Increased levels of polyamines in rapidly growing tissues have been demonstrated, and recently rather high concentrations of conjugated polyamines such as N¹-acetylspermidine have been found in certain malignant tumors. The purpose of this study is to analyze concentrations of free and conjugated polyamines in cyst fluids of brain tumors.
Materials used were cyst fluids obtained in brain tumor surgery: 25 specimens were from cysts of benign brain tumors (acoustic neurinoma, 8 cases; craniopharyngioma, 7 cases; hemangioblastoma, 6 cases; meningioma, 2 cases; pituitary adenoma, 2 cases) and 17 specimens from malignant brain tumors (malignant astrocytoma, 2 cases; glioblastoma, 15 cases). After deproteinization of cyst fluids with 6N perchloric acid, polyamine levels were measured with the use of high-performance liquid chromatography (HPLC) using cation-exchange resin before and after acid hydrolysis. Polyamines separated in various fractions by HPLC were further analyzed before and after acid hydrolysis.
The cyst fluids contained putrescine, spermidine, N¹-acetylspermidine, and several other minor peaks. The levels of N¹-acetylspermidine were much higher in cyst fluids of malignant brain tumors than in benign brain tumors. Higher concentrations of putrescine were also demonstrated in cyst fluids of malignant brain tumors. The increase in spermidine contents after acid hydrolysis was more than that which was derived from N¹-acetylspermidine alone. In fact, some fractions other than the N¹-acetylspermidine fractions yielded putrescine and/or spermidine upon acid hydrolysis. These data suggest that not only N¹-acetylspermidine but also other polyamine conjugates are present in cyst fluids of brain tumors. Presumably N¹-acetylspermidine and other conjugated forms are preferentially released into cyst fluids from malignant tumor tissues.
The present study shows that not only putrescine but also N¹-acetylspermidine in cyst fluids are promising markers of brain tumors.

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The outer membranes of the subdural neomembranes (SNs) from 30 patients with chronic subdural hematoma were examined by light and electron microscopes. All the specimens were gained by “en bloc” resection together with the overlying dura mater. Seventeen cases had histories of head injury which varied from 10 to 90 days prior to the operation.
Besides the cells known to occur in SN, there were many cells which had ultrastructural characteristics of both smooth muscle cell (SMC) and fibroblast, showing a wide range of transitional morphology between them. They are so-called “myofibroblasts” (MFs) and were observed abundantly in all the cases. In four SNs, typical SMCs were present. They were distributed in a layered fashion in the midzone of the SNs. Examination of the relationship between the incidence of MF and the histological stage of SN or post-traumatic interval revealed that the SMCs were found only in the SNs with fibrosis and after 8 weeks of post-traumatic interval. The SNs containing SMCs showed many MFs in them.
It is not recorded in the literature that the presence of MFs in SNs is a common finding, or that SMCs appear in the early stage of SN formation. Although it could not be proven, the origin of SMCs was suggested to be fibroblasts. Considering the recent studies of MF in general pathology, it is conceivable that MFs and SMCs play a role in the contraction and organization of SNs.

