Two cases of benign choroid plexus papilloma are reported, one in the third ventricle in an 8-month-old boy and the other of disseminated choroid plexus papilloma in the cervical spinal leptomeninges occurring after an interval of four years following the removal of choroid plexus papilloma originating in the fourth ventricle in a 7-year-old boy. The ultrastructure of these tumors was demonstrated and compared. Though the benign choroid plexus papilloma closely mimiced the architecture of the normal choroid plexus, the disseminated choroid plexus papilloma had no fenestrations nor pinocytotic vesicles in the walls of the capillaries or endothelial cells and was presumed to have ceased secretion of cerebrospinal fluid.

抄録全体を表示

The authors obtained the following results in an experiment of 30 lateral head impacts applied to 10 monkeys.
1. Lateral impact tolerance which is an index of concussion was estimated to be about twice as high as sagittal impact tolerance, but more experimental cases in the future will be required to decide the proper tolerance level.
2. Concussions had three types of effects on the cardiopulmonary system, and significant mutual correlations and correlation with concussion severity were shown.
3. It is characteristic of lateral impact that, although the tolerance level appears to be high, there are diverse and characteristic pathological changes, and it is assumed that contusions such as gliding contusion and Zentrale Hirnschaden (or intermediary contusions) are apt to occur in cases of lateral impact.

抄録全体を表示

Healing of the carotid artery after endarterectomy in adult mongrel dogs was investigated at intervals from 15 minutes to two weeks after surgery by light and scanning electron microscopy. In the control group, a fibrin-platelet carpet was found on the surface of the endarterectomized wall of the vessel soon after surgery. A large, typical, red thrombus was noted on the endarterectomized surface in three of six control animals 15 minutes after the operation, and in another one hour after the operation. On Day 1 after surgery, no new thrombus formation was detectable. On Day 3, most of the mural thrombi had disappeared, and formation of new-endothelium had started and was completed about one week after the operation. In the group treated with aspirin, thrombus formation in the wall was much less just after operation, and no large thrombi were seen in any animals. Almost no newly formed endothelium was detectable on Day 3. After one week, new endothelium covered only about 60% of the inner surface of the artery, but after two weeks the formation of new-endothelium was almost complete in all dogs. Thus, with aspirin treatment, formation of new endothelium seemed to be delayed and the new endothelial cells seemed to grow somewhat differently from those in the control group.

抄録全体を表示

Current investigations have indicated that prolonged vasoconstriction in vasospasm following subarachnoid hemorrhage due to rupture of intracranial aneurysms is the result of a combined action of various vasoconstrictive agents such as serotonin, oxyhemoglobin, thrombin and prostaglandins. PGI₂ (prostacyclin), on the other hand, has been known to possess antagonistic actions to some of the above agents.
To elucidate the role of PGI₂ as a natural protecting factor against the occurrence of vasospasm, its inhibitory action against vasoconstrictions induced by serotonin, oxyhemoglobin, PGA₂, PGD₂, PGE₂ and PGF_2α was studied in vitro using the canine basilar artery. PGI₂ in concentration of 10^-6 M caused vasodilation ranging between 20 to 70% of the basal contraction developed by each agonist. Thus it was revealed that PGI₂ caused a significant dilation of the artery which had been constricted by any of the above agents. Since the progressive diminution in PGI₂ synthesis in experimental SAH has been previously demonstrated, the result of the present study indicates a possible benefit of the us₂ of PGI2 as well as the need for preservation of PGI₂ synthesis in any pharmacological treatment of vasospasm.

抄録全体を表示

The direct surgical attack on carotid-siphon aneurysm is hazardous and difficult as compared with other intracranial aneurysms because of its location adjacent to the skull base, the optic nerves and chiasm. The authors report and discuss the surgical treatment of carotid-siphon aneurysms based on our surgical experience of 20 such aneurysms in 18 cases during the period from October 1971 to September 1980.
1. Many aneurysms arising from the C₂ carotid-ophthalmic portion of the internal carotid artery can be treated by neck clipping through the pterional approach. It is preferable to clip the neck through a contralateral pterional approach in some cases where the fundus projects posteromedially.
2. For giant aneurysms, it is advisable, along with internal carotid artery trapping, to perform superficial temporal-middle cerebral artery anastomosis.
3. Small aneurysms arising from the C₃ or C₄ portions of the internal carotid artery will become only faintly visible in angiograms after internal carotid artery ligation with superficial temporal-middle cerebral artery anastomosis, which indicates its effectiveness as a treatment for such aneurysms.

