Ultracytochemical localization of Ca⁺⁺-adenosinetriphosphatase (ATPase) activity was investigated in the choroid plexus of the rat fourth ventricle. A newly devised lead citrate method (Ando et al., 1981) was employed for the detection of this enzyme. Electron dense reaction products for Ca⁺⁺-ATPase activity were shown on the external surfaces of apical plasma membranes, including those of the microvilli and cilia, and on the external surfaces of basal plasma membranes, especially those of the basal infoldings. The gap junctions also showed reaction products on the cytoplasmic side of the plasma membranes. Among the intracellular organelles, activity was seen exclusively on the cristae of mitochondria. From these findings, it can be suggested that Ca⁺⁺-ATPase participates in Ca⁺⁺ transport and in the regulation of cerebrospinal fluid secretion in association with intracellular Ca⁺⁺ and Na⁺, K⁺-ATPase.

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Barbiturates in high doses have been used for the protection of the ischemic neurological condition after subarachnoid hemorrhage. The authors examined the pharmacological effects of three kinds of barbiturates (pentobarbital, thiopental, and thiamylal) on isolated canine basilar arteries, measuring the isometric tension of the arteries in vitro and the effects of intravenously administered pentobarbital on an experimentally induced canine angiospasm model, using an angiographic technique. The results obtained were as follows: 1) Barbiturates induced relaxation of canine cerebral vascular strips which had been contracted with high KCI and prostaglandin F₂ alpha, in a dose dependent manner. 2) Barbiturates showed non-competitive inhibition of extracellular calcium ions in a preparation treated with high KC1, and the drug inhibited contraction induced by caffeine in a calcium free solution. 3) Systemic administration of the drugs showed no significant vasodilatory action on an experimentally induced spastic artery. An inhibitory action of the barbiturates on contraction of isolated arterial strips in vitro might be due not only to blockage of calcium influx across the cell membranes but also to inhibition of the intracellular calcium ion mobilization. However, in the conventional therapeutic dose, direct action of the agent on the artery can not be expected in the teatment of spastic cerebral artery caused by subarachnoid hemorrhage.

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This study was designed to assess the therapeutic application of photodynamic or photoradiation therapy (PDT) using hematoporphyrin derivative (HPD) and argon laser for human glioma. Fluorescence assays of HPD were obtained using a microfluorescence photometer mounted on a microscope (Leitz, West Germany). An optimal time and exposure dose after injection of HPD were evaluated in the experimental brain tumors, 9L glioma cells implanted into the rat brain. An argon laser with 488 nm wavelength was used as a light source. The amount of HPD in the experimental brain tumor was large between 24 and 96 hours after injection of 10 mg/kg of HPD, and it was also confirmed in the human patients with glioma. The different experimental brain tumor treatment groups, using a dose of 383 joules/cm². sec of HPD-PDT, were evaluated by mean life spans. They were 22 ± 6 days in a non-treated group, 27 ± 5 days in a group treated by operation or surgical removal alone, and 69 ± 5 days in a group given intraperitoneal and local administration of HPD and operation-PDT. An alteration of the tissue temperature during HPD-PDT exposure of 450 joules/cm². sec was studied. Tissue temperature increased between 4°and 9°C within normal tissue 4 mm from the injured area. Sixteen patients with glioma were treated by HPD-PDT. All the patients underwent surgical removal of the tumor, followed by PDT 72 hours after intravenous injection of 5 mg/kg of HPD. The radiation exposure was between 243 and 1, 564 joules/cm² ⋅sec. Six patients with malignant glioma revealed a recurrence of the tumor in the exposed area within 6 months after PDT. They received a low dose, less than 311 joules/cm². sec, or had a large residual volume of the tumor after surgery. It is suggested that the argon laser exposure should be above 343 joules/cm². sec in energy for a remaining tumor of small volume.

