Neurologia medico-chirurgica

Neurophysiological Organization of the Superior Colliculus Pathways Related to Gaze Control

Minoru MAEDA, Shozo ISHII

1981 Volume 21 Issue 1 Pages 1-10
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.1

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To elucidate the role of the superior colliculus in gaze control, intracellular responses in superior colliculus neurons (tectospinal, TS and tectoreticular, TR) to electrical stimulation of the vestibular nerve, the optic disk and contralateral superior colliculus were studied in chloralose-anesthetized cats.
1) Stimulation of the contralateral optic disk typically produced EPSPs in TS and TR neurons with disynaptic and polysynaptic latencies. Ipsilateral optic disk stimulation induced only polysynaptic EPSPs. Trisynaptic EPSPs were recorded following stimulation of the contralateral vestibular nerve. Polysynaptic EPSPs and EPSPIPSP sequences were evoked from the ipsilateral vestibular nerve. TS and TR neurons received excitatory inputs more consistently and strongly from the contralateral optic disk and vestibular nerve than from the ipsilateral ones.
2) Responses to sinusoidal oscillation indicate the presence of at least semicircular canal inputs to tectal neurons.
3) Vestibular afferent volleys converge on and facilitate interneurons which mediate trisynaptic retinotectal transmission. Visuovestibular interaction at the level of the interneurons may play an important role in visually triggered movement (gaze) accompanied by head movement.
4) Stimulation of the contralateral superior colliculus evoked monosynaptic IPSPs in both TS and TR neurons. It is very likely that these monosynaptic IPSPs partly participate in the production of tectotectal inhibition as was suggested from lesion experiments. Tectotectal projections which may mediate such inhibition were revealed by retrograde transport of HRP.

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Immunocytochemical Approach to Virus-Induced Brain Tumors

—From the Aspect of T (Tumor) Antigen—

Kazuo TABUCHI, Masahiro TSUBOI, Hiroshi NORIKANE, Tomohisa FURUTA, Yos ...

1981 Volume 21 Issue 1 Pages 11-18
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.11

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Recently isolated human papovaviruses such as JC and BK viruses are not only antigenically related to SV40, but also neuro-oncogenic in experimental animals. Cells transformed in vitro or brain tumors induced by these viruses are usually free of infectious virus. However, the causual relationship between the tumor or transformed cells and the viruses can be immunocytochemically demonstrated by the presence of virus-specific non-virion antigens such as T (tumor) antigen. In the present study, the authors successfully applied a sensitive enzyme-labelled antibody method using Fab' fragment to localizing T antigens in SV40 or BK virus-induced brain tumors and infected cells. T antigens of SV40 and BK virus are immunocytochemically indistinguishable. Positive staining for T antigen is seen as a granular pattern in the tumor cell nuclei, but not the nucleoli, in the interphase and it appears as a loose network of electron-dense reaction precipitates associated with nuclear chromatin, whereas the chromosomes in mitosis do not seem to be tagged with immunoperoxidase reaction products for T antigens. On the other hand, T antigen is first observed in the cytoplasm of SV40-infected cells as early as 3 hours postinfection with subsequent transport to the nuclei within 24 hours. The intensity of staining of T antigen is markedly reduced because of maturation of virions in the infected cell nuclei 24 hours after infection. The authors believe that extensive studies of papovavirus T antigens are necessary to elucidate papovavirus oncology and may provide more information regarding possible viral etiology of human tumors of the central nervous system.

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Post-Treatment Kinetics of BCNU in a 9L Rat Brain Tumor Model

