Na⁺-K⁺-adenosine triphosphatase (Na⁺-K⁺-ATPase) was studied ultracytochemically in decapitated and superoxide-treated rat brains in order to elucidate the relationship between enzyme activity and damage of membranous structures. All experiments were performed on male adult Wistar rats. The decapitated group consisted of 12 animal brains removed 3, 6, and 12 hours after decapitation. The normal control consisted of 4 animal brains removed immediately after decapitation. The superoxide-treated group consisted of 9 animal prefixed brains immersed in a hypoxanthine-xanthine oxidase system for 20, 60, and 120 minutes. In both groups, 1 mm sagittal sections of cerebellar vermis were fixed for 50 minutes in a mixed solution of 0.25% glutaraldehyde and 1 % paraformaldehyde (0.1 M cacodylate buffer, pH 7.3) at 0°C. Non-frozen sections, approximately 15 μm thick for light microscopy and 40 μm thick for electron microscopy, were prepared by a microslicer. Histochemical procedure was carried out by incubating specimens in the substrate medium using lead citrate as capturing reagent for 40 minutes at 37°C. Following the incubation, specimens were embedded in Spurr's resin. Ultrathin sections were stained in 2% uranyl acetate for 3 minutes at 20°C. Three different kinds of medium (substrate free, substitution of Na⁺ for K⁺, and ouabain addition) were utilized for control in each experiment. In the normal control Na⁺-K⁺ATPase reaction was microscopically detected mainly at the cerebellar glomerulus. Electron microscopy revealed the reaction product localized on postsynaptic membranes, plasmalemmas of both axon and dendrite, and filamentous structures of axonal cytoplasm in glomerulus. However, the reaction was negative in mossy fibers and soma of granular cells. Na⁺-K⁺-ATPase activity was almost unchanged 3 hours after decapitation. It decreased considerably in 6 hours, and disappeared in 12 hours. In contrast, Na⁺-K⁺-ATPase activity changed dynamically after superoxide treatment. 60-minute peroxidation caused considerable increase in the activity as compared with both normal control and 20 minute-treated brains, although apparently irreversible histological changes had already occurred. Such increase in the enzyme activity seemed to be rather larger than the degree of membranous damages. Na⁺-K⁺-ATPase had completely diminished by 120-minute peroxidation. These findings show that damage of the plasmalemma precedes the disappearance of Na⁺-K⁺-ATPase activity in ischemic brains. The remaining Na⁺-K⁺-ATPase activity does not always suggest the reversibility of ischemic lesions.

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Twenty-eight non-operated supratentorial meningiomas were selected from the autopsy files of Montefiore Hospital to study the relationship between the brain and the tumor. Though meningiomas are usually well demarcated from the brain, their interface with the brain takes various forms, i.e., smooth type, lobular type, finger-like expansion type, and invasive type. The so-called “capsule” mainly consists of arachnoid membrane, arachnoid trabeculae, septae of the tumor and pial membrane. In several cases, there is no obvious connective tissue that can be called a “capsule” between the tumor and the brain. Vessels in the subarachnoid space are located between lobules of the tumor or surrounded by connective tissue. Sometimes, they are completely entrapped in the tumor. Loss of neurons, gliosis, cyst formation, edema and even calcification are seen in the underlying brain. The thickness of the underlying cortex does not always depend on the size of the tumor. Even small meningiomas, 2-3 cm in diameter, are sometimes associated with a thin cortex.

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Seventy-seven patients with the cervical disc disease were surgically treated using operative microscope and air drill since 1976. These cases were analyzed with regard to operative methods and the criteria for selection of the operative method. The methods were selected by means of the preoperative neurological and radiological findings. The operative methods included: anterior discectomy with or without fusion, vertebrectomy with fusion, and laminectomy in which en bloc wide laminectomy was utilized. When selection of the operative methods was made according to the pathophysiological findings of the lesion, the operative results improved. However, some technical refinements still remained to be achieved. As a recent approach, lesions were removed as completely as possible by means of the anterior approach.

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The mechanism of action of Ca²⁺ antagonist has been postulated to be a transmembrane calcium influx blockade. The effect of intra-arterial and intra-thecal administrations of diltiazem on experimental cerebral vasospasm has been previously reported by the authors.
A pilot study, examining the clinical effect of diltiazem on symptomatic cerebral vasospasm, was done. This study included 105 patients with a ruptured supratentorial aneurysm, who were operated on at acute or chronic stage. They were classified preoperatively according to the Hunt and Hess neurological grading system; 18 in grade I, 30 in grade II, 37 in grade III, and 20 in grade IV. Patients in grade V were excluded from this study. After the aneurysm was clipped, 7.3×10^-6 M diltiazem was applied topically to the exposed arterial segments. Subsequently, patients received a continuous intravenous diltiazem infusion (60 mg/24 hrs) for several days, followed as soon as possible by oral administration (90 mg/day). The duration of treatment by diltiazem was 2 weeks following the operation. Recently, an preoperative administration of diltiazem was carried out. One hundred and five cases (diltiazem group) were compared with a control group of 100 cases who were operated on before administration of diltiazem started. The appearance and severity of symptomatic cerebral vasospasm was not affected by diltiazem, but the outcome of the grade II and III patients with or without vasospasm improved significantly at 3-month follow-up examination. Systemic hypotension was not induced by the routes or doses of administration of diltiazem. The preliminary results reported here indicate that diltiazem may prove to have an additional antiischemic effect.