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Regional cerebral blood flow (rCBF) was measured 59 times in 54 completed stroke patients. The rCBF measurements were performed twice in 3 patients and three times in one patient. The rCBF measurements were performed by means of the ¹³³Xe intracarotid injection method, using a scintillation camera and an on-line computer system. The rCBF data were analyzed and compared with the computed tomography (CT) and angiographic findings from each patient. Patients were classified into three groups which were defined from the CT findings as follows: Group 1, 13 patients with non-cortical low density area on CT scans; Group 2, 27 patients with enhanced cortical ischemic lesion; Group 3, 19 patients with non-enhanced cortical low density area. The Group 2 patients were studied between 7 and 33 days from the onset which did not overlap with the days for Group 3. The average of the mean hemispheric values of rCBF (mean CBFs) of completed strokes were significantly lower than those of the normal controls, transient ischemic attacks, and reversible ischemic neurological deficits. There was no significant difference in the averages of mean CBF between Group 2 and Group 3. Although there was a correlation between the elapsed time from the onset and the decrescent tendency of mean CBF of Group 2, there was no correlation with those of Group 3. Focal abnormalities were less frequent than diffuse ischemia in Group 1. Hemispheric patterns of flow distribution (HPFDs) were variously disturbed. Focal ischemia (6 cases, 22%), diffuse ischemia (14 cases, 52%), focal hyperemia (5 cases, 19%), and luxury perfusion (one case) were seen in Group 2. The patients with focal hyperemia and luxury perfusion showed a capillary blush which was characteristic of recanalization on the cerebral angiography (CAG). Focal ischemia (37%) and diffuse ischemia (63%) were shown, whereas hyperemia was not shown in Group 3. Focal ischemic areas with the rCBF below 32.8 ml/100 g/min were identical with the low density areas on CT scans.
It is suggested that completed stroke has various pathological conditions such as ischemia, hyperemia, and luxury perfusion of rCBF, contrast enhancement on CT scan, and capillary blush on CAG, accompanied by recanalization within 1 month after the onset, and that the ischemic lesion of completed stroke is destined to be completed without hyperemia by 1 month from the onset.

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In order to study the effect of bromocriptine on prolactinoma, the gel filtration chromatographic behavior of prolactin was measured in both serum and cerebrospinal fluid (CSF) of six cases of prolactinoma which showed high concentration of prolactin after surgery and administration of bromocriptine. Prolactin levels of paired blood and CSF samples were measured by using a doubleantibody radioimmunoassay. Molecular weights of prolactin were estimated using an Ultrogel AcA 44® column with standard molecular markers. Although the postoperative prolactin level in serum decreased from 1, 657 ng/ml to 468 ng/ml on the average, the prolactin level in CSF showed an increase from 761 ng/ml to 1, 503 ng/ml on average. Long term administration of bromocriptine contributed to normalizing the prolactin level in serum. However, the level in the CSF could not be settled in the normal range. Gel filtration of serum and CSF gave three types of prolactin with different molecular weights: “little” “big” and “big-big”. In postoperative serum samples, the proportions of the three components were 71±4%, 19±2%, and 10±4%, respectively. In postoperative CSF samples, the proportions were 96±2%, 2 ±1%, and 2±1%, respectively. “Little” prolactin was much less in proportion after administration of bromocriptine. These results indicate that prolactin molecules in the tumor parenchyma leaks into the CSF, and that there would be different mechanisms of bromocriptine in reducing prolactin level in both serum and CSF among individual cases. Large molecular prolactin may arise as a derivative or aggregates of standard prolactin.

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Subependymal giant-cell astrocytoma (SGCA), a rare intraventricular tumor, occurs mainly in young patients in conjunction with tuberous sclerosis (TS). This tumor arises characteristically from the medial part of the floor of the lateral ventricle, occluding the foramen of Monro. This report presents a rare adult case of SGCA, not associated with TS, which arose from the trigone of the lateral ventricle. The patient, a 42-year-old male, was admitted with episodes of psychomotor seizure for the past 2 years. The seizures consisted of hot sensations in his throat while breathing and of amnesic attacks. Electroencephalography showed occasional spike discharges localized in the right temporooccipital region. Computed tomography revealed the presence of an ovoid high density mass in the right trigone of the lateral ventricle with intense contrast enhancement. Surgery revealed a dark red, highly vascularized soft friable tumor. Light microscopic examination of the tumor characteristically showed cells of 3 morphological types, i.e. swollen gemistocytic cells, ganglion-like cells, and elongated and spindle-shaped cells. Mitoses and endothelial proliferations were extremely infrequent. Immunoreactive glial fibrillary acidic protein was present in the cytoplasm and processes of some smaller cells. Phosphotungstic-acid haematoxylin-positive fibrils were present in the perinuclear region of the spindle-shaped cells. Nissl's substances were seen at the margin of the cytoplasm of the ganglion-like giant cells.

