There are many published reports about the morphology of brain tumors, but only a few describe their blood vessels in detail. This report documents the results of a systematic light microscope study of the blood vessels in glioblastoma multiforme.
Specimens obtained from surgery (52 cases) and autopsy (9 cases) were divided into four areas: normal brain, area of reactive astrocytes adjacent to the tumor, tumor, and necrotic tumor. The blood vessels of the four areas were analyzed and compared with each other. In the normal area, most of the vessels were capillaries in the gray matter. In the area of reactive astrocytes, the capillary network is more conspicuous than in the normal brain, due to the prominence of astrocytic vascular feet. In the peripheral portion of the tumor, endothelial proliferation was conspicuous in almost all cases. In the center of the tumor, two types of vessels were observed. One had a small caliber and a thick wall and the other had a larger caliber and a thin wall. The large vessel was usually filled with erythrocytes. In the area of necrotic tumor, the vessel walls were also necrotic. More large vessels were observed in this area than in the central portion of the tumor.
These various types of vessels are presumed to have different permeability characteristics that may be manifested in and around glioblastoma multiforme.

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The authors report an experimental trial to record cerebral blood flow (CBF) continuously by means of a thermal diffusion method using a Peltier stack. The authors performed the experiments after Carter's method and confirmed that a stable recording was possible. To calibrate the flow probe, they used CBF values obtained by the electrolytic method. The authors proved theoretically and experimentally that calibration of the flow probe is possible without knowing the CBF values at the time of cardiac arrest.
The thermal diffusion method using a Peltier stack is a very useful method for monitoring CBF continuously, especially during neurosurgical operations. Many problems of cerebral hemodynamics should be solved by measuring CBF values by this method.

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A technique of intraoperative angiography is described. It may provide the operating surgeon with valuable information, and it involves a minimum of special equipment. A catheter is introduced via the superficial temporal artery, without puncture of the common carotid artery or the femoral artery. The equipment required includes a portable X-ray machine, tubing, a syringe, contrast medium, and a pair of simple devices for holding a film cassete against the Sugita head frame. When the surgeon believes that an intraoperative angiography is indicated, the superficial temporal artery, which has been exposed by the scalp incision, is punctured, and a guide wire is introduced. The guide wire is advanced adversely into the common carotid artery. The catheter is then threaded over the guide wire into the common carotid artery. Because of the presence of the catheter in the external carotid artery, the injected contrast medium only fills the internal carotid artery, enabling finer figures to be seen.
This technique may be of great value in patients with arteriovenous malformation (AVM), especially if it is deep-seated and there is any question as to a retained part, as well as in verifying the complete removal of an AVM, intraoperatively.

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Seven pituitary adenomas with suprasellar extensions were examined with a 0.5 tesla superconductive magnetic resonance imaging (MRI) system. MRI clearly displayed the anatomical structures, such as an optic pathway and internal carotid arteries in the cavernous sinus, but it could not show the cavernous sinus itself or the nerves in it. Sagittal and coronal inversion recovery images were very useful for visualization of the optic pathway and short spin echo images of the parasellar anatomy. To delineate tumors, coronal and sagittal images were superior to axial images in all pulse sequences. Prolongation of the spin-lattice relaxation time (T₁) and spin-spin relaxation time (T₂) was observed in every case with no relation to tissue type of the tumors.

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Systematic anterior pituitary function tests were performed in 23 patients with cerebral infarction in the region of the middle cerebral artery, and the results were assessed for correlation with various clinical factors.
By radio-immunoassay, growth hormone and cortisol during the insulin tolerance test (regular insulin, 0.15-0.20 U/kg), luteinizing hormone and follicle stimulating hormone under luteinizing hormone-releasing hormone (100μg), thyroid stimulating hormone and prolactin under thyroidreleasing hormone (500μg) were determined. The impaired rate was calculated in each patient as the percentage of the number of impaired anterior pituitary hormones in the number of effectively examined anterior pituitary hormones. The data were statistically assessed by variance analysis for sex, age, consciousness level, disease stage at the test time, type of computed tomography scan, and complications versus the impaired rate. The results were as follows: 1) Growth hormone, thyroid stimulating hormone, cortisol, luteinizing hormone, prolactin, and follicle stimulating hormone secretions were impaired in 65%, 52%, 26%, 17%, 17%, and 9% of the cases, respectively. 2) The case incidence of impaired anterior pituitary hormonal secretion was 83%, but its intensity was mild in most of the patients. 3) The impaired rate was significantly high in patients with consciousness disturbance and complications such as cerebral edema. 4) The impaired rate tended to be high in patients in the early stages of the disease.