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Six cases of intracranial hemorrhage associated with disseminated intravascular coagulation (DIC) syndrome were reported. Previously, intracranial hemorrhage was said to be much less frequent than cerebral infarction in DIC. However, intracranial hemorrhage was demonstrated in all of the 6 cases suffering from DIC who received computerized tomographic scanning. The high incidence of intracranial hemorrhage in this series was attributed to weakness of vascular wall which possibly resulted from primary intracranial diseases. Primary intracranial diseases existed in 3 cases: cerebrovascular disease, head injury, and meningitis. In complication with multiple organ failure, all of these patients expired. Aggressive treatment did not influence the outcome. Treatment of such cases should be early diagnosis and treatment of primary disease, which is likely to be the cause of DIC.

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Acute subdural hematoma of the posterior fossa is rare, occupying 0.5% to 1.6% of all acute subdural hematomas. In children, it is extremely rare. There has been only 11 cases reported in the literature, excluding neonatal cases. Herein a case was reported of an acute subdural hematoma of the posterior fossa in a child who survived after an emergent surgical exploration.
A 6-year-old female was involved in a motor vehicle accident. She fell to the ground, hitting the left occipital region. After a semi-lucid interval several hours, her consciousness deteriorated and she was brought to the hospital. On examination, the patient was comatose, and showed decerebrate posture with bilateral pin-point pupils. Computed tomography scan revealed a huge hematoma which occupied the left posterior fossa and moderate obstructive hydrocephalus. A left suboccipital emergency craniectomy was performed, and an occipital bone fracture was confirmed. Then, subdural hematoma was confirmed, which seemed to be caused by bleeding from a cerebellar cortical small artery. Most of the clots were removed, and hemostasis was achieved. The postoperative course was favourable. The patient became alert 2 weeks later, and was discharged with a very mild ataxic gait 2 months later. No post-traumatic hydrocephalus is seen as yet.

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his paper reports a diffuse dural sinus obstruction due to invasion of a solitary malignant glioma. A 32-year-old female suffered from an anaplastic astrocytoma in the left frontal lobe. Her symptoms were mental disturbance and right hemiparesis. A computed tomography scan with contrast medium revealed a round enhanced mass in the left frontal region, attached to the superior sagittal sinus, with a perifocal low density zone. The tumor was well demarcated from the brain and was removed totally at operation. Tumor recurrence was found 7 months after the initial operation, and subsequently, the patient underwent 5 craniotomies within 13 months. Whenever the tumor recurred, it was macroscopically removed totally, and her symptoms subsided. Because recurrent massive regrowth of the tumor was rapid, intraoperative irradiation was performed with Linac electron beam on two occasions, 20 Gy 6 MeV and 25 Gy 9 MeV, respectively. Soon after the fifth craniotomy, she developed mental disturbance and motor weakness again, and obstruction of the superior sagittal sinus was confirmed by digital subtraction angiography. A large subcortical hematoma in the bilateral fronto-parietal region led to her death 15 months from onset of illness. Postmortem examination showed that the superior sagittal sinus, transverse sinus, and straight sinus were obliterated by tumor mass. However, there was no evidence indicating subarachnoid dissemination or remote metastases of the tumor. Pathological examination of the tumor attached to the sinus wall disclosed abundant reticulin fiber in the anaplastic astrocytoma. Tumor cell adhesive factor, fibronectin, glial fibrillary acidic protein and other staining were performed. The results indicated a biological peculiarity of this tumor in regard to solitary regrowth and dural sinus invasion. It is quite possible that the rare pathological findings were caused by decrease of natural resistance of the dura mater due to irradiation with electron beam and the biological nature of the tumor.