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There have been only a few reports on cases of extracerebral cavernous angioma in the middle cranial fossa. The patient was a 45-year-old male with the chief complaints of hypoactivity and memory disturbance. On admission, memory disturbance and bilateral papilledema were confirmed neurologically. Plain craniograms revealed erosion of the left petrous bone. Computed tomography showed a high-density area in the whole left middle cranial fossa, which was slightly enhanced. Carotid angiography, however, indicated an avascular mass. Microsurgical total extirpation by a two-stage operation was successful in this case. The first operation was subtotal removal including excision of the tumor by loop electro-cautery followed by bleeding control with a bipolar coagulator. Total removal was performed in the second operation. The patient had mild postoperative disorders of the trigeminal and abducent nerves.
Total extirpation is difficult under these conditions because the operation is apt to cause bleeding and because the tumor contains the large artery and the cranial nerves. Therefore, the prognosis for this condition is poor despite measures such as the combined use of radiation.

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Intracranial aneurysms arising from the posterior cerebral artery are rare. A 36-year-old female was brought to Hatano Red Cross Hospital as an emergency case following a sudden onset of severe headache, nausea, and numbness in the left half of the body. On admission, she was slightly delirious and presented nuchal stiffness, left-sided hemiparesis, hemianopsia, and hemihypesthesia associated with hyperpathia, which was elicited even by the lightest touch on the left upper limb. A computed tomography scan showed in the right ambient cistern a round high density lesion which was enhanced after contrast infusion, although no blood density in the basal cisterns was detected. Angiography revealed a large aneurysmal dilatation, measuring 15×25 mm in diameter, at the junction of the right posterior cerebral and the posterior temporal arteries. One month later, clipping of the partially thrombosed aneurysm with a broad based neck was carried out through the zygomatic approach. Postoperatively the patient's condition was complicated by embolism of the pulmonary artery and thrombosis of the right posterior cerebral artery distal to the aneurysmal neck. However, she eventually returned home with residual neurological deficits of left-sided hemianopia and hemihypesthesia. The surgical approach to aneurysms of this region is discussed and the importance of minimizing retraction of the temporal lobe and preserving the vein of Labbe is emphasized. The zygomatic approach is considered to be suitable for aneurysms in this location.

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A patient with the chondroid variant of chordomas at the skull base is presented. This 49-year-old female complained of diplopia. Examination revealed right abducens palsy only. The cause of the abducens palsy could not be demonstrated. 4.5 years later, she showed right abducens paralysis and mild dysesthesia in the distribution of the second division of the right trigeminal nerve. Pathological findings revealed physaliphorous cells, which indicated typical chordoma. A large amount of mucin was seen in the stroma. Typical cartilaginous cells were not proved. These findings indicated the transitional form between typical chordoma and chondroid chordoma. Dysesthesia of the right side of her face disappeared postoperatively. She has had a good clinical course for the ensuing year. It has been reported about chondroid chordoma that the more chondroid the tumor the longer the survival. To distinguish chondroid variants among chordomas is very important for prediction of the survival time. In cases with a chronic abducens paralysis, careful investigations should be performed to rule out a parasellar tumor. Reinvestigation is necessary immediately after the appearance of other neurological abnormalities.

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A 57-year-old man was admitted because of visual disturbance due to a recurrent pituitary adenoma. Nine years ago craniotomy was performed for the chromophobe adenoma and postoperative radiation therapy was applied with tumor dose of 50 Gy. Digital subtraction angiography indicated existence of an aneurysm at the carotid bifurcation and the finding was confirmed by conventional angiography, which revealed a saccular aneurysm and irregularity of the carotid walls. In surgery there were not only the saccular aneurysm found in the angiogram, but also three other fusiform aneurysms and severe sclerotic change at the major arteries adjoining the sellar region. Azzarelli et al. reported a fatal case due to the development of arteriosclerotic intracranial fusiform aneurysms following radiation therapy for suprasellar germinoma. This case is the second case which indicates the development of intracranial aneurysm following radiation therapy. Emphasis is placed on careful follow-up examination for radiated pituitary adenoma with computed tomography, digital subtraction angiography, or occasionally conventional angiography, even though the postoperative condition of the primary lesion is stabilized.

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Depressed skull fracture in neonates is usually associated with trauma at delivery. So-called “spontaneous” congenital or intrauterine depressed skull fracture in newborn babies rarely occurs and has been infrequently documented in the literature. A case of congenital depressed skull fracture in a newborn infant, possibly resulting from cephalo-pelvic disproportion at delivery is presented.
A 3, 240g female infant was delivered vaginally by vertex presentation of a gravida i, para i, 39-year-old woman at 40 weeks of gestation. Delivery was prolonged and an obstetrical vacuum extractor was used. Apgar score was 8 at 1 minute. At birth a right frontal skull depression, measuring 4×4 cm, was noted. The infant was admitted when she was 50 days old. On admission physical and neurological findings were unremarkable except for the right frontal skull depression. Plain skull films and computed tomography scans demonstrated a ping-pong ball fracture of the right frontal bone without any fracture line. Cranioplasty was performed uneventfully when the infant was 52 days old. A flat sacrum and contracted pelvis were observed on the mother's pelviogram.
Congenital or intrauterine depressed skull fracture of the newborn is reviewed and the pathogenesis of this condition is discussed.