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The authors report their personal experience of the surgical treatment of trigeminal neuralgia with special reference to the results of microvascular decompression (MVD) in cases with basilar artery (BA) trunk compression. In the past 7 years, 730 patients with trigeminal neuralgia were surgically treated in their institute. These included 595 patients with genuine tic douloureux (Group 1), 42 with atypical trigeminal neuralgia (Group II), and 8 with atypical facial pain (Group III). In the Group I tic patients, typical neurovascular compression was observed in 582 cases (97.8%). In this series of 582 cases, 45 patients had vascular compressions by the elongated BA. Among these, simple BA compression was rare (4 cases, 8.9%) and the majority had multiple vessel compression along with anterior inferior cerebellar artery, superior cerebellar artery, petrosal vein, vertebral artery, or a combination of these vessels. Clinical features of these 45 cases, operative technique to mobilize tortuous and enlarged BA, and the surgical results are presented. The importance of enhanced computed tomography scan in predicting BA compression preoperatively is stressed. The vertebrobasilar artery was visualized as a linear enhancement crossing the prepontine cistern in all cases of BA compression. The postoperative follow-up period ranged from 6 to 50 months (mean: 19 months). Complete pain relief was obtained in 43 cases (95.6%). In 2 cases (4.4%), tic pain recurred at 2 and 3 months postoperatively. Because of the tremendous tortuousity, hypertrophy, and sclerosis of the BA, it was extremely difficult in all cases to transpose the BA sufficiently off the nerve root. As many as 23 cases (51%) had a total of 41 neurological symptoms and signs after surgery, although most of them were only temporary and disappeared within 1 to 3 months. The most frequent neurological complications were facial hypesthesia and diplopia due to the fourth or sixth cranial nerve paresis. There were six permanent neurological deficits in 5 patients (11%).
The authors are convinced that MVD, though it involves some technical difficulties, should be attempted, and that the procedure will lead to a satisfactory result.

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In 35 posterior fossa operations with intraoperative brain-stem auditory evoked potential (BAEP) monitoring, there were seven microvascular decompression (MVD) operations performed for five cases of hemifacial spasm and two of trigeminal neuralgia. Among these seven patients, three cases, two of hemifacial spasm and one of trigeminal neuralgia, showed postoperative hearing disturbance. In these cases, intraoperative BAEPs showed aggravations of all waveform components including wave I. Otoneurological examinations revealed the hearing disturbances were caused not only by retrocochlear lesions but also by cochlear lesions. These findings suggest that postoperative hearing disturbance after MVD surgery is deeply related to circulatory disturbance of the internal auditory artery.

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The author herein reports a new operative approach, the basal interhemispheric (BIH) approach, for anterior communicating artery aneurysms (ACo AN). This approach is a modification of the anterior interhemispheric (AIH) approach developed for lesions in and around the anterior third ventricle.
The patient is fixed in the supine position and the head is dorsiflexed. A bicoronal skin incision is made behind the hairline and subperiosteal dissection of the skin flap is performed to the nasion and both upper portions of the orbits. The supraorbital nerves must be preserved in this procedure when the nerves penetrate the supraorbital foramina. A bifrontal craniotomy is performed as in the routine AIH approach and then an additional craniotomy is performed in the basal frontal and nasal bones. A small dural incision is made in the mid-basal portion of the right side. Microsurgical dissection of the interhemispheric fissure is performed directly toward the pre and suprachiasmatic areas near the folded portion of the arachnoid membrane, instead of the knee portion of the corpus callosum as in the AIH approach. Thus, the approach to the aneurysm can be performed using a shorter and more limited interhemispheric dissection than with the AIH approach. After the intradural procedure, the dura should be closed water tight, the additional bone flap is fixed, and then the area of the opened frontal sinus is completely covered with periosteum. The bifrontal bone flap is secured at four points and skin and galea are closed in the usual manner. The bifrontal bone flap is removed for external decompression if necessary.
Fourteen cases of ACo AN (clear consciousness: 7 cases, drowsy state: 6 cases, semicoma: 1 case) have been operated on up to the present time, and all cases have recovered to a good condition. Furthermore, they don't show any cosmetic problem due to additional midline bone flap. It should be stressed that ACo AN can be approached with minimum brain retraction and dissection of the interhemispheric fissure using this BIH approach. This is a most important point in surgery for ACo AN in the acute stage.

