Neurologia medico-chirurgica

Altered Structure and Expression of the p53 Gene in Human Neuroepithelial Tumors

Kazuo TABUCHI, Kouzou FUKUYAMA, Toshihiro MINETA, Mamoru OH-UCHIDA, Ka ...

1992 Volume 32 Issue 10 Pages 725-732
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.725

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The p53 gene, located on chromosome 17p13.1, may be important in the pathogenesis of human neuroepithelial tumors, because it is a tumor suppressor gene and genetic alteration is essential for certain human cells to acquire the neoplastic phenotype. The structure and expression of the p53 gene were investigated in cultured human glioma cells and biopsied specimens of neuroepithelial tumors. Immunocytochemical examination of p53 gene expression revealed positive nuclear staining in six of seven glioma cell lines tested. Sodium dodecyl sulfate-polyacrylamide gel electrophoretic analysis demonstrated unequivocal heterogeneity of migration rate in p53 bands. Pulse-chase analysis clearly showed an increased half-life of p53 in cultured human glioma cells. These abnormalities are presumably due to genetic alterations in the p53 gene. Nucleotide substitutions in exon 5, 7, or 8 of the p53 gene could be detected by polymerase chain reaction-single strand conformational polymorphic analysis in four of seven (57%) human glioma cell lines, and nine of 29 (31%) biopsied specimens of neuroepithelial tumors examined. The present results indicate that genetic alterations in the p53 gene are responsible for the tumorigenesis of at least some human neuroepithelial tumors.

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Cerebral Vein Disorders and Postoperative Brain Damage Associated with the Pterional Approach in Aneurysm Surgery

Yusuke KAGEYAMA, Kazumasa FUKUDA, Shigeki KOBAYASHI, Masaru ODAKI, Hir ...

1992 Volume 32 Issue 10 Pages 733-738
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.733

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The possible causes of postoperative brain damage were examined in 100 cases of cerebral aneurysms operated on by the pterional approach. Postoperative brain damage occurred in 15% of cases, located mostly in the inferior frontal lobe. Its incidence was higher in early than in delayed operation and increased with severity of preoperative clinical conditions but not correlated with patient age and aneurysm location. The venous perfusion patterns in the inferior frontal lobe were classified into three types based on preoperative venograms: Sylvian type drained mainly into the superficial Sylvian veins (SSVs), Frontal type drained mainly into the frontal bridging veins, and Intermediate type. Postoperative brain damage was most frequent in the Sylvian type with statistical significance (p < 0.01). The brain retraction procedure impairs regional cerebral blood flow (rCBF). Venous congestion in the retracted inferior frontal lobe, caused by stretching and narrowing of SSVs due to both brain retraction and dissection of the Sylvian fissure, also reduces rCBF. Thus, a marked reduction in rCBF in the retracted area causes postoperative brain damage. Postoperative venograms showed the SSVs to be obscured in 24% of patients, indicating that the pterional approach possibly influences the SSV perfusion. A venous perfusion disorder during the pterional approach is the most important factor in postoperative brain damage, and careful preoperative assessment of cerebral veins is indispensable.

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Preliminary Results of Interstitial ¹⁹²Ir Brachytherapy for Malignant Gliomas

Kengo MATSUMOTO, Minoru NAKAGAWA, Hisato HIGASHI, Tomohide MAESHIRO, K ...

1992 Volume 32 Issue 10 Pages 739-746
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.739

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Twenty-six patients with recurrent or unremovable malignant gliomas were treated by interstitial brachytherapy with iridium-192 seeds. Stereotactic implantation of the afterloading catheters using the Brown-Roberts-Wells computed tomography (CT)-guided stereotactic system was performed in 24 patients and surgical implantation in two patients with pontine glioma. The response to therapy was measured by serial CT, magnetic resonance imaging, and clinical examination. Tumor regression was seen in 17 patients 1-3 months after implantation. Tumor progression was seen in only three patients. After interstitial brachytherapy, the most commonly observed CT finding was central low density. Median survival time was 18 months after implantation. Autopsies in five patients revealed the delayed effects of radiation injury such as typical vascular changes, microcalcification, and coagulative necrosis in the implant area and tumor recurrence at the periphery. The results suggest that brachytherapy is not curative but prolonged the median survival time by 6 months.

