The pathophysiology and developmental impairment of congenital hydrocephalus were studied in an albino rat model (HTX). Of 292 newborn HTX rats in a closed colony, 53% were found to have communicating hydrocephalus, which changed to noncommunicating hydrocephalus within 5 days of birth. Three types of hydrocephalus were identified. “Rapidly progressive hydrocephalus” affected 45% of the newborn rats, all of which died from 20 to 49 days (mean, 28 days). In 5%, the progress of the hydrocephalus slowed or ceased (“compensated hydrocephalus”), and these animals survived as long as the nonhydrocephalic rats. The third type of hydrocephalus, which was found in about 14% of adult rats, did not cause head enlargement, although autopsies revealed moderate ventricular dilatation (“normal pressure hydrocephalus”). Comparative histopathological study of 1- and 7-day-old hydrocephalic rats disclosed progressive edema and ultimate destruction of cerebral white matter. Nerve cells in the cerebral cortex proliferated and differentiated, and cortical cell lamination increased from three to six layers during this period. However, as ventricular dilatation progressed, the width of the cerebral mantle gradually decreased, the cortical cell laminae became obscured, and a disturbance in axon formation was evident. In animals with compensated hydrocephalus, extensive disruption of axon and myelin formation was noted in the cerebral cortex, basal ganglia, and thalamus. In normal pressure hydrocephalus, there appeared to be edema of the periventricular white matter and disturbance in myelin formation in the cortical area.
In an in vitro study, the chemosensitivity of EFC-2 human glioma cells to ACNU, BCNU, cisplatin, and bleomycin sulfate was evaluated by growth suppression and colony forming assays. The EFC-2 cell line was cloned from a human glioblastoma multiforme. Cisplatin was the most effective agent in this study. ACNU and BCNU had very similar dose-response curves, although this result was not statistically significant.
Lymphocyte subpopulations were monitored by means of monoclonal antibodies in 89 patients with primary or metastatic malignant brain tumors. In 27 normal volunteers, the ratio of helper/inducer (Leu 3a) to suppressor/cytotoxic (Leu 2a) T cells was 1.84 ± 0.32 (mean ± SD). The ratio decreased to 1.21 ± 0.34 in 32 patients who were newly diagnosed as malignant gliomas, and to 1.01 ± 0.34 in 21 patients with metastatic brain tumors. Among patients with malignant gliomas whose Karnofsky performance status was over 40%, the ratio increased during remission and/or when computed tomography showed tumor reduction. These results suggest that the suppressor T cells are more prevalent than helper T cells in patients with malignant brain tumors. Furthermore, immunosuppression and tumor load appear to be related, since the Leu 3a:Leu 2a ratio increased following effective treatment and tumor reduction in patients with Karnofsky ratings of over 40% but decreased in patients who were in the terminal stage of their disease.
Thirty patients with acute cerebrovascular disease were evaluated by both computed tomography (CT) and magnetic resonance (MR) imaging. The 17 patients with cerebral infarction (CI) were evaluated within 24 hours and the 13 with intracerebral hemorrhage (ICH) within 6 hours of the onset of symptoms. All ICHs were detected in T2-weighted images and appeared as perifocal, ring-like areas of high signal intensity. T2-weighted images also demonstrated a ruptured aneurysm and an arteriovenous malformation. In T1-weighted images, all ICHs displayed high signal intensity, which paralleled the CT images and is characteristic of MR imaging with an ultra-low magnetic field. These findings were obtained as early as 90 minutes from the onset of symptoms. In cases of CI, T2-weighted images obtained 3-7 hours after onset demonstrated the pathology more clearly than did CT. This study proved MR imaging useful in the evaluation of both ICH and CI in the acute stage. In addition, it was possible to differentiate ICH from CI in the acute stage by T2-weighted images alone.
A group of 25 patients with patent extracranial-intracranial anastomoses were followed for 18 months in an effort to determine the long-term effects on regional cerebral blood flow (rCBF). The 133Xe inhalation method was used to measure rCBF. In patients whose preoperative mean rCBF (mCBF) on the affected side was low, i.e., less than 40 ml/100 gm/min, or who had internal carotid artery occlusion (ICO) or middle cerebral artery occlusion (MCO), mCBF on the affected side increased postoperatively. In patients with high preoperative mCBF rates on the affected side, i.e., 40 ml/100 gm/min or more, or internal carotid artery stenosis (ICS) or middle cerebral artery stenosis (MCS), mCBF on the affected side did not change after bypass. Postoperatively, the hemispheric difference in mCBF between the anastomosed and opposite sides was small in cases with ICO or MCO and negligible in patients with ICS or MCS, relative to the preoperative values. The rCBF significantly increased in the frontal, precentral, and superior temporal areas in patients with ICO, MCO, or low preoperative mCBF rates on the affected side.