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Six cases of sinus pericranii are reported and new classifications are proposed. The age of onset varied from neonate to 22 years. Two patients were male and four were female. In all cases, diagnostic radiography obtained by direct injection of contrast medium at the site of epicranial blood cyst revealed communication between the intracranial dural sinus and sinus pericranii. Total removal of the tumor was performed in four patients, and ventriculo-peritoneal shunt alone was carried out in two cases associated with hydrocephalus.
Sinus pericranii is a symptom-complex, and not an independent clinical entity. Therefore, its definition and classification are matters of controversy. The authors describe a new classification from the pathological aspects, based on their own cases and previous reports. The new classification is the following. Type 1: multilocular blood cyst consisting of fibrous connective tissue similar to the architecture of cavernous hemangioma. (This type is defined as the only type of sinus pericranii by some authors.) Type 2: true hemangiomas (such as capillary hemangioma and cavernous hemangioma) as neoplastic entities. Type 3: varicose vein represented by enlarged emissary vein. Type 4: herniated dural sinus through the defect of calvarium. Type 5: miscellaneous.

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Three patients with normal-pressure hydrocephalus, treated by installation of a low-pressure ventriculo-peritoneal shunt system equipped with an anti-siphon device, did not improve in clinical signs and ventricular size on computed tomography (CT). However, the lumbar infusion manometric test in the horizontal position showed that the shunt systems were functioning and cerebrospinal fluid absorption was good in all patients. The clinical signs and ventricular dilatation on CT were remarkably improved by replacing the shunt system to one without an anti-siphon device. The shunt malfunction seemed to be caused by the anti-siphon function itself, especially when the patients were in sitting and/or standing position.

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A case of surgically treated subarachnoid hemorrhage during pregnancy is reported. A 23-yearold woman at 22 weeks' gestation developed severe headache and frequent vomiting. On admission, she had mild confusion, disorientation, and moderate neck stiffness. Computed tomography scan of the head revealed subarachnoid hemorrhage. As a chest X-ray showed aspiration pneumonia, intentional delayed operation was selected. Cerebral angiography done on the 4th admission day disclosed a saccular aneurysm at the left internal carotid-posterior communicating junction. On the 12th admission day, at 24 weeks' gestation, craniotomy was carried out and clipping of the neck of the aneurysm was performed under gas-oxygen-fluothane general inhalation anesthesia. During the surgery, trinitroglycerin was administered in order to induce hypotension under continuous fetal heart rate (FHR) monitoring by cardiotocogram. Postoperative courses of the mother and fetus were uneventful, and the mother delivered a healthy female baby by a normal vaginal delivery when she was 38 weeks pregnant.
FHR monitoring, which is feasible from 16 weeks' gestation, well represents the state of the fetus, and is useful for the surgical treatment of pregnant woman. Some consideration would be needed of probable teratogenicity induced by inhalation anesthetics such as halothane or nitrous oxide in patients before 16 weeks' gestation.

