The author introduced and applied a new method for investigation of cell motility in different human brain tumors, and studied their morphological characteristics during movement with a scanning electron microscope. Applying the principle that brightness of objects is reflected on the level of the video signal, motility of cultured cells in the Rose's chamber was continuously traced by controlling the video signal obtained from a video camera mounted on a phase contrast microscope. Displacement of the cultured cells on the plane was expressed as a sequential change of a pen recorder and in this system, the displacement of 1.5 μm corresponded to a change of 100 mV of the potential level. Cultured brain tumor cells showed differences in motility characteristics according to the cell origin. Meningioma and glioblastoma cells showed high motility. Malignant astrocytoma cells showed high motility when compared with benign astrocytoma cells. One of the morphological characteristics in movement of the cultured brain tumor cells was ruffling membrane formation at the periphery of the cytoplasm, the same as that observed in other mammalian cells. Direction and speed of the cell displacement were closely correlated with the site of formation and activity of ruffling. The glioblastoma and meningioma cells showed conspicuous ruffling activity. Some of these ruffles either stood erect or folded backwards. On the other hand, low grade astrocytoma cells showed faint ruffles at the apex of the cell processes. The significance of these differences in terms of motility and morphology shown in cultured brain tumor cells was discussed.
A rat brain tumor model was developed for chemotherapy by percutaneous innoculation of ascites hepatoma cells (AH-7974) through an optic canal. Using this in vivo model, efficacy of ACNU, one of the nitrosourea compounds, and adriamycin, an anthracycline derivative, was studied. The median survival time was significantly prolonged by a single injection of 10 mg/kg of ACNU on the 4th post-innoculation day and by double injections on the 4th and the 7th days when compared with the control group. No significant prolongation of life span was obtained by adriamycin except in the group given 5 mg/kg on the 7th day. The response of ascites hepatoma cells to these drugs was also studied using in vitro and subcutaneous tumor systems. The in vitro growth of the tumor cells was significantly suppressed by ACNU and adriamycin. The tissue concentrations of these drugs in both subcutaneous tumor and brain were equal. However, it was found that the tumor-brain ratio was different for these drugs because the normal brain was more permeable to ACNU than to adriamycin. This might be one reason why ACNU is a potent drug for brain tumors as well as for systemic tumors.
Anastomosis between the extracranial artery and the cerebral artery is now an important reconstructive procedure for cerebrovascular occlusive disease. However, there are still some problems which remain unsolved in the hemodynamics of the anastomotic system. Since the external carotid artery and the cerebral vessels normally possess opposite reactivities to carbon dioxide and other drugs, it is necessary, in EC-IC anastomosis, to ascertain the reactivity of the anastomozed system. In this study, chemical control of the lingo-basilar anastomotic system was investigated in dogs. Blood flow in the basilar and lingual arteries was measured by an electromagnetic flowmeter. The lingual artery was anastomosed end to side to the basilar artery which had been clipped at its origin. Blood flow of this anastomotic system was also measured electromagnetically. (a) Flow in the basilar artery: Following 7% CO2 inhalation, blood flow increased by almost 100%. Intravenous administration of epinephrine and norepinephrine (2 μg/kg) produced a rapid increase in blood flow to 77% and 71 % respectively, associated with a marked rise in systemic blood pressure. Intravenous injection ofpapaverine (2 mg/kg) increased blood flow (136%) despite of a slight fall in BP. The effect of apnea and resumption of respiration on blood flow showed a biphasic change. Acute hypertension was induced by inflation of a balloon which had been inserted into the aorta. Blood flow increased temporarily, but returned rapidly to its resting level. Autoregulation was well maintained. (b) Flow in the lingual artery: Seven percent CO2 inhalation produced a reduction of blood flow (25%). After injection of epinephrine and norepinephrine, the flow was decreased 55% and 48% respectively despite a marked rise in BP. Papaverine produced an increase in blood flow (143%). (c) Flow in the lingo-basilar anastomotic system: Alterations in blood flow following the above-mentioned procedures were well correlated with the changes in the basilar arterial flow. Thus, it may be concluded that the lingo-basilar anastomotic system is chemically controlled through responses of the cerebral vessels and not of the external carotid system.
