We previously demonstrated evidence suggesting increased neural activity in the pontine reticular formation ventromedial to the principal nucleus of locus coeruleus after experimental concussive head injury in the cat. We report here that microinjections of small doses of the cholinergic agonist carbachol (0.4 μg in 0.2 μl, bilaterally) into this restricted brain stem region of the awake cat produces a reversible, flaccid, comatose state analogous to that of the lowest score on the Glasgow Coma Scale, the grading system commonly employed in assessments of human coma. Microinjection of the local anesthetic tetracaine into the same region failed to produce detectable effects, and therefore the carbachol effects were probably due to activation of pathways within the injection sites that actively inhibit various aspects of the animals' responsiveness to the external environment. The flaccid, comatose state produced by carbachol was not the result of epileptic processes, since neither epileptic electroencephalographic discharges nor convulsive movements were observed. The muscarinic antagonist atropine reversed the carbachol effects. We shall also discuss possible implications of these data in terms of mechanisms of flaccid coma associated with good recovery in humans.

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Congenital hydrocephalus induced in rats by N-methyl N-nitrosourea was studied morphologically. Special attention was paid to early changes occurring during the perinatal period. Alterations in the subependymal layer preceded diverse changes in the ventricular fine structures and ependymal cells. Horseradish peroxidase injected intraventricularly into the hydrocephalic brain rapidly penetrated the immature subependymal layer and widely dispersed within the differentiating white matter. These findings indicate that, in the early stage of congenital hydrocephalus, cerebrospinal fluid easily penetrates the parenchyma and disrupts the cellular environment of the differentiating subependymal layer. This process is assumed to be central to the progression of congenital hydrocephalus in the immature brain.

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Treatment and outcome in 31 cases of recurrent medulloblastoma arising in childhood are described. As initial treatment, all patients underwent some degree of tumor resection, and 28 patients received radiation therapy postoperatively. The younger children tended to have recurrence earlier after the initial treatment and to die sooner after recurrence than the older children. Early recurrences (within the first 2 postoperative years) often took the form of spinal subarachnoid dissemination, whereas late recurrences (after more than 2 years postoperatively) most often involved intracranial regrowth. Patients who underwent extensive tumor resection and received higher doses of radiation to the entire neuraxis generally had longer remission than those who had less extensive tumor removal and lower doses of radiation. Two of four patients who received intrathecal chemotherapy with methotrexate, cytosine arabinoside, and hydrocortisone as part of the initial treatment had remission lasting more than 3 years. The usual treatment for recurrent medulloblastoma was reirradiation, which generally improved survival time. Tumor removal plus intrathecal chemotherapy in selected cases of recurrence also provided abatement of symptoms. Early recurrence was usually difficult to control, whereas treatment for late recurrence was generally palliative but not curative. Average survival was 4.3 months after early recurrence, and 21.9 months following late recurrence. Two of the nine patients subjected to autopsy had no local recurrence but had extensive spinal subarachnoid dissemination. At the time of initial extensive tumor resection, irradiation or intrathecal chemotherapy, or both, should be added to prevent regrowth of the tumor and subarachnoid dissemination.

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A male patient was presented with a large, prolactin-secreting pituitary adenoma containing conspicuous calcifications. Microscopic examination showed the calcifications to be surrounded by active secretory adenoma cells. In addition to receiving postoperative external irradiation, he was treated with bromocriptine for over 3 years. The serum prolactin level decreased, and a shrinkage of the calcified lesions as well as a reduction in the tumor size have been observed on computed tomograms. Our results suggest that the hormone secretion is closely associated with the formation of the conspicuous calcifications.

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Primitive neuroectodermal tumors are very rare, malignant tumors of the cerebrum of young individuals, predominantly composed of undifferentiated cells, with differentiation along either neuronal or glial lines. Primary cystic tumors of the thalamus are also very rare and have been reported only in children. The case described here is the first report of a cystic tumor arising from the thalamus of an adult and containing pathologic features of a primitive neuroectodermal tumor. According to the literature, and in our clinical experience as well, primitive neuroectodermal tumors tend to diffusely disseminate into the subarachnoid space, which presents several diagnostic and therapeutic problems.