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Two cases of an epithelium-lined cyst of the quadrigeminal cistern are reported. Case 1, a 16-year-old girl, was admitted because of rapidly progressive visual disturbance. Neurological examination showed papilledema, abducens palsy, Parinaud's sign, hearing impairment, truncal ataxia, and incoordination. She was also slightly dull in response. Case 2, a 12-year-old girl, had experienced occasional headache and nausea for 3 months before admission. Neurological examination revealed early papilledema and cerebellar incoordination of the right side. In both cases, computed tomography scans revealed a large low density area in the quadrigeminal cistern and dilation of the third and lateral ventricles. The cyst wall was partially resected and a cyst-subarachnoid shunt was established in both cases with an additional ventriculo-peritoneal shunt in Case 1. Light microscopic examination of the cyst wall disclosed a layer of columnar or cuboidal epithelial cells and thin collagenous connective tissue. Electron microscopic study showed that the epithelial cells were mostly composed of non-ciliated cells, with a few ciliated cells. Basement membrane and junctional complexes were seen, but secretory granules were not found.
Literature on epithelium-lined cysts of the quadrigeminal cistern was reviewed and the histogenesis of the cyst was discussed. Although the origin of epithelium-lined cysts is still controversial, histological findings in the present cases indicate that the cysts originated from the primitive neuroepithelium, because of the resemblance to the choroid plexus.

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A case of meningioangiomatosis without association with von Recklinghausen's disease is reported.
A 39-year-old man was admitted because of head injury. Computed tomography (CT) scan showed right acute epidural hematoma, left intracerebral hematoma, and a mass with calcification in the right parietal region. Craniotomy, evacuation of epidural hematoma, and external decompression were performed. Enhanced CT scan revealed that the mass was slightly enhanced around calcification. Angiography demonstrated an avascular mass. Cranioplasty and partial removal of the mass were carried out. Microscopically, irregularly-branched thick-walled blood vessels extended into the gray matter from the meningeal surface, and proliferated blood vessels were surrounded by wavy or concentric arrangement of spindle-form cells in association with intervening neural tissue. A diagnosis of meningioangiomatosis was made. Spindle-form cells were not found to contain S-100 protein. Electron microscopic findings demonstrated that the proliferating cells were composed of spindle-form nuclei rich in heterochromatin and slender cytoplasm containing microfilaments, in association with desmosomal junctions and basal lamina-like structure on occasion. These findings disclosed that spindle-form cells were not derived from Schwann cells but that they may be meningothelial cells in origin.

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Solitary bone cysts are relatively common in long bones, but rare in skull bone. A rare case of the solitary bone cyst (unicameral bone cyst) in the skull is reported. A 7-year-old boy was referred to the department for painless swelling of the left parietal region. On admission, the patient revealed no physical or neurological abnormality except for a mild circumscribed swelling of the left parietal region. Plain skull X-ray films and tomograms showed a radiolucent lesion about 4 cm in diameter, within the left parietal bone, but no hyperostotic area could be noted in this lesion. Computed tomographic scan also revealed a low density lesion in the left parietal bone which showed no contrast enhancement. Left parietal craniotomy was undertaken and total removal of the cystic lesion was performed. The cyst was single, multiloculated and was lined by thin granular tissue. The cavity was filled with bloody fluid. The postoperative course was uneventful. Histological examination revealed that loose connective tissue was lining the cavity wall and no epithelial or endothelial lining cells. Osteoid tissue and osteoclast-type giant cells were found in the cavity wall. When a roentgenogram shows a well-circumscribed radiolucent lesion, the solitary bone cyst should be taken into consideration, and surgical exploration is necessary in order to confirm the diagnosis.

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A case of a 17-year-old boy with a spinal epidural abscess and a history of pus in the knee, followed by paraplegia is reported. Myelography, metrizamide computed tomography myelography, and radioisotope scan were useful in the diagnosis. A laminectomy of Th10 was performed. During the operation, extension of the abscess cavity was ascertained with a contrast medium. The pus was removed completely. However, the neurological results were unsatisfactory.
Pertinent literature is reviewed and the 46 cases in Japan are analyzed. The importance of early diagnosis and early operation is emphasized.

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