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Local cerebral blood flow in 28 patients (aged from 13 to 71) with cerebrovascular disorders was studied 37 times by single photon emission computed tomography (SPECT) using N-isopropyl-p-[¹²³I] iodoamphetamine (IMP), and compared with findings of X-ray computed tomography (CT) and ^81mKr (Kr) perfusion images. There were three patients with occlusion of the internal carotid artery, two with stenosis of the internal carotid artery, six with occlusion of the middle cerebral artery, five with occlusion of the bilateral vertebral arteries, five with moyamoya disease, two with aortitis syndrome, and five with cerebral arteriovenous malformation. Examinations were performed using a rotating gamma camera with dual heads in both SPECT-IMP and SPECT-Kr. In the IMP study, both SPECT and planar images were obtained 30 and 120 minutes after intravenous injection of IMP. SPECT-Kr was performed by continuous infusion into the ascending aorta of ^81mKr generated by an ⁸¹Rb-^81mKr generator. Sampling time was about 20 minutes in 22 examinations and about 10 minutes in 15 examinations by SPECT-IMP, and about 4 minutes in all the examinations by SPECT-Kr. SPECT-IMP images 30 minutes after injection showed low perfusion area in all but four examinations in three patients: one patient with transient ischemic attack alone and two patients with aortitis syndrome. In 26 of the 33 examinations, SPECT-IMP images 30 minutes after injection revealed more extensive or obvious low perfusion areas than the low density lesions in X-ray CT, and low perfusion even in the areas without low density lesions. In all of the 33 examinations, low perfusion areas shown in SPECT-IMP images 30 minutes after injection became obscure after 120 minutes. In respect to representation of local cerebral blood flow, SPECT-IMP images 30 minutes after injection seemed to be better than after 120 minutes. In 26 of the 33 examinations, low perfusion areas in SPECT-Kr images were more extensive and obvious than in SPECT-IMP images. However, SPECT-IMP images seemed to show a more definite anatomy than SPECT-Kr images. The nidus of a cerebral arteriovenous malformation was shown to be a low perfusion area in SPECT-IMP images, but appeared as a high perfusion area in SPECT-Kr images. It is likely that SPECT-Kr images showed mainly intravascular flow of the nidus. In comparison with SPECT-Kr, SPELT-IMP was considered to be an easy and noninvasive three dimensional study of local cerebral blood flow.

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Side-to-side anastomosis is rarely performed by neurosurgeons, and the best conditions for microvascular side-to-side anastomosis are still unknown. To discover which conditions maximize blood flow through the anastomosis, side-to-side anastomosis between bilateral common carotid arteries was studied in 25 rats. The results were that the anastomotic orifice should be larger than twice the vessel diameter, and that the anterior wall should be sutured interruptedly. As clinical applications for side-to-side anastomosis, revascularization of the anterior cerebral artery (ACA) using inter-ACA anastomosis was performed in two patients with excellent results.

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The authors evaluated the effect of hyperoxia including hyperbaric oxygenation (HBO) on increased intracranial pressure (ICP). Seventeen postoperative cases of subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm in an acute stage were studied. The intervals from the onset to ICP studied ranged from 3 to 17 (average±SD: 7±4) days. ICP was monitored through a ventricular drainage (CVD) tube using a Statham pressure transducer P-50. In the hyperbaric chamber, ICP was monitored during the resting state [before HBO, 1 atmosphere absolute-air breathing (1ATA-air)], before HBO 1ATA-pure oxygen inhalation (1ATA-O₂), 2ATA-O₂, after HBO 1ATA-O₂, after HBO 1ATA-air and 200 ml glycerol administration. Mean ICP showed a 20% decrease in the period before HBO 1ATA-O₂ and 23 to 27% decrease during HBO and return to the resting state after decompression. A notable finding was 18% rebound increase after oxygen inhalation ceased. Glycerol lowered ICP about 50% and was more effective in reducing ICP than HBO. Changes of PaO₂ were as follows: at rest; 82±12 mmHg, before HBO 1ATA-O₂; 406±73 mmHg, 2ATA-O₂; 761±167 mmHg, and after HBO 1ATA-air; 79±13 mmHg (mean±SD). The somatosensory evoked potential (SEP) test revealed improved parietal N₁ (P₁-N₁ peak to peak) amplitude in 43% during HBO, in 17% after HBO and in 12.5% after the administration of glycerol. Causes of ICP decrease during hyperoxia are considered to be vasoconstriction and a slight hypocapnia. The authors propose to name the vasoconstriction caused by hyperoxia “O₂ response”. “O₂ response” may be one of the regulating mechanisms of cerebral blood flow like autoregulation and CO₂ response. ICP decrease caused by hyperoxia in intracranial hypertension may depend upon the capacity of the “O₂ response” of patients. Two main causes of the rebound phenomenon after decompression in SAH patients may be rebound vasodilatation after HBO and the natural worsening of hydrocephalus. Brain function evaluated by SEP tests suggested the beneficial effect of HBO. This may be due to the improved oxygen supply to the brain in addition to the ICP decrease during HBO. The effect of HBO is temporary and there exists a rebound increase of ICP after HBO. In the management of increased ICP, other methods to control ICP such as ventricular drainage and administration of dehydrating agents should be used together with HBO.