Kazuhiro NOMURA, Takao HOSHINO, Stephanie M. PENTECOST

1981 Volume 21 Issue 1 Pages 19-25
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.19

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After in vivo treatment with BCNU at 13.3 mg⁄kg, the dose lethal to 10 % (LD₁₀), rats implanted with 9L brain tumors exhibited an increased life span (ILS) of 56%. The growth fraction (GF) of treated tumors, as measured by fractionated doses of ³H-thymidine administered over 40 h, decreased for the first 2 to 10 days post-treatment, then increased and overshot the baseline (though by no more than 10 %) by Day 21. A second treatment with a LD₁₀ of BCNU either 5, 10, or 14 days after the initial treatment increased the ILS to 126-128 % and resulted in long-term survival (ILS>300 %) in 20 % to 30 % of animals, but did not produce a remarkable change in GF beyond that resulting from the initial treatment. Histological examinations revealed increased numbers of giant cells 2 to 6 days after the initial treatment; however, mitosis decreased immediately following treatment and remained low for the next 8 days. These results imply that (in this animal model, at least) a cell cycle non-specific (CCNS) drug is more effective as a second treatment after initial treatment with a CCNS drug than is a cell cycle specific one.

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Clinicopathological Study of Brain Tumor Radiotherapy

Masaru TAMURA, Jun-ichi KAWAFUCHI, Yoichi ISHIDA

1981 Volume 21 Issue 1 Pages 27-37
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.27

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A clinicopathological study was made on 45 autopsy cases of brain tumors treated with radiotherapy. Morphological changes after radiotherapy were classified into six categories : 1) tumor disappearance, 2) small residual tumor, 3) extensive tumor necrosis, 4) proliferative tumor growth, 5) mixed glioblastoma and fibrosarcoma, and 6) no remarkable change. When the tumors are primarily radiosensitive, tumor disappearance or small residual tumors might occur. Germinomas, some of lymphomas and medulloblastomas were representative of primary radiosensitivity. When the tumors are secondarily radiosensitive, or tumor cell necrosis is brought about by blood vessel degeneration caused by radiation, there might be extensive tumor necrosis. About one a half of the astrocytic tumors and glioblastomas were thought to have a combination of primary and secondary radiosensitivity. One case of oligodendroglioma, two cases of ependymoblastoma, two cases of malignant lymphoma and two cases of metastatic tumor also showed extensive tumor necrosis. The other half of the astrocytic tumors and glioblastomas showed proliferative tumor growth. They seemed to be less radiosensitive. Two cases of glioblastoma at the time of the operation changed into mixed glioblastoma and fibrosarcoma in the autopsy. No remarkable changes were observed in cases of teratoma and pineocytoma which were mature benign tumors with little blood vessel supply.
No definite correlations were observed between the pathological changes and therapies such as the degree of resection, doses of irradiation and chemotherapy in astrocytic tumors and glioblastomas. There were, however, some tendencies for small residual tumors and extensive tumor necrosis to be brought about by extensive tumor resection, full courses of radiotherapy and intensive chemotherapy.

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Pathological and Clinical Basis of the Indications for Treatment of Craniopharyngiomas

Tatsuya KOBAYASHI, Naoki KAGEYAMA, Jun YOSHIDA, Naoki SHIBUYA, Takeshi ...

1981 Volume 21 Issue 1 Pages 39-47
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.39

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Pathological and clinical studies were performed concerning the indications of operative treatment for craniopharyngiomas with seven autopsied brains and 15 cases which had been treated by extensive removal of the tumor.
From the present study, it could be concluded that the total removal of the tumor was not always possible without potential neuroendocrinological deficits. The pathological basis is that the tumor cells invaded adjacent brain structures as fingershaped or island-like protrusions without significant glial cleavage and with close approximation to the neurons of the micron order in some cases, while in the other cases, a thicker layer of gliosis including Rosenthal fibers and fibrillary astrocytes existed between the tumor and neuronal structures.
From the clinical study, the risk factors in the indication of extensive removal of craniopharyngioma could be correlated with the prognosis. These factors are the size and the location of the tumor, the existence of diabetes insipidus and psychiatric signs, and more significantly an irregular defect in the floor of the third ventricle.

