5, the operative mortality and morbidity were very high in both the elderly and younger patients. These results suggest that grade 4 or 5 patients should be treated conservatively, unless a large intracranial hematoma is identified.
6. We conclude from these results that elderly patients in grade 1 and 2 should be treated surgically as soon as possible. In grade 3, surgical treatment should be delayed during the first two weeks of conservative treatment. Meticulous postoperative care of elderly patients is mandatory to prevent various complications.

抄録全体を表示

The authors discuss laser surgery of meningiomas which are difficult or impossible to remove by conventional methods. The CO₂ laser surgical unit (scalpel), Medilaser-S, Model MEL-442, was originally developed for neurosurgery by Takizawa and his team. One of the conspicuous advantages of the CO₂ laser scalpel is its ability to remove highly vascularized tumors with minimum bleeding. Another advantage is that it enables a surgeon to remove a firm tumor precisely without using mechanical force. The cases included in this paper are highly vascularized sphenoid ridge meningioma, giant falx meningioma, firm tuberculum sellae meningioma, tentorial meningioma, ventricular meningioma and orbital meningioma. Disadvantages of the CO₂ laser scalpel and methods to offset them are also discussed. These disadvantages may be surmounted by the combined use of the electrosurgical unit, cryosurgical unit, CUSA system, etc. The CO₂ laser scalpel is not ideal, but it is no doubt a break through in surgery of brain tumors which are difficult to remove by conventional methods.

抄録全体を表示

Fifty-three patients with hemifacial spasm, six patients with trigeminal neuralgia and five patients with unilateral tinnitus were treated by a “microvascular decompression” method and follow-up results for more than one year were evaluated. Follow-up operative results of 44 patients with hemifacial spasm were : 1) excellent—24, 2) good—12, 3) fair—7 and 4) poor—1. The operative results of hemifacial spasm were evaluated according to Jannetta's classification¹⁷⁾ combined with the degree of postoperative hearing reduction. Reduction of hearing acuity occurred in nine out of 53 patients. No recurrence of hemifacial spasm was encountered during follow-up period. It was interesting enough that the ipsilateral facial paresis which existed preoperatively gradually improved after decompressive surgery for hemifacial spasm. Eight out of 10 patients who developed facial paresis without having previous traumatizing surgical treatment and six out of 13 patients who had undergone previous peripheral surgical treatment for hemifacial spasm gradually improved after this decompressive surgery. All six patients with trigeminal neuralgia were completely cured and they noticed no sensory changes on the affected side of the face postoperatively. Four out of five patients with tinnitus were improved by the surgery.
The most characteristic forms of compressing arteries were that the arteries crossdistorted the cranial nerves usually at their exit zones from the brain-stem and the arteries were angled and sclerotic focally at the compressing sites. Vertebral angiographic studies provided a key to solve the problem of why these arteries were sclerotic at the angular part and why hemifacial spasm affected one side of the face. Although the etiology of these hyperactive dysfunctions of the cranial nerves is still controversial, vascular compression-distortion seems very likely to be responsible for these syndromes. The “microvascular decompression” of cranial nerves is a refined and nontraumatic technique which seems to promise a stable and permanent cure of the hyperdysfunction of cranial nerves.

抄録全体を表示

Two cases with vertebral and basilar aneurysms arising at midline on the lower clivus, which were operated on by the transoral transclival approach, are reported. The transclival approach seems to be the most satisfactory for cases with aneurysms in this location, as it offers direct exposure of aneurysms and the surrounding structures without retraction of the brain-stem and cranial nerves or vessels.

抄録全体を表示

Surgery of the peripheral nerves is briefly reviewed with special emphasis on the timing and the techniques of nerve repair.
The sooner a severed nerve can be repaired, the better the quality of the recovery. While delays of a few months after injury appear to have no serious effect on the outcome of nerve sutures, the chances of successful recovery decline after six months. It is not common for markedly good recovery to follows nerve suture a year or more after injury. Investigation of the local neuropathological factors and the metabolic changes within the neuron suggests that, in the divided nerve, the interrupted fascicles should be sutured as soon as the longitudinal extent of the injury can be accurately determined. A short delay in nerve repair, however, is often indicated when successful regeneration of the budding neuron across a repair site is thought possible. The possibility for recovery of a lesion in continuity can be predicted eight to twelve weeks after injury by recording nerve action potentials. Nerve action potential recording in the early months after injury allows identification of partial injury and the neuroapraxic element of an injury. It also provides a measure of relatively early regeneration.
The traditional method of repairing peripheral nerves has been the epineurial suture. Concern over the reaction to suture materials which might interfere with nerve regeneration resulted in the search for sutureless methods of uniting the nerve ends. Plasma clot maintains the nerve ends in apposition and does not appear to set up any reaction, but it is absorbed before natural healing has effected a firm union at the nerve ends. Sheathing methods have been designed to hold the nerve ends together and protect the junctional zone by an encircling tube of biological or non-biological materials, and at the same time confine regenerating axons to the suture line by preventing them from straying further afield. None of these methods has eliminated the malalignment of axons and is suitable for large nerves or nerve sutures with a tension on the suture line.
A good epineurial closure does not always mean that all of the internal architecture of the nerve has been restored. Funicular nerve suture to improve the results of nerve repair was discussed by Langley and Hashimoto as early as 1917. By careful approximation of the corresponding fascicles, this method can improve the quality of the recovery after nerve suture by preventing the wasteful regeneration of axons outside funiculi and their entry into functionally unrelated endoneurial tubes. With the increasingly wide use of the operating microscope in neurosurgical practice, it is now clear that this method can be applied more generally.

抄録全体を表示