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Fracture of the articular process of a cervical vertebra has received little attention in the literature. This fracture is often overlooked because only a very subtle change is shown in conventional radiological examinations.
In this review of 26 patients with cervical vertebra trauma examined with a high resolution computed tomography (CT) scanner (Somatom II) in the past 3 years, the authors found 6 cases with fracture of the articular process of a cervical vertebra. The diagnosis was mainly based on the very useful findings of CT scan. On the other hand, the plain neck films had less diagnostic value. Some indirect signs, however, such as an anterior subluxation and narrowing of the intervertebral foramen revealed in the plain neck films seemed valuable. The clinical symptoms of this fracture consisted of radicular injury and persistent neck pain. Hyperflexion injury, which seemed to be a notable tendency, was considered as a possible mechanism of this fracture in 2 cases. Anterior fusion was performed in 3 cases and in 3 other cases conservative therapy was continued.
A therapeutic policy for this fracture has not been established. The authors emphasize that both anterior fusion and the removal of the fractured fragment are necessary when anterior subluxation is obvious and the fractured fragment has caused the radicular injury.

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From 1974 through 1983, 18 patients with metastatic epidural spinal tumors were admitted, and 12 cases were operated on, in order to relieve pain and neurological deficits. The age distribution of the 12 cases was between 4 and 74 years. Complete motor paralysis was seen in six cases, and incomplete motor paralysis, in five cases. One showed no deficit except pain. Pain, either local or of radicular origin, was most common and present in 11 cases. Laminectomy and partial tumor removal were performed in six cases. Since 1981, more extensive excision of tumors and posterior fixation using Harrington rods or methylmethacrylate were performed on four cases. The remaining two cases, with lesions in the cervical vertebral body, received vertebrectomy with fixation using methylmethacrylate in one, and autograft in the other. Postoperatively, pain relief was obtained in nine out of the 11 patients (82%). Among them two patients with extensive tumor removal and one with vertebrectomy became pain-free. Improvement of motor deficit was obtained in three of the five patients with incomplete paralysis treated by either laminectomy or extensive tumor removal, and in two of the six patients with complete paralysis, treated by the latter procedure. Among these five recovered patients four became ambulatory.
Our overall results suggest that extensive excision of metastatic lesion with either anterior or posterior fixation had better outcomes than simple decompressive laminectomy alone for pain relief and recovery from motor deficits.

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A case of spinal multiple extradural cyst is reported and reviewed. A 33-year-old male was admitted to the Osaka University Hospital. He had suffered from spastic paraparesis for the previous 8 months. On admission he couldn't walk by himself. A myelogram showed epidural masses in the thoracic region. Post-myelogram computed tomography showed a flattened and narrow spinal cord surrounded by the subarachnoid space, and large cysts located behind the spinal cord. A myelogram by direct puncture of the cyst defined three cysts. The patient was treated by removal of the three cysts and closure of the openings. The cyst wall was composed of dura mater and arachnoid membrane. About 30 days after the operation, he could walk unsupported, and sensory disturbances also diminished. The cysts, though communicating, appeared to have compressed the spinal cord.

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Two cases of anomalous origin of the anterior cerebral artery (ACA) associated with occlusive cerebrovascular diseases are presented.
Case 1, a 4-year-old boy, was admitted because of right-sided hemiparesis. Cerebral angiography revealed moyamoya disease and an anomalous artery originating at the right carotid siphon to join the ACA. The right ophthalmic artery and bilateral A, segment of the ACA were hypoplastic. The anomalous ACA had been gradually occluded in the course of the progression of moyamoya disease. Case 2, a 2-year-old boy, was admitted with right-sided hemiparesis following a nonpenetrating blunt head injury. Cerebral angiography revealed severe stenosis at the cervical segment of the left internal carotid artery and the anomalous origin of ACA on the right. This anomalous artery joined the anterior communicating artery to perfuse both ACA territories.
In the past, this anomalous artery has only been debated in view of its embryological interest, but it should contribute as a circulatory collateral pathway in association with occlusive cerebrovascular diseases.