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Intracapsular Irradiation Therapy of Craniopharyngiomas with Radioactive Gold: Indication and Follow-up Results

Takafumi KODAMA, Yasuhiko MATSUKADO, Shozaburo UEMURA

1981 Volume 21 Issue 1 Pages 49-58
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.49

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Sixteen cases out of 27 patients with craniopharyngiomas were arbitrarily subjected to combined treatment of simple surgical evacuation and intracapsular irradiation with 198-Au. Follow-up studies were performed on 15 cases and they ranged from 6 months to 11 years. One patient was omitted from the study because of a short postoperative period. Immediate postoperative morbidity and the endocrine functions at the end of the follow-up study were compared with those of the patients who underwent extensive surgical resection of the tumors. Intracapsular irradiation with 198-Au was found to have satisfactory effects in the treatment of cystic craniopharyngioma, especially in recurrent cases of initially solid tumors, with respect to the preservation of the endocrine functions and the daily activity of the patients. The immediate postoperative hazards in the patients' care were also much less and they were found to be easily manageable. The patients, who had been followed up for over 5 years, maintained an occupational IQ score in the normal range and the patients under school age were all able to continue their school lives. One of the female patients, who had been married after the treatment, could have two children without any specific replacement therapy, and another patient in childhood who had shown physical retardation due to HGH deficiency, showed favorable results with crescormon administration in comparison with cases of extensive resection. Although the dosimetric value of 198-Au should be varied according to the size and thickness of the capsule, it was found that 15 to 30 mCi of 198-Au was the appropriate dosis for treatment.

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Total Removal of Clivus Meningiomas and the Operative Results

Akira HAKUBA, Shuro NISHIMURA

1981 Volume 21 Issue 1 Pages 59-73
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.59

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Results of treatment of clivus meningiomas have been quite disappointing, primarily because of the position of the mass which is anterior to the brain stem and in direct contact with the vertebral and/or basilar artery. Most neurosurgeons consider it to be inoperable and simply perform a biopsy or partial removal. However, when the tumor is not too large and hard, total removal of a clivus meningioma should be tried with some precautions. The approach must be chosen to provide the shortest access to the main feeders, and multisided exposure should be obtained according to the location and the extension of the tumor. Out of our six cases of total removal, excellent results were obtained in two cases. In one of these two cases, an upper clivus meningioma was resected through a transpetrosal-transtentorial approach combined with a suboccipital approach, and in the other patient a middle clivus meningioma was removed through a suboccipital approach combined with extensive retrolabyrinthine removal of the petrosal bone. The operative results of the remaining cases were not so encouraging.

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Experimental and Clinical Studies on Prognosis-Deteriorating Factors in the Acute Stage of Intraventricular Hemorrhage

Mitsusuke MIYAGAMI, Tetsuo MURAKAMI, Ken-ichi WAKAMATSU, Tsutomu KONDO ...

1981 Volume 21 Issue 1 Pages 75-83
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.75

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Intraventricular hemorrhage in its acute stage was investigated both experimentally and clinically with special emphasis on factors that aggravate its prognosis.
In an experimental study, two groups of animals, one with blood clots in the ventricle and the other with liquid blood in the ventricle, were compared in terms of pathophysiological and morphological features. The fatal outcome in the experimental dogs was related to the amount of blood injected and its rate of injection. The injection of non-heparinized blood into the ventricle might have a more delaterious effect on the brain than that of heparinized blood.
The following factors were shown to play a significant role in deterioration of the existing disease: 1) the amount of hematoma and the rate of blood injection (or speed of bleeding), 2) intraventricular blood clot formation and its extent, 3) disturbance of cerebrospinal fluid circulation, 4) paraventricular tissue damage, 5) the site and extent of intracerebral hematoma and ventricular perforation and 6) the primary disease and age.

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Fibrinolytic Activity in CSF of Patients with SAH in the Acute Phase Measured by a Rapid Method (Correlation with t-AMCA Concentration in CSF)