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An autopsy case of intracranial vertebral dissecting aneurysm associated with medial mucoid degeneration is reported and 54 cases of vertebro-basilar dissecting aneurysm in the literature are reviewed. A 37-year-old man with history of hypertension was admitted in a semicomatose state. Computed tomographic scan showed severe subarachnoid hemorrhage (SAH), especially in the posterior fossa with ventricular reflux, and vertebral angiography disclosed a fusiform dilatation with proximal narrowing of the left vertebral artery and narrowing in the midportion of the basilar artery. Continuous ventricular drainage was performed, but the patient died from rebleeding on the 14th hospital day. Autopsy revealed massive SAH around the brain stem and a fusiform aneurysm of the left vertebral artery. Microscopic examination demonstrated a local thickening of the wall with tearing of the intima and the media. A hematoma between the media and the adventitia communicated with the true lumen of the artery. The muscular layer was replaced by myxomatous connective tissue. The basilar artery had mild fibrous thickening of the intima and duplication of the internal elastica. The medial mucoid degeneration was discovered by iron-colloid stain in the intracranial arteries, especially in the vertebro-basilar system. However, arteriosclerotic change was minimal. The authors emphasize that SAH as initial symptom and hypertension as predisposition occur more frequently in vertebro-basilar dissecting aneurysms than previously described.

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A callosal-choroid plexus lipoma associated with subcutaneous lipoma is presented. More than 100 cases of callosal lipoma with the characteristic X-ray findings have been reported. However, such a combined occurrence as this is very rare. Only 14 cases have been published in the literature, and the majority of the cases were accompanied by the dysraphic lesions. The operative findings of this case revealed that the subcutaneous lipoma was not continuous with the callosal lipoma. These cases were analyzed with emphasis on the association of dysraphism in the pathogenesis of intracranial lipomas.

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A case of trigeminal neuralgia (TGN) associated with hemifacial spasm (HFS) caused by a tortuous vertebro-basilar (V-B) artery is reported. Computed tomographic (CT) scan with contrast enhancement (CE) was significantly useful in the diagnosis of the tortuous V-B artery. A 72-yearold man, complaining of intermittent facial pain and twitching of the left facial muscles, had been unsuccessfully treated with carbamazepine and nerve block. On admission, muscle twitch was seen in the left orbicularis oculi, cheek, and platysma muscles. Sensory disturbance was noted in the territory of the left trigeminal nerve. Corneal reflex was decreased in the left side. CT with CE revealed a linear structure in the prepontine cistern, suggesting a tortuous V-B artery. Left vertebral angiogram showed a markedly enlarged and tortuous V-B artery, protruding into the left cerebellopontine cistern. It was suggested that the tortuous V-B artery was the cause of both symptoms of TGN and HFS. Neurovascular decompression was then successfully performed. Immediately after the operation, the facial pain and the twitch completely disappeared. Eleven such cases have been reported in the literature, but this is the first report of a successfully treated case by neurovascular decompression.

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A 63-year-old female with a large meningioma of the middle cranial fossa was admitted. The tumor was fed mainly by the hypertrophied middle meningeal artery. Immediately following a seemingly successful embolization of that artery with gelfoam powder, consciousness of the patient rapidly declined and anisocoria and decerebrate posturing developed. An intratumoral massive hemorrhage ruptured into and extended widely in the subdural space was confirmed by computed tomography scan. The hematoma was evacuated and the tumor was radically removed by emergency craniotomy, and the patient recovered.
Therapeutic embolization for meningiomas and other highly vascular intracranial tumors has been established as a useful and relatively safe adjunctive preoperative measure, and an intratumoral massive hemorrhage in the period immediately following this procedure has seldom been reported in the literature. However, the present case shows that it is apparently a potential complication of this procedure. The possible mechanisms of an intratumoral hemorrhage following therapeutic embolization of the feeding arteries are briefly discussed.

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A case of synchronous multiple primary malignant tumors accompanied by glioblastoma is reported. The patient, a 27-year-old woman, was admitted with nausea, vomiting, and a slight consciousness disturbance. Five months before, she had noticed a lump in both breasts, and 1 month later, an abnormal shadow was noted on chest X-ray. Computed tomography scan showed a cystic lesion with ring-like enhancement in the left frontal lobe. Chest X-ray and the tomogram showed a tumor shadow in the right upper lung field. The brain tumor was totally removed. Histologically, it was glioblastoma (first primary focus). One month following brain surgery, a bilateral mastectomy with lymph-node dissection was performed. Histopathological examination revealed ductal carcinoma without metastasis to lymph-node, and they were diagnosed as bilateral primary breast carcinomas (second and third primary foci). Lung tumors gradually progressed in spite of chemotherapy, and she expired due to respiratory insufficiency. Histopathological examination of the autopsied lungs revealed primary papillary adenocarcinoma of apical portion of the upper lobe of right lung with numerous small hematogenously disseminated metastatic tumor nodules in entire lobes of both lungs (fourth primary focus). Moreover, an occult sclerosing carcinoma of papillary type was found in the thyroid (fifth primary focus).
There have been no previous reports on five synchronous primary malignant tumors in which one of the primary sites was within the brain.

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