抄録全体を表示

Twenty eight basilar-superior cerebellar aneurysms (BA-SCA) and 31 basilar bifurcation aneurysms (BA-BIF) in 57 patients were analysed in a radiometric study to determine the usefulness of the transsylvian approach. The line between the anterior clinoid process and the posterior clinoid process was adequate as a base line for measurement of aneurysmal location. The height of internal carotid bifurcation (ICAh) defined the entrance of the trans-sylvian approach. Postoperative complications such as oculomotor palsy or hemiparesis were less frequent when the ICAh was higher than 10 mm in both BA-SCA and BA-BIF. The height of the aneurysm (ANh) was another important factor which determined the difficulty of operation. Neurological deficits were less common when ANh was between 5 mm and 10 mm above the baseline. Simple radiometry offers an important clue as to the difficulty of operation.
Results of surgery was quite satisfactory and there was only one death in each (16 BA-SCA and 18 BA-BIF) that were treated by the trans-sylvian approach.

抄録全体を表示

Computed tomography (CT) of the cervical spinal column was carried out in 42 patients using a General Electric CT/T or a Toshiba TCT60 Type A scanner. There were 22 cervical disk lesions, 4 spinal neoplasms, 6 narrow spinal canals with or without ossification of posterior longitudinal ligament, 2 syringomyelias, 6 traumas and 2 Arnold-Chiari malformations. In all patients, CT-examination followed conventional spinal X-ray studies. Correlation between the CT and conventional X-ray findings revealed the better diagnostic capability of the CT. For example, the measured midline sagittal diameter of the spinal canal in a patient with the narrowest canal in this series was 7.4 mm on the CT and 9.6 mm on the conventioned plain film at the C₅ level. To know the precise sagittal diameter of the cord itself, CT myelography (CTM) is indispensable. CTM is useful in determining the nature of the disease, the risk and approach of surgery, and for evaluation after the surgical procedure. Although the range of motion of cervical joints and intervertebral foramen are visible with conventional films, the size and extension of a tumor, the degree of bony errosion and the spinal subarachnoid space can be precisely identified only by CT. CT study of the spine and spinal cord is a simple procedure and less likely to produce complication, even with CTM, although there are certain limitations in the examination which are also presented.

抄録全体を表示

The results of the microsurgical treatment of 300 patients with painful lumbar spinal diseases were reported. Radical removal of the disc material, preservation of the epidural fat tissue around the lumbar nerve roots, and meticulous hemostasis produced good results. Yet, even with this technique, a pseudoradicular or referred pain still developed after surgery, despite of the disappearance of a radicular pain or radicular signs.
Pseudoradicular pain is characterized by: 1) Lasegue sign only after raising the straightened leg more than 40 degrees; 2) no radicular signs; 3) marked pains localized in the area innervated by the dorsal ramus which is involved in a pathological process; and 4) no pain in the popliteal fossa.¹⁰⁾ Our operative results revealed that this uncomfortable pain developed most frequently after operative procedures involving facets and lateral recesses, such as in facetectomy or foraminotomy for superior facet syndrome (80% postoperatively) and for cases of lumbar herniated disc (63% postoperatively). The pain could be elicited by stimulation or irritation of the dorsal rami of the lumbar spinal nerves during surgery involving the articular facets. That was why pseudoradicular pain frequently developed after treatment of superior facet syndrome based on hypertrophied articular process or lumbar herniated discs.

抄録全体を表示

Angiographic findings of 105 cases with internal carotid artery (ICA) occlusion were classified into 10 types according to the site of the occlusion and the development of the direct and indirect collaterals. Angiographic and pathologic correlation was made on 12 autopsy cases in the pre-CT era. Furthermore, clinical, angiographic, and pathological features were evaluated in 9 cases with probable embolic occlusion out of the 12 autopsy cases. Extent of the infarction on the CT of 93 out of the 105 cases with ICA occlusion was classified into 6 types and correlated with the angiographic types and the nature of ICA occlusion (embolism vs thrombosis). The roles of CT and angiography in the evaluation of disturbances in the cerebral circulation were discussed.

抄録全体を表示

Tumors of the foramen magnum are rare and the incidence is between 1.6% and 2.4% of all spinal tumors; therefore the personal experiences of one neurosurgeon with this type of tumor are necessarily limited. This unfamiliarity, combined with the curious presentation of some of the lesions due to the complex anatomy of this region, has made the diagnosis of foramen magnum tumors difficult. Unless this is kept in mind, one might fail to consider these lesions in the differential diagnosis, causing a delay in appropriate treatment until permanent damage results.
The purpose of this paper is to describe the symptomatology and diagnosis, as well as the surgical treatment, of 21 cases of foramen magnum tumor encountered at our clinic during the last 10 years.

抄録全体を表示

Carl Peter Thunberg (1743-1828), a student of the famous Swedish botanist Carl Linné, visited Nagasaki and Edo in 1775-76. During his stay in Japan, he collected and named numerous plants and so has been called the father of Japanese botany. But he also taught western medicine to Japanese colleagues and introduced mercury in the treatment of syphilis. More than any person before him, he introduced Japan to the outside world. Thunberg deserves the credit of being the pioneer of occidental medicine and science in Japan.

抄録全体を表示