Terutaka NISHIMATSU, Takashi SHIBASAKI, Hideo SASAKI, Hideaki NUKUI

1981 Volume 21 Issue 1 Pages 85-93
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.85

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To decide the minimum dose of antifibrinolytic agent for the conservative treatment of subarachnoid hemorrhage (SAH) in the acute phase, we developed a method to measure reduction in fibrinolytic activity of the cerebrospinal fluid (CSF) within a short period of time. It was reproducible and the result was expressed by the t-AMCA score. CSF was collected every 30 minutes or six hours in nine cases of SAH who were treated with an antifibrinolytic agent (t-AMCA) at a daily dose of 4-6 grams and the t-AMCA score obtained was compared with the dosage, t-AMCA concentration in CSF and daily excretion volume of CSF through drainage.
The results showed that the concentration of antifibrinolytic agent in CSF was negatively correlated with the daily excretion volume of CSF, and correlated with the dosage when the excretion volume was under 150 ml/day. The t-AMCA score usually changed in a constant pattern which was not related to the concentration of antifibrinolytic agent in CSF. In cases in which treatment was initiated within 48 hours after the hemorrhage, rapid reduction of the fibrinolytic activity in CSF was obtainted within 24 hours after administration, while in one case in which treatment was performed on the 6th day after hemorrhage, a favorable reduction in the fibrinolytic activity could not be obtained until the third day after administration. In a case in which repeated assays were performed in a short period, rebound fibrinolysis was observed two hours after administration and three days after withdrawal.

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Complications of Carotid Angiography in 939 Patients with Intracranial Aneurysms

Hiroshi NIIZUMA, Ryungchan KWAK, Takatsugu OHI, Jiro SUZUKI

1981 Volume 21 Issue 1 Pages 95-100
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.95

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The incidence of complications of cerebral angiography was investigated in 2, 772 carotid angiographies performed on 939 cases of intracranial aneurysms. Complications were seen in 30 cases (3.6%) and in 32 angiographies (1.2%). The incidence diminished year by year. However, when compared with the control group, the incidence of complications was apparently higher in cases of aneurysms. Complications were often seen in the acute stage after subarachnoid hemorrhagic attacks or after operations. Cerebral vasospasms seemed to be one of the important factors in the high incidence of complications. Carotid angiography should be performed with utmost care on aneurysm cases especially in the acute stage. Re-rupturing of an aneurysm during angiography was seen in only one case.

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Experimental and Clinical Study on Peripheral Nerve Allografting

Yasusuke HIRASAWA, Atsuo INOUE

1981 Volume 21 Issue 1 Pages 101-110
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.101

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There are numerous factors that affect the success of peripheral nerve grafting. Among these are (1) the type of injury to the nerve; (2) the degree of damage to the surrounding tissue and its complications; (3) the general condition of the patient; (4) the age of the patient; (5) the size, level and location of the nerve defect; (6) the local nutrition and the amount of scar in and around the nerve; (7) the accuracy of repair and the suture method; (8) the time lapse between injury and grafting; (9) the kind, length and thickness of the graft; (10) sterilization and preservation methods of the graft; (11) the problem of histocompatibility; (12) the method of immunosuppression; and (13) the rehabilitation method.
In the authors' clinic, research has been carried out to improve the methods of sterilization and preservation using a Cialit solution and cathode irradiation, the immunosuppressive method using steroid and Imuran, and microsurgical techniques such as sheathing method, full thickness grafting and cable grafting. The results of these experimental studies were applied in some clinical cases.
The experimental and clinical data on the peripheral nerve allografting in our clinic have been reported in this paper.

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Intracavernous Aneurysms and Carotid-Cavernous Fistulas. A Clinicopathological Study

Hisaya MIYAZAKI, Masaki KURIHARA, Hiroaki ISHIZAKA, Masashichi KAWANO, ...

1981 Volume 21 Issue 1 Pages 111-120
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.111

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The location of the original sites of the lesions was studied in 22 non-traumatic and 21 traumatic intracavernous carotid aneurysms in which the neck of the aneurysm was confirmed, and also in 23 traumatic carotid-cavernous fistulas in which the location of the fistula was identified. In the cavernous sinus, common sites of non-traumatic and traumatic carotid aneurysms as well as traumatic carotid-cavernous fistulas were the C₃-segment and C₄-C₅ junction of the internal carotid artery although 27 per cent of non-traumatic carotid aneurysms originated in the C₄-segment of the carotid artery.
An anatomical study of 37 cavernous sinuses removed from 23 cadavers revealed the following findings.
The inner surface of the venous sinus was covered with endothelial cell layers. The size and shape of the venous sinuses vary considerably, but they can be divided into three major groups: 1) the broken (58 per cent) or 2) the unbroken (33 percent) according to the amount of trabeculae and 3) the small scattered venous channel without trabeculation (9 per cent).
The third, fourth and fifth cranial nerves ran through the lateral wall without exception, but the sixth cranial nerve was found in the lateral wall in only 48 per cent of the specimens. The internal carotid artery was entirely surrounded by the venous sinus in 72 per cent of the cavernous spaces studied.
Based on the above findings, the possibility of direct surgery on aneurysms in the cavernous sinus and carotid-cavernous fistulas is discussed.