The results of stereotactic aspiration, conventional craniotomy, and conservative treatment were compared in 91 cases of putaminal hemorrhage, all involving a medium-sized hematoma (20-60 ml). The average interval between onset of symptoms and operation was 7.4 days for stereotactic aspiration and 11.5 hours for craniotomy. Patients with low neurological grades and low computed tomography (CT) classifications had better outcomes regardless of treatment. Among patients with a neurological grade of 3, the outcome was significantly poorer with conservative treatment than with stereotactic aspiration or conventional craniotomy (p < 0.05). Among grade 4a patients, conventional craniotomy yielded the best results (p < 0.05). Among those with CT classifications III and IVa, the outcome was significantly poorer with conservative treatment than with stereotactic aspiration or conventional craniotomy (p < 0.05).
Four cases of acute subdural hematoma in judo players are presented. Three were teenagers and one a young adult. Three sustained very severe injuries involving rupture of the bridging vein draining into the superior sagittal sinus without primary cortical laceration. These four cases are described and the incidence and nature of judo-related head injuries are discussed.
A rare neurosurgical event is described, in which an acute subdural hematoma developed during tack-up suture of the dura mater after evacuation of an acute epidural hematoma. The source of the second hematoma was determined to have been a ruptured bridging vein. The author discusses the potential risk of tack-up suture when there is a large gap between the dura mater and the inner surface of the skull.
A 62-year-old male was hospitalized because of mild ataxia and right hemiparesis. Computed tomography and magnetic resonance imaging clearly demonstrated a mass in the fourth ventricle, and a suboccipital craniectomy was performed. The tumor was tightly adherent to the choroid plexus of the fourth ventricle and was supplied by the choroidal branch of the posterior inferior cerebellar artery. The histological diagnosis was fibroblastic meningioma. One year later, there was no evidence of tumor recurrence. However, the right hemiparesis, which proved to be secondary to a cerebral infarction, persisted.
Eight months after total removal of a falx meningioma, a computed tomographic scan disclosed five enhanced masses near the operative site. The enhancement was ring-like in one mass and homogeneous in the others. All were initially thought to be tumor recurrences, but the mass exhibiting ring enhancement proved to be a granuloma that had formed around a cotton pledget, which was inadvertently left during the first surgery. The radiological findings of postoperative intracranial foreign-body granuloma and the cytological features of recurrent meningioma are discussed.
An intramedullary spinal cord teratoma was diagnosed in a 4-year-old boy who presented with gait disturbance. A congenital thoracic cord tumor was suspected on the basis of neurological and radiological findings. Magnetic resonance imaging demonstrated a mass extending from the C7 to Th6 levels; its heterogeneous intensity suggested a teratoma. The tumor was subtotally removed via C6-Th6 laminectomies. Histological examination showed a teratoma consisting of mature and immature tridermic elements. The postoperative course was uneventful and he was discharged without major neurological deficits.
Although osteochondromas are among the most common benign tumors of bone, they rarely compress the spinal cord or cauda equina. We describe a case in which a solitary sacral osteochondroma compressed the cauda equina, producing sensory disturbance and urinary dysfunction. The tumor was removed via lumbar hemilaminectomy. The pertinent literature is discussed, as well as the diagnostic features of plain x-ray, computed tomography, and magnetic resonance imaging.
We report a case of intracranial Aspergillus granuloma that originated in and extended from the sphenoidal sinus. The patient, a 68-year-old male gardener, had no predisposing medical condition, such as cancer or immunosuppression. His symptoms, in order of appearance, were visual disturbance, headache, and ophthalmoparesis. A review of the literature concerning this rare disorder disclosed that these three symptoms, along with inflammation of the face, are common. On magnetic resonance (MR) imaging, the lesion appeared as an isointense mass extending from the sphenoidal sinus. Differentiation from malignant nasopharyngeal tumors is difficult, however, because the MR images are similar. Radical excision followed by aggressive antimycotic chemotherapy can result in a good outcome if a correct, early diagnosis is made.
We report a patient who experienced episodes of vertigo, nausea, and vomiting caused by rotational vertebral artery stenosis at the first segment. At surgery it was found that the left vertebral artery was compressed by the cervical sympathetic chain 2 cm distal to its origin when the patient's head was turned to the right. The artery was also compressed by an osteophyte at the C6-7 level. The sympathetic chain was sectioned, the osteophyte was removed, and the transverse foramen of C6 was unroofed. Decompression of the vertebral artery conferred symptomatic relief. The literature concerning compression of the first segment of the vertebral artery is reviewed.
Symmetrical lucency was found on computed tomography in the bilateral basal ganglia following severe seizures in a patient who had undergone an otherwise uneventful posterior fossa craniotomy. The lucency was transient and resolved completely. Lucency of the bilateral basal ganglia has been reported previously, but has usually been permanent. Focal edema secondary to hypoxia during seizures is the most likely cause of transient lucency.