TNP-470 (TNP), an analog of fumagillin, inhibits cell proliferation and tumorigenesis in estrogen-induced pituitary tumors in rats. This study found that treatment with TNP or TNP and bromocriptine suppressed vascular formation in these pituitary tumors more than bromocriptine alone. TNP had a greater suppressive effect on vascular formation in pituitary tumors than in normal pituitary gland. Laminin and basic fibroblast growth factor (FGF) were detected around new blood vessels in normal pituitary gland and pituitary tumor. TNP did not completely suppress laminin or basic FGF expression. The effect of TNP on pituitary tumor may involve inhibition of vascular formation by mechanisms mediated by other factors in addition to basic FGF. Treatment with bromocriptine and TNP acts indirectly and directly on vascular formation and may provide a useful chemotherapeutic modality for pituitary tumors.
Brain surface elastance, defined as the pressure needed to compress the cortex 3 mm, was measured using the ophthalmodynamometer in six cats using three burr holes (frontal, parietal, and occipital) on each side. An intracranial mass was then used to compress the right side for 3 hours, and cardiac arrest was induced after the mass was removed. Elastance was measured four times: before insertion of the mass, 10 and 70 minutes after removal of the mass, and 60 minutes after cardiac arrest. The results showed that: brain surface elastance does not change between sides, but varies among regions with the parietal region having the highest elastance; elastance increases after compression by an intracranial mass, but not after cardiac arrest; and stiff brain tends to restore poorly. Elastance is apparently increased by the formation of edema. Measuring brain elastance may be useful in predicting brain restoration subsequent to removal of mass lesions.
The clinical characteristics of eight pediatric and five adult patients with Chiari malformation were evaluated. Six pediatric and five adult patients had associated syringomyelia. All patients initially underwent a suboccipital craniectomy with upper cervical (C-1 and/or C-2) laminectomy and duraplasty, and/or shunting procedures. The clinical characteristics of the pediatric and adult groups were compared. The mean interval between onset of symptoms and operation was shorter in the pediatric group (3 yrs 6 mos) than in the adult group (7 yrs I mo). Pediatric patients without syringomyelia had the shortest mean interval of 1 year 8 months. Preoperatively, the clinical features were more severe in the adult patients than in the pediatric patients. Postoperatively, seven of eight pediatric patients improved and one stabilized, while two of five adult patients improved, one stabilized, and in two the disease continued to progress despite multiple corrective procedures. Cine magnetic resonance imaging revealed correction of the abnormal cerebrospinal fluid (CSF) flow at the craniovertebral junction and decreased to-and-fro movement in the syrinx after posterior fossa decompression, which were closely correlated with the improvement of clinical features in pediatric patients. However, adult patients required further procedures because of the multifactorial nature of the disease. Evaluation of abnormal CSF pathways at the craniovertebral junction is important for investigating the pathogenesis of Chiari malformation and associated syringomyelia.
Sixty-four patients with “unilateral” occlusive disease of the circle of Willis were studied to evaluate progression to bilateral disease. Seventeen patients developed bilateral lesions during a period of 1-7 years after the diagnosis of unilateral lesion. Most of these patients had ischemic attack as the initial episode and had repeated attacks before admission. Young children, mostly less than 10 years of age, tended to develop bilateral lesions within 1-2 years, but adults tended to have only a unilateral lesion. Children or young adults with unilateral occlusive lesion of the terminal portion of the internal carotid artery are likely to develop bilateral disease within 1-5 years.
Two unusual cases of brain metastasis from hepatocellular carcinoma (HCC) are described. A 15-yearold boy presented with intracerebral hemorrhage from brain metastasis from HCC, and died of rebleeding 1 month after surgery. Cerebral metastatic HCC in a child is quite rare, and has not previously been reported. A 65-year-old male with a 2-year history of treatment for HCC presented with a brain metastasis from HCC without intracerebral hematoma manifesting as gradual onset of headache. Brain metastases from HCC presenting without intracerebral hemorrhage are rare.
A 12-year-old boy presented with a rare case of intracranial metastasis 33 months after surgical treatment for Ewing''s sarcoma of the rib. His chief complaints were headache, right hemiparesis, and disturbance of speech. Computed tomography revealed a large metastatic lesion in the left occipitoparietal region. The tumor was totally removed through an emergency operation. Seven months later the intracranial tumor recurred. Another operation was performed, but he showed spinal cord involvement at the T-10 level and died. The possibility of central nervous system metastasis should be considered in long-term follow-up survivors with Ewing''s sarcoma.
A 21-year-old female presented with a cerebral primitive neuroectodermal tumor (PNET) without either glial or neuronal differentiation, who has survived for 27 months without neurological deficit following total removal of the tumor, radiotherapy, and intensive chemotherapy. Both immunohistochemical and ultrastructural studies are important for the diagnosis of PNET. “Undifferentiated” PNET may be a distinct entity from common PNET which shows either glial or neuronal differentiation or both.
A 62-year-old female presented with a distal anterior inferior cerebellar artery (AICA) aneurysm showing severe involvement of the facial and acoustic nerves manifesting as progressive left hearing disturbance and left facial nerve paresis. She was admitted to our hospital 2 months after the onset. A saccular aneurysm arising from the meatal loop of AICA was found between the facial and acoustic nerves which were damaged directly by the aneurysm. Magnetic resonance imaging demonstrated a vascular anomaly, differentiating this disorder from cerebellopontine angle tumor, and evidence of an old subarachnoid clot. These characteristics were extremely helpful for the differential diagnosis. Neck clipping and aneurysmectomy were performed to achieve decompression of the cranial nerves. One year and 2 months later full function of the facial nerve returned but the hearing disturbance persisted.
A 40-year-old female presented with gait disturbance and dysarthria. Computed tomography revealed a large cystic tumor in the cerebellar vermis with a mural nodule located in the deepest portion of the cyst. The magnetic resonance (MR) imaging appearance suggested cavernous angioma. The solid nodule was completely removed through the suboccipital approach. The cyst was filled with transparent yellowish fluid which showed positive Froin''s sign. The histological diagnosis of the mural nodule was cavernous angioma. The cyst wall consisted of gliosis and contained no angiomatous tissues. Postoperative MR imaging demonstrated that the nodule was totally removed and the cyst size was reduced. The neurological deficits improved postoperatively. The mechanism of formation of the large cyst was assumed to be repeated peritumoral hemorrhage.
A 71-year-old female presented with a syncopal attack. She underwent surgery for what appeared to be a meningioma. However, a small incision in the dura mater caused severe bleeding. Histological examination of the biopsy specimen showed sinus cavernoma with an incomplete pseudocapsule. The dura mater encapsulated the cavernous sinus cavernoma, explaining the severe bleeding from the dural incision. She was treated with Linac irradiation (40 Gy) which resulted in a decrease in tumor size. Radiation therapy is indicated for the treatment of cavernous sinus cavernoma, especially if associated with severe intraoperative bleeding.