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A Provocative Internal Carotid Artery Balloon Occlusion Test with ^99mTc-HM-PAO CBF Mapping —Report of Three Cases—

Masaki KOMIYAMA, Virender K. KHOSLA, Katsuhiko TAMURA, Yasunori NAGATA ...

1992 Volume 32 Issue 10 Pages 747-752
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.747

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The balloon occlusion test (BOT) of the internal carotid artery (ICA), combined with induced hypotension and cerebral blood flow (CBF) mapping, was carried out in three patients with a large or giant aneurysm of the ICA. Occlusion of the ICA for 10 minutes in the normotensive state was followed by 5 minutes of induced hypotension. During the last 2 minutes of hypotensive occlusion, technetium99m-hexamethyl-propyleneamine oxime was administered to study the CBF. All patients tolerated the procedure well. One patient with moderate CBF reduction developed ischemic complications 24 hours after permanent ICA occlusion. Another showed no significant change in CBF and tolerated permanent ICA occlusion well, while the third refused permanent occlusion. The provocative BOT combined with CBF mapping is a promising predictor of complications of ICA occlusion secondary to perfusion abnormalities.

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Moyamoya Disease Associated with Pituitary Adenoma —Report of Two Cases—

Kazunori ARITA, Tohru UOZUMI, Shuichi OKI, Satoshi KUWABARA, Shinji OH ...

1992 Volume 32 Issue 10 Pages 753-757
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.753

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Moyamoya disease associated with prolactin (PRL)-producing pituitary adenomas occurred in two females with elevated blood PRL levels (285 and 120 ng/ml). Computed tomography revealed cystic tumors extending from the sella turcica to the suprasellar cistern. Carotid angiography demonstrated stenoses or obstructions of the bilateral internal carotid arteries at their end point and development of bilateral basal moyamoya vessels. Histological diagnosis in one case was PRL-producing chromophobe adenoma. No stigmata of neurofibromatosis or any history of irradiation was found. Compression of carotid arteries by the tumor was unlikely. These cases should therefore be classified as moyamoya disease accompanied by brain tumor, a very rare occurrence. The hypothalamic disturbance caused by moyamoya disease may have induced the hyperprolactinemia, resulting in secondary prolactinoma.

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Intracranial Extension of an Orbital Pseudotumor Accompanied by Internal Carotid Artery Occlusion —Case Report—

Tohru NISHI, Yuji SAITO, Kenji WATANABE, Tohru UOZUMI

1992 Volume 32 Issue 10 Pages 758-761
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.758

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A rare case of histologically verified orbital pseudotumor with intracranial extension in a 33-year-old male is reported. Preoperative radiographs showed the mass extending beyond the orbit and involving the bilateral cavernous sinuses. The intracranial lesion at biopsy surrounded the right internal carotid artery above the right cavernous sinus. Cerebral angiography showed complete occlusion of the cervical portion of the right internal carotid artery. Possibly, multiple lesions had extended contiguously through the venous system around the cavernous sinus, with subsequent involvement of the internal carotid artery. This case suggests that orbital pseudotumor may not be a separate clinical entity, but a part of the syndrome caused by inflammation of the venous system around the cavernous sinus.

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Cavernous Angioma of the Cerebellum and Cerebellar Atrophy —Case Report—

Akihiro TAKAHASHI, Hiroyasu KAMIYAMA, Hiroshi ABE, Satoshi KURODA, Hir ...

1992 Volume 32 Issue 10 Pages 762-764
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.762

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A cavernous angioma of the cerebellum occurred in a 55-year-old female presenting with a 3-year history of slowly progressive cerebellar signs and symptoms. Computed tomography and magnetic resonance imaging revealed a lesion in the left cerebellar nuclei and atrophic change of the affected cerebellar hemisphere. The final diagnosis was made at operation. The cerebellar nuclei and white matter were probably affected by the slowly expanding lesion, with repeated hemorrhage leading to degeneration of the afferent and efferent fibers, and subsequent atrophy of the affected cerebellar hemisphere.