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Differential Diagnosis and Treatment of Small Subdural Effusion in Children

Koreaki MORI, Hajime HANDA, Masatoshi ITOH, Takehiko OKUNO

1981 Volume 21 Issue 1 Pages 121-125
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.121

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Twenty infants with peripheral low density areas over the frontal lobes in CT scans that resembled cortical atrophy or early communicating hydrocephalus are reported. Most cases presented minimal developmental retardation and a slightly bulging fontanelle. In many cases, peripheral hypodensity over the frontal lobes disappeared and the infants' development eventually reached normal levels without operations. The lesion might be called “infantile benign subdural effusion” and should be treated conservatively. Two illustrative cases are presented and the differential diagnosis is discussed.

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Size Reduction of a Large Prolactinoma by Bromocriptine Treatment. Report of a Case^*

Shigejiro MATSUMURA, Shintaro MORI, Tohru UOZUMI

1981 Volume 21 Issue 1 Pages 127-130
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.127

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A 32-year-old male patient with prolactin-producing pituitary adenoma was treated with 10 mg/day of bromocriptine (CB-154). The pre-administration baseline value of prolactin was 5, 000 ng/ml, which markedly decreased to 2-3 ng/ml after treatment. Computed tomography and pneumoencephlography performed at the time CB-154 administration was started showed the presence of a large supra and right parasellar extension of this tumor. About one year after the start of CB-154 treatment, the tumor had completely disappeared on CT scans. It is thought that CB-154 treatment reduced the size of a large prolactin-producing pituitary adenoma in this case.

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Dural Arteriovenous Malformation in the Anterior Fossa. Case Report

Shoji BITOH, Hidemitsu NAKAGAWA, Norio ARITA, Masaaki FUJIWARA

1981 Volume 21 Issue 1 Pages 131-134
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.131

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A report was given of a 61-year-old male with dural arteriovenous malformation in the anterior fossa, accompanied by a left putaminal hemorrhage. This vascular malformation, located in the dura mater of the tip in the left anterior fossa, was fed by the anterior ethmoidal artery of the left ophthalmic artery, without any additional contributions from the external carotid artery. Venous drainage consisted of the superficial cortical vein directed toward the superior sagittal sinus. Surgical procedures including electrocoagulation of the dural lesion and excision of the draining vessel resulted in the complete absence of any vascular malformation on the angiogram.

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A Case of Syringomyelia: Electrophysiological Analysis and Treatment for Attacks of Periodical Spasms and Intractable Pain

Kaoru TAGUCHI, Masaru WATANABE, Masahiko IOKU

1981 Volume 21 Issue 1 Pages 135-142
Published: 1981
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.21.135

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A 31-year-old woman underwent cervical laminectomy for decompression and diagnosis of syringomyelia which involved the higher cervical cord. After surgery, the patient complained of paresthesia with severe deep pain which appeared in her feet and migrated upwards in succession to her hands. At the same time, the patient suffered intense muscle spasms which started in the sternocleidomastoid and migrated downwards in succession to her legs. These attacks occurred all day, repeatedly, at intervals of 120 to 300 sec. Based on electrophysiological analysis, these attacks were considered to be due to abnormal discharges which developed in the lesion in the cervical cord, and stimulation of the pathways showing somatotopic laminations in the cord. Electrical stimulation of the median nerve at the wrist was effective against these attacks and complete remission was obtained by diphenylhydantoin administration.

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