Neurologia medico-chirurgica

Thermal Damage Threshold of Brain Tissue —Histological Study of Heated Normal Monkey Brains—

Nobuhiko MATSUMI, Kengo MATSUMOTO, Nobuya MISHIMA, Eiji MORIYAMA, Tomo ...

1994 Volume 34 Issue 4 Pages 209-215
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.209

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The thermal damage threshold of normal brain tissue was evaluated from immediate and delayed histological changes caused by hyperthermia treatment of normal monkey (Macaca fuscata) brains. A 2450 MHz microwave antenna and an antenna cooling system devised by our group were used for interstitial hyperthermia treatment. The antenna within the cooling system was inserted through a small craniectomy under general anesthesia. The temperature at a reference point, 4 mm radially away from the surface of the cooling system, was maintained at 42, 43, 44, 45, or 46°C for 60 minutes. Eighteen animals were treated and sacrificed immediately after the treatment, while nine animals were treated and sacrificed 7 days after the treatment. The histological changes were studied microscopically on sections stained with HE or Kluver-Barrera''s method. The non-survival experiment demonstrated that areas heated at 44°C or below showed no obvious irreversible changes. The survival experiment showed areas heated at 44°C or above developed coagulative necrosis. These histological findings indicate that thermal damage occurs in normal brain tissue after heating at 44°C or above for 60 minutes, suggesting that the safety limit for brain hyperthermia is 43°C for 60 minutes.

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Intratumoral Administration of Tumor Necrosis Factor-α for Malignant Gliomas —Two Case Reports—

Toshiki YAMASAKI, Kouzo MORITAKE, Jonathan T. PAINE, Minoru FUKUDA, Fu ...

1994 Volume 34 Issue 4 Pages 216-220
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.216

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Two patients with histologically verified glioblastoma multiforme and anaplastic astrocytoma were treated with four courses of intratumoral administration of human natural tumor necrosis factor-α (TNF) (specific activity 2.0 × 10⁶ Japan reference unit [JRU]/mg protein) at intervals of 3-5 months. Each consisted of eight to 10 serial injections, ranging from 5 × 10³ to 10⁴ JRU/injection, at intervals of 3-5 days. There was no simultaneous administration of steroids. Serial neurological examinations and neuroimaging studies with computed tomography and magnetic resonance imaging demonstrated partial responses ranging from 28 and 36 months in duration. No significant TNF-related brain edema, intracerebral bleeding, or neurotoxicity occurred. Local immunotherapy with TNF may be used safely to contribute to therapeutic efficacy.

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Familial Arteriovenous Malformations of the Brain —Two Case Reports—

Shin GOTO, Masamitsu ABE, Takehisa TSUJI, Kazuo TABUCHI

1994 Volume 34 Issue 4 Pages 221-224
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.221

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Familial arteriovenous malformation (AVM) of the brain is an uncommon entity. A 24-year-old female presented with sudden onset of left hemiparesis due to an AVM with a hematoma in the right frontal lobe, which was surgically removed. Her 23-year-old younger sister presented with motor aphasia and right hemiparesis due to an AVM with a hematoma in the left frontoparietal lobes, which was surgically removed. Thirty-two patients in 15 families have been described in total. The mean age of these patients was 28 years, with 15 males and 17 females. Multiple AVMs occurred in four patients (12.5%), more frequently than in non-familial cases.

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Cerebellopon tine Angle Meningioma Associated with Cranial Accessory Nerve Neurinoma —Case Report—

Haruhisa TSUKAMOTO, Takashi HIKITA, Tosuke TAKAKI

1994 Volume 34 Issue 4 Pages 225-229
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.225

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A 46-year-old female presented with a rare association of cerebellopontine (CP) angle meningioma with accessory nerve neurinoma manifesting as headache, occasional diplopia, speech disturbance, swallowing difficulty, and unsteady gait. Magnetic resonance imaging demonstrated a large tumor in the left CP angle. The tumor was totally removed through a lateral suboccipital approach. During the operation another smaller tumor was found originating from the cranial accessory nerve and was also totally removed. Histological examination found that the larger tumor was a meningotheliomatous meningioma and the smaller an Antoni type A neurinoma. The symptoms were apparently due to the larger tumor. Careful examination of neuroimages is necessary even after the main lesions responsible for the symptoms are identified.