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Pleomorphic xanthoastrocytoma is a rare, but clinically and histologically distinctive supratentorial glioma in young patients. Such a case, occurring in the right frontal lobe, is presented. The patient, an 8-year-old girl, had been well until February 1984 when she developed left facial spasm. Neurological examination on admission in May 1984 revealed left facial palsy with frequent facial spasm. Computed tomography (CT) demonstrated a small right frontal mass associated with a large area of low density in the surrounding brain. A right fronto-temporal craniotomy revealed a firm and solid tumor, 3 cm in diameter, involving the overlying leptomeninges. The tumor was well demarcated and was totally removed. Histologically the tumor showed marked cellular pleomorphism and a dense network of collagen and reticulin fibers, but there was no mitosis or necrosis. Some of the tumor cells contained lipid droplets. Glial fibrillary acidic protein was demonstrated in the cytoplasm of many tumor cells by immunoperoxydase study. The patient has been well without any neurological deficits postoperatively. CT showed no evidence of recurrence.
Twenty cases of pleomorphic xanthoastrocytoma have been reported in the literature. The clinical features are distinctive, for instance, preponderance in young patients, good prognosis, superficial location of the tumor with marked pleomorphism in pathology. However, late recurrence, mostly with malignant change occurred in 6 of the 20 cases. It is suggested that long term follow-up is necessary.

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A case of fracture of the floor of the anterior cranial fossa and the sella turcica, followed by cerebrospinal fluid (CSF) rhinorrhea, which was successfully repaired with fibrin glue, is reported. A 30-year-old male was admitted with Glasgow Coma Scale score 10 after a car accident. Neurological examination disclosed conjugate deviation to the right, with isocoria and prompt light reaction of both pupils. Plain craniograms showed compound and depressed fractures of the frontal bone, an obscurity of the outline of the sella turcica, and pneumocephalus. Computed tomography (CT) scan showed the skull fractures, frontal lobe contusion, subarachnoid hemorrhage and pneumocephalus. An emergency operation was performed to remove bone fragments and contusional hematoma, and to repair the dural tear. The patient regained consciousness but showed bitemporal hemianopsia and a decreased visual acuity of both eyes, and developed transient diabetes insipidus and anterior hypopituitarism. Two months later, he developed CSF rhinorrhea, and CT scan disclosed a wide-open fracture of the planum sphenoidale. A second operation was successfully performed to repair the CSF fistula, using fibrin glue as a sealing material for the bone defect in the sphenoid sinus. Dura was also repaired this time. Fibrin glue seems to be a very useful and logical material for the treatment of CSF leakage. Fracture of the sella turcica is rather uncommon, but should be searched for if cranial nerve injuries, CSF leakage, diabetes insipidus or hypopituitarism are found.

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A case of tension pneumocephalus following ventriculo-peritoneal shunt is reported. A 28-year-old male was admitted with the diagnosis of arteriovenous malformation at the right temporooccipital lobe. Uneventful total removal of the arteriovenous malformation was performed. However, postoperatively symptoms of arterial vasospasm and progressive hydrocephalus developed, so a ventriculo-peritoneal shunt was inserted. The postoperative course was good, but about 3 weeks after the operation, the clinical symptoms aggravated gradually and computerized tomography scan showed expanding intraventricular air. At the reoperation, a small skin defect covered by crust was found at the shunt surgery wound, and the dura mater around the shunting tube remained as a defective space. It was suspected that the air invaded the lateral ventricles along the shunting tube through the skin and dura defect.
Twelve similar cases could be found in the literature.

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