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Diaphragma Sellae Meningioma Associated Only with Signs of Hypopituitarism —Case Report—

Shuzo OKUNO, Manabu HISANAGA, Shigeru TSUNODA, Toshisuke SAKAKI

1992 Volume 32 Issue 10 Pages 765-768
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.765

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A rare diaphragma sellae meningioma presenting only with signs of hypopituitarism occurred in a 54year-old male. Preoperative magnetic resonance (MR) imaging clearly demonstrated a small lesion in the supradiaphragmatic area immediately beneath the optic chiasm, displacing the pituitary stalk laterally. Intraoperatively, the tumor was confirmed to be attached only to the posterior leaf of the diaphragma sellae. Histological examination revealed a transitional type meningioma. Such a small meningioma may be associated only with hypopituitarism, as compression is confined to the pituitary stalk, not affecting the optic pathways. MR imaging can demonstrate the clinicopathological features of this small but significant tumor.

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Hemichorea Associated with Ipsilateral Chronic Subdural Hematoma —Case Report—

Masami YOSHIKAWA, Mitsuo YAMAMOTO, Kenji SHIBATA, Keiji OHTA, Yasushi ...

1992 Volume 32 Issue 10 Pages 769-772
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.769

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Left-sided hemichorea developed suddenly in a 73-year-old male. Computed tomography revealed a left subdural hematoma (SDH) and infarction in the right corona radiata and temporo-occipital region. Hemichorea subsided completely after removal of the SDH. Postoperative single photon emission computed tomography with technetium-99m-hexamethyl-propyleneamine oxime revealed a global low-perfusion area in the right cerebral hemisphere. Right carotid angiography demonstrated severe stenosis of the trunk of the right middle cerebral artery. The cerebral blood flow in the right cerebral hemisphere had probably already decreased to nearly the critical level and was reduced further by the left SDH, inducing the left-sided hemichorea due to dysfunction of the right cerebral hemisphere. This case shows that when hemichorea ipsilateral to a SDH is present, it is important to ascertain whether there is a pre-existing ischemic lesion in the contralateral cerebral hemisphere, particularly in the basal ganglia, thalamus, or corona radiata.

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Magnetic Resonance Findings in Spontaneous Dissection of the Cervical Internal Carotid Artery —Case Report—

Satoshi KURODA, Takeo ABUMIYA, Akihiro TAKAHASHI, Hiroyuki IMAMURA, Hi ...

1992 Volume 32 Issue 10 Pages 773-777
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.773

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The magnetic resonance (MR) appearance of a spontaneous dissection of the cervical internal carotid artery (ICA) in a 53-year-old male is described. Cerebral angiograms demonstrated a long-segment stenosis of the left cervical ICA beginning above the common carotid bifurcation and extending to the skull base (“string sign”). T₁-, T₂-, and proton density-weighted MR images of the upper neck revealed a high-intensity crescent mass expanding the arterial wall and narrowing the arterial lumen of the left ICA. This high-intensity mass was considered to represent the mural hematoma of the involved ICA. Gradual improvement of the dissection was confirmed by both angiography and MR imaging. Cerebral angiograms have shown pathognomonic findings such as double lumen and intimal flap in only some patients with ICA dissection. Our experience suggests that MR demonstration of the mural hematoma is specific and important for diagnosis and follow-up in cases of spontaneous dissection of the cervical ICA.

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Giant Aneurysm at the Junction of the Left Internal Carotid and Persistent Primitive Trigeminal Arteries —Case Report—

Koji TSUBOI, Fumiho SHIBUYA, Takashi YAMADA, Tadao NOSE

1992 Volume 32 Issue 10 Pages 778-781
Published: 1992
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.32.778

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A 67-year-old female presented with an unruptured giant aneurysm at the junction of the left internal carotid artery (ICA) and the persistent primitive trigeminal artery (PTA), manifesting as progressive left abducens nerve paresis. The PTA was clipped by the left suboccipital approach. The aneurysm was then successfully thrombosed by ligation of the left ICA at the cervical portion following left superficial temporal artery-middle cerebral artery anastomosis. The left abducens nerve paresis improved postoperatively. Magnetic resonance imaging was of considerable value in the pre- and postoperative evaluation of the giant aneurysm.

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