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Malignant fibrous histiocytoma (MFH) is well known as a soft tissue tumor of the extremities. MFH of the skull is relatively rare, especially with multiple metastases. A 59-year-old female was admitted with complaint of a painless tumor in the left temporal region in March, 1983. Skull plain film showed an osteolytic and osteosclerotic lesion, with a “moth-eaten” appearance, of the temporal bone. Computed tomography (CT) scans revealed a high density mass lesion invading intraand extracranially. Selective external carotid angiography revealed abnormal tumor vessels like a corkscrew and a marked tumor stain. The tumor was extirpated. The histological diagnosis was MFH. The patient received chemotherapy with mitomycin C intraoperatively, and was discharged without any neurological deficits. She was readmitted with complaint of general fatigue 7 months later. Plain chest X-ray films showed a tumor in the mediastinum and depressed fracture of the third thoracic vertebra. CT scans revealed the invasion of the mediastinal tumor to the spinal canal and the hydrothorax. She died in July, 1984. The autopsy showed multiple metastases of MFH to the mediastinum, the third thoracic vertebra, and the right lung, and an associated meningioma in the left cerebellopontine angle. There was no local recurrence.

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A rare case of medulloblastoma with a large cystic component is reported. A 13-year-old girl was admitted to Kanto Rosai Hospital presenting the symptoms of increased intracranial pressure (ICP) and truncal ataxia. Computed tomographic scan revealed a mid-cerebellar high density mass lesion with a cystic low density component rostral to the high density mass, resulting in obstructive hydrocephalus. There was no contrast enhancement around the cyst wall. The patient underwent emergent suboccipital decompression and the symptoms of increased ICP disappeared thereafter. Subsequent excision of the tumor was performed. The cystic component, which contained xanthochromic fluid, was observed as a cavity isolated from the fourth ventricle. The wall of the cyst was apparently normal and was not excised. The histological diagnosis was medulloblastoma.
Besides the hemorrhages and the necrotic changes in the tumor tissue, cerebrospinal fluid entrapment can play a major role in the cyst formation of medulloblastoma. The latter was considered to be the main mechanism of cyst formation in this case.

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The chromosomal aberration of double minute chromosomes (DMS) is a peculiar structural anomaly characterized by the occurrence of strongly varying numbers of often very small, paired chromatin bodies, in addition to the ordinary chromosomes. A glioblastoma multiforme with DMS was found in a 73-year-old female patient, who had received neither radiation nor chemotherapy before the tissue was explanted. She received computerized tomography of the brain because of severe headache, and a brain tumor was found in the right parieto-occipital lobe. The brain tumor was extirpated subtotally and the operative specimen indicated glioblastoma multiforme. In the cytogenetic study, nine cells containing DMS in this tumor tissue showed the hyperdiploid picture, with the total number of chromosomes varying from 50 to 57. Monosomy was found on chromosomes #10, 12, D group, #17, F group, and #21, trisomy on chromosomes A group, #6, 7, 8, 9, 16, and X, nullisomy on chromosome #22, in the karyotype analysis. All of the nine cells containing DMS showed karyotypic abnormalities, while DMS were not seen in the cells with normal karyotypes. Marker chromosomes ranging from 12 to 16, other than DMS, were seen in all of the nine cells. The number of DMS varied considerably among the cells, ranging from 17 to 133. The number of DMS correlated neither with the total number of the chromosomes nor with the number of marker chromosomes. There was no chromosomal abnormality indicating homogeneously staining regions in all of the cells observed in this tumor tissue. In the course of in vitro culture, both the cells with DMS and DMS within the cells gradually diminished in number.

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Adrenocorticotropic hormone (ACTH) -secreting pituitary adenomas show hypercortisolism and several clinical symptoms of Cushing's syndrome. Some pituitary adenomas, however, contain immunoreactive ACTH Or-ACTH) without hypercortisolism or clinical symptoms of Cushing's syndrome. This was defined as silent corticotroph cell adenoma by Kovacs et al. in 1978.
A case of silent corticotroph cell adenoma with high levels of plasma it-ACTH was experienced. A 34-year-old male was admitted because of visual acuity and visual field disturbances. He was obese, but showed no clinical symptoms of Cushing's disease. Plain computed tomography scan showed a large irregular-shaped mass extending from the sellar region to the third ventricle, which was enhanced homogeneously with contrast medium. Endocrinological investigations showed plasma it-ACTH in high levels and serum cortisol in the upper limits of the normal range. The tumor was a chromophobic pituitary adenoma and ACTH immunoreactivity was demonstrated by immunocytochemical staining. Gel chromatography demonstrated a peak of ACTH immunoreactivity alone, which eluted at an earlier position than 1-39 ACTH.

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