Pathogenesis of gastrointestinal bleeding (GI bleeding) following cerebrovascular accidents (CVA) was studied by gastroendoscopy. Gastroendoscopic examinations were performed in patients with acute cerebrovascular accidents. These patients were operated on except for 2 cases. The gastroendoscopic examination was performed under general anesthesia just before or after the operation. Forty seven patients were examined (35 cerebral hemorrhages, nine subarachnoid hemorrhages, two infarctions, one moyamoya). The gastroscopy was performed in 25 cases within 24 hours from the onset of the CVA. Acute gastric changes within 24 hours were mainly gastric petechiae (GP). These findings were classified as follows: GP(1), petechiae localized in the fundal region; GP(2), petechiae observed diffusely and mainly in the fundal region; and GP(3), petechiae observed on the whole gastric wall with bleeding. GI bleeding and the degree of petechiae were closely related. GI bleeding was noticed in 25% of GP(1), 89% of GP(2) and 100% of GP(3). No fresh ulcerative findings were noted within 24 hours in our cases. Acute gastric changes were related to the level of consciousness. CT scans showed that cerebral hemorrhage frequently involved the hypothalamic region in cases of GP (2) or GP(3). It is concluded that characteristic acute gastroendoscopic findings within 24 hours from the onest of CVA are petechiae and the main cause of GI bleeding are these petechiae. Mucosal ulceration of the stomache and duodenum are secondary changes following petechiae.
Thirty five cases of tumors in the pituitary region were analysed by two-plane CT (ordinary sections and reverse sections) in order to obtain a more accurate image of the tumor and thus establish an appropriate indication for the subnasal transsphenoidal approach. Ordinary sections were examined at +25° from Reid's base line and reverse sections were examined at -20° from Reid's base line by EMI 1010. The reverse section was preferable in eliminating artifacts caused by body movements, air in the sinus or tooth filling. The reverse section was also advantageous because it was almost identical to the route of the subnasal transsphenoidal approach. In some cases, the overlapping and magnification method was used in the reverse section to clearly demonstrate small lesions. The tumors of pituitary region were classified into six groups (Types I ?? VI) according to their degree of extension and direction of growth: Type I: intrasellar tumors; Type II : tumors with extension to the chiasmatic cistern; Type III: tumors with suprasellar extension compressing the third ventricle up to the foramen of Monro; Type IV: tumors with suprasellar extension beyond the foramen of Monro; Type V: tumors with parasellar extension; and Type VI: huge tumors extending upward and compressing the lateral ventricle. Small tumors such as Types I and II were detected more clearly by the reverse section than by the ordinary section. In cases of large tumors (Types III ?? VI) relation of the tumor to the surrounding structures such as the sphenoid sinus, third ventricle, lateral ventricle, middle fossa and brain stem was accurately demonstrated by the reverse section. In the differential diagnosis of tumors in the pituitary region, tumors showing mixed density or slightly high density and widening of the antero-posterior diameter of the sella in the precontrast reverse section and homogeneous enhancement by infusion were likely to be pituitary adenomas. One third of the pituitary adenomas showed ring-like high density in the post-contrast reverse section. Calcification was not seen in the pituitary adenomas by CT scans. All craniopharyngiomas belonged to TypesIII ?? VI. Craniopharyngiomas showed high and/or low density, and various degrees of calcification in plain CT scans. Ring-like high density was seen in two thirds of the craniopharyngiomas. About one third of the craniopharyngiomas showed widening of the antero-posterior diameter of the sella. The subnasal transsphenoidal approach was applied to patients with tumors of Types I ?? III, and subcapsular total removal of the tumor was successfully performed. For older or severely complicated patients with tumors of Type IV, the subnasal transsphenoidal approach was also an appropriate method to decompress the optic nerve effectively and safely.
Cystic meningioma is rare and the frequency is only about 1.2 ?? 2.0% of all meningiomas in the literature. The authors experienced three cases of cystic meningioma. The first case was a 55-year-old male. He showed mental deterioration of 5 months duration. On admission he was apathetic and showed marked disorientation. Bilateral papilledema and the right pyramidal signs were also noticed. In CT scans, a well-defined homogenous high density area was seen in the left frontal lobe which was markedly enhanced. A well-circumscribed low density area was also seen in the center of the high density area. In the operation, exploratory puncture yielded 15 ml of xanthochromic viscous fluid. An elastic hard tumor was found attached to the left superior sagittal sinus and extended into the frontal lobe. The pathological diagnosis was meningocytic meningioma with a cyst. The second case was a 42-year-old female. She had suffered from headache and nausea for 3 months prior to admission. Neurological examination did not reveal any distinct deficit, but CT scan revealed a well-defined low density area in the right occipital region and a well-circumscribed high density area in the periphery of the lesion. In the operation, a large cyst was found, directly under the dura mater. About 30 ml of deep xanthochromic fluid was obtained by a puncture. The tumor, attached to the dura mater, was totally removed and the pathological diagnosis was meningocytic meningioma with an angioblastic component. The third case was a 30-year-old female whose complaints were headache and visual disturbance of 5 months duration. Except for bilateral papilledema, the neurological examination was normal. Neuroradiological examination indicated a left parietal mass lesion suggesting a cystic change. In the operation, about 25 ml of xanthochromic fluid was obtained by an exploratory puncture. The tumor was well-defined, elastic hard and attached to the falx. The pathological diagnosis was cystic meningioma of the transitional type. The clinical features, the pathogenesis of cyst formation and the diagnostic value of CT scans were discussed with a review of 37 cases reported in Japan. Location of the cystic meningioma was predominantly left-sided and most of these tumors were situated in the convexity. The pathogenesis of the cyst formation is still obscure although many theories have been proposed. Although diagnostic value of CT scans for cystic meningioma is very high, some cases are misdiagnosed as cystic gliomas. Clinical data and results of conventional neuroradiological examinations should also be taken into account.