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Extracranial Vertebral Artery Aneurysm Causing Spinal Subarachnoid Hemorrhage —Case Report—

Eiji MORIYAMA, Katsuzo KUNISHIO, Hiroshi NORIKANE, Yuzo MATSUMOTO, Chi ...

1994 Volume 34 Issue 4 Pages 230-232
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.230

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A 48-year-old female presented with spinal subarachnoid hemorrhage (SAH) due to the rupture of an extracranial vertebral artery (VA) aneurysm. The aneurysm arose from the junction of the third and the fourth segments of the left VA just inside the dura mater, and was partially coated with Biobond. This is only the second such case reported. We recommend complete four-vessel angiography in evaluating patients with SAH, with special attention given to the extracranial VA if spinal SAH is suspected.

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Recurrent Malignant Histiocytosis with Cerebrospinal Involvement —Case Report—

Satoshi HIROSE, Sadahiro SHIMADA, Yoshihiro TAKEBE, Yasuhiko TOKURIKI, ...

1994 Volume 34 Issue 4 Pages 233-236
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.233

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A 61-year-old male presented with recurrent malignant histiocytosis of the brain manifesting as nausea and headache. Malignant histiocytosis is a disorder of proliferating histiocytes characterized by a rapidly progressive and fatal course, but central nervous system involvement is relatively rare. Magnetic resonance (MR) imaging demonstrated cerebrospinal fluid (CSF) dissemination of histiocytes as a lowintensity area on the T₁-weighted image with marked gadolinium-diethylenetriaminepenta-acetic acid enhancement and a high-intensity area on the T₂-weighted image. CSF cytological examination revealed an increased level of atypical histiocytes. Brain and spine irradiation, and intrathecal methotrexate and prednisolone administration induced remission. MR imaging is particularly useful for the diagnosis of meningeal dissemination of malignant histiocytosis.

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Aspergillus Brain Abscess in a Patient with Normal Immunity —Case Report—

Noriaki KAWAKAMI, Takafumi NISHIZAKI, Shuichi SUGIYAMA, Haruhide ITO

1994 Volume 34 Issue 4 Pages 237-240
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.237

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A 53-year-old male with normal immunity presented with Aspergillus brain abscess manifesting as frontal headache. T₂-weighted magnetic resonance imaging revealed a hypointense lesion in the left frontal lobe extending into the right frontal lobe. The hypointense appearance on T₂-weighted images appears to be characteristic of aspergillosis. Bifrontal craniotomy exposed an elastic-hard mass in the base of the left frontal lobe extending into the right frontal lobe, and into the left ethmoid sinus. The mass contained a cavity with white fluid. The abscess was removed almost totally. The histological diagnosis was Aspergillus abscess. Antibiotic treatment with amphotericin B and fluconazole was given for 2 months postoperatively. No recurrence was identified during 15-month follow-up.

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Pediatric Cerebellar Infarction Caused by Atlantoaxial Subluxation —Case Report—

Ichiro MIYATA, Takashi IMAOKA, Tetsuya MASAOKA, Tsukasa NISHIURA, Hiro ...

1994 Volume 34 Issue 4 Pages 241-245
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.241

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An 11-year-old girl developed cerebellar infarction presenting as a posterior fossa mass lesion after stretching and flexing her neck. Cerebral angiography demonstrated irregular narrowing of the right vertebral artery at the C2 level and x-rays of the upper cervical spine showed atlantoaxial subluxation with os odontoideum. She underwent surgical decompression with removal of infarcted tissue. The cerebellar infarction probably resulted from occlusion of the vertebral artery, followed by brain swelling due to recanalization.

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Primary Ewing''s Sarcoma of the Occipital Bone —Case Report—

Kiichiro ZENKE, Takao HATAKEYAMA, Hisaki HASHIMOTO, Saburo SAKAKI, Kou ...

1994 Volume 34 Issue 4 Pages 246-250
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.246

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A 12-year-old boy presented with primary Ewing''s sarcoma of the occipital bone manifesting as intermittent high fever and local pain in the occipital region. Plain skull x-ray films disclosed an unclear lytic lesion in the occipital bone. Computed tomography and magnetic resonance imaging demonstrated the irregularly enhanced mass. The tumor was removed totally. He received intensive chemotherapy and radiation therapy postoperatively. No recurrence or metastasis has been noted, and he was in good condition 18 months after the operation.

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