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A 34-year-old male with a right C4 root neurinoma was operated on and the tumor was totally removed. Short latency somatosensory evoked potentials (SL-SEPs) recorded before operation revealed only P₁ (P₉) and N₁ potentials. SL-SEPs were sequentially recorded and compared with changing symptoms and signs in an attempt to identify the primary generator of P₂ (P₁₁) potential. The recovery of SL-SEPs largely corresponded to recovery of vibration and position sensations; P₂ and following potentials appeared with improvement of these deep sensations. These findings suggest that P₂ potential may originate in the dorsal column or in a site rostral to the tumor.

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Treatment for craniopharyngioma, particularly in adults and cases of recurrence, is still fraught with problems. One difficulty is that postoperative hormonal function may be abnormal even after successful surgery. We have treated craniopharyngioma primarily with simple evacuation and intracapsular irradiation, using ¹⁹⁸Au-colloid.
Only a few cases of natural pregnancy and normal delivery following treatment for craniopharyngioma with hypothalamic extension have been reported. We will describe and discuss a case in which natural pregnancy and normal delivery occurred twice after such treatment.

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This report describes a well-differentiated chondrosarcoma that originated in the temporal base of the skull and developed extradurally in the right parasellar region in a 68-year-old female. The clinical, radiological, and histopathological findings, with special emphasis on the ultrastructure of the tumor, are discussed and compared with those of previous reports.

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A 4-year-old female patient underwent surgery for an enterogenous cyst of the cervical spinal canal. The cyst fluid was drained and a portion of the cyst wall was excised for histological and electron microscopic evaluation. Nine months after surgery the patient was doing well, with no signs of recurrence. Enterogenous cysts may be confused with ependymal cysts. After a thorough review of the literature, we based our diagnosis of enterogenous cyst on the results of periodic acid-Schiff staining and electron microscopic findings.

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A patient presented with brain metastasis from a soft tissue fibrosarcoma originating in the pectoralis major muscle. Aortography and computed tomographic scan showed tumor invasion of the sternum, carotid artery, and vertebral artery. There was no pulmonary involvement. The metastases appeared to have been blood-born, consequent to direct invasion of the arteries. Soft tissue fibrosarcoma is an uncommon tumor and its metastasis to the brain is very rare.

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A 70-year-old female was treated surgically for an extracerebral cavernous hemangioma of the middle fossa. The literature contains reports of one autopsy and 20 operative cases of cavernous hemangioma of the middle fossa. We compared these cases with cerebral cavernous hemangiomas and found that the incidence is high in Japanese females and in individuals over 20 years of age (average age, 43 years). Signs and symptoms are usually disturbed visual acuity or ocular movement rather than manifestations of increased intracranial pressure. Plain x-rays showed destruction of the sella without hyperostotic changes of the sella or the middle cranial fossa. CT scans showed isodensity/high-density areas of a dumbbell configuration, with the smaller part in the sella and the larger part in the middle fossa. Other CT features were contrast enhancement and evidence of atrophic processes in the surrounding brain. Conventional angiography showed an avascular mass lesion, but tumor staining was demonstrated only by prolonged injection, selective angiography, or subtraction. A review of the literature and our own operative findings suggest that the origin of this tumor is the cavernous sinus. Total removal of such tumors is difficult because of profuse intraoperative bleeding, and operative mortality is high (38%). It should be stressed that correct preoperative diagnosis is very important in decreasing operative deaths.

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We report an unusual long survival case of malignant lymphoma involving the two unusual sites separately within 20 years. A malignant lymphoma occurred in the brain of a 55-year-old male who had had a malignant lymphoma of the testis 20 years earlier. This report was referred to discuss whether intracranial malignant lymphoma was primary or metastatic.

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