Since the introduction of CT in February, 1977, 64 cases with 67 traumatic extradural hematomas were experienced. These cases were analysed, especially with regard to CT findings of the hematomas, small extradural hematomas, and combined intracerebral hematomas, and the correlation between CT gradings and clinical outcomes. From these analyses, the following results were obtained. In 64 out of 66 hematomas, except for a case of sagittal sinus hematoma, shapes were biconvex on CT scans. The other two were planconvex and crescent. One sagittal sinus hematoma could not be diagnosed by CT alone because the highest parietal slice was not taken. In 60 acute hematomas, densities of 59 were high. The other one was hypo or iso-dense. In six subacute hematomas, two were hypo and iso-dense respectively. These two cases showed a marked dural enhancement for contrast material. Initial admission CT scans disclosed 35 large hematomas (> 20 mm in thickness) and 29 small ones ( ≤20 mm). The other three were not clear in the initial CT scans. Among 12 small hematomas for which initial CT scans were performed within 6 hours after injury and sequential CT scans were carried out, six were shown to become larger. Three of these were operated on thereafter. Eleven cases with small hematomas on the initial CT scans were operated on. Their bleeding sources were the middle meningeal arteries in three cases, dural vein in one, fracture sites in four, and unclear in three. In 16 combined intradural lesions, ten were traumatic intracerebral hematomas. Four of these intracerebral hematomas were found simultaneously with extradural ones in CT scans. Six were obviously found later than the latter. Two cases with multiple extradural hematomas were reported. After evacuation of one extradural hematoma, additional extradural and intracerebral hematomas developed at other sites in these cases.
Thymomas are rare in general. Extrathoracic metastasis from such tumors is also infrequent. Involvement of the central nervous system by the true thymic tumor has been reported in only seven cases. Since the CT scan was invented, such metastasis has been found more frequently. This paper describes a case of malignant thymoma with brain metastasis which was diagnosed by CT scan. Improvement of the symptoms was noted after removal and subsequent irradiation of the metastatic tumor.
A case of epidural hematoma secondary to a ventriculoperitoneal shunt for hydrocephalus was described, and 42 cases of epidural hematoma as a complication of internal decompression were reviewed from the literature. Internal decompression in 42 cases consisted of ventricular puncture, ventricular drainage, ventriculography or shunt with or without suboccipital craniectomy in 35 cases, and supratentorial craniotomy without these procedures, but with certain other procedures such as suction of cerebrospinal fluid during surgery in 7 cases. The authors' case was a 19 year-old female who had a left frontal arteriovenous malformation which caused an intracerebral hematoma and intraventricular hemorrhage. She was treated by evacuation of the intracerebral hematoma and total resection of the arteriovenous malformation. External drainage from the left lateral ventricle was performed for 2 days. Postoperative meningitis was followed by communicating hydrocephalus, and a right ventriculoperitoneal shunt was installed 2 months after the hemorrhage. After the operation the patient was awake, but became drowsy in one hour. A large right temporoparietal epidural hematoma was detected by CT scan. After immediate evacuation of the hematoma, the patient recovered with left hemiparesis which cleared in 3 months without deficit. A review of the literature shows that epidural hematomas following internal decompression tend to arise in young and middle aged patients from 10 to 40, whereas subdural hematomas following shunt procedure tend to arise in infants and the elderly. Epidural hematoma is not always related to the operative site or side. One of explanations of the epidural hemorrhages is detachment of the dura as a result of dural contraction due to its elasticity under falling intracranial pressure. In 67.4% of a total of 43 cases including our case, onset of signs and symptoms appeared during the operation or in a few hours after the operation. In 25.6%, epidural hematoma was not disclosed before death and in 27%, it was found by exploratory burr holes, burr holes for shunts or decompressive craniotomy. Only 23.2% or 4.6% of all cases were adequately diagnosed preoperatively by angiography or CT scan, respectively. Prognosis of the epidural hematoma complicating internal decompression was quite poor and 44.2% of the cases died and 11.6% recovered with deficits. It is necessary to keep the possibility of acute epidural hematoma in mind during or after internal decompression and to examine the patient immediately by CT scan for unexplainable postoperative or intraoperative events.