A murine monoclonal antibody of the immunoglobulin M subclass, termed M1C, was prepared by fusion of P3X63Ag8U.1 mouse myeloma cells with spleen cells from BALB/c mice immunized with the recently established human medulloblastoma cell line MED-3. MED-3 cells are unique in expressing both neuronal and glial phenotypes. The antigen recognized by M1C was expressed predominantly in the cytoplasm of antigen-bearing cells, but was also present in lower concentration on the cell surface. Flow cytometry showed M 1 C binding to MED-3 cells increased during the G₂/M phase, and decreased after induction of differentiation with N⁶, O²-dibutyryl cyclic adenosine monophosphate. Biochemical analysis indicated that M1C recognized a 25-kd protein. Immunoperoxidase staining of cultured cell lines showed that although M 1 C recognized a large panel of malignant tumorderived cell lines, the staining of malignant glioma-derived cell lines was strongest. Immunohistochemical examination of various human tissues revealed that M1C reacted strongly with malignant gliomas but did not recognize low grade astrocytomas, neuroblastomas, or tumors from other organs. Cross-reactivity with normal tissues was restricted to peripheral blood lymphocytes. The immunoreactivity of M1C was quite different from the two previously described monoclonal antibodies against medulloblastoma. M 1 C is the first reported MoAb against medulloblastoma, which recognizes a differentiation and proliferation-dependent antigen expressed in malignant gliomas in particular, and may be useful in determining the differentiation and proliferation features of medulloblastomas and gliomas.

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The severe combined immunodeficiency (SCID) mouse was investigated as a model system to study the growth and immunogenicity of human gliomas. Human glioma cell lines U-251MG, KNS-42, SF-188, A-172, and T-98G were injected subcutaneously into SCID mice. The cell lines U-251MG and KNS-42 grew as large, subcutaneous masses; SF-188, A-172, and T-98G did not grow. Glioma-immune system interactions were studied by the transplantation of human peripheral blood lymphocytes into tumorbearing SCID mice. In the resultant SCID-human (SCID-hu) mice, transplanted lymphocytes infiltrated into the subcutaneously growing tumors and expressed the surface markers of human B, T, and natural killer cells. The SCID-hu mouse is a potentially powerful model to study the basic tumor biology of some human gliomas and also represents a useful screening system to evaluate experimental immunotherapies for brain tumors.

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The effect of thyrotropin-releasing hormone (TRH) on spinal cord Na⁺-K⁺-adenosine triphosphatase (Na⁺-K⁺-ATPase) activity after spinal cord injury was evaluated in rats. The rats were injured by compression of the cord at T-10 for 1 minute with a 50-g clip. Saline in the placebo group (n = 8) and TRH (0.6 mg per dose) in the TRH group (n = 9) were administered intraperitoneally as bolus injections in two doses, at 45 and 120 minutes after the injury. The Na⁺-K⁺-ATPase activity level in the TRH group was significantly higher (p = 0.024) than in placebo group. These results indicate a possible role for TRH treatment in spinal cord injury.

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Coagulation and fibrinolysis factors were studied in six patients after local thrombolysis with urokinase (720, 000 IU). Transient abnormalities, such as prolonged prothrombin time, decreased plasminogen and α₂-antiplasmin activities, decreased fibrinogen, and increased fibrin degradation products were seen on the day after thrombolysis, but tended to return to the normal range on the 4th day except for one patient who suffered from disseminated intravascular coagulation. Antithrombin III activity did not change so much. Therefore, the dosage of urokinase should be as low as possible to prevent fluctuations in the coagulation and fibrinolysis system.

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Outcome after temporal lobe resection, extratemporal resection, and corpus callosotomy was studied in 33 children aged 15 years or less with medically intractable epilepsy. Seizure-free control was achieved in 67% (6/9) of pediatric patients versus 67% (60/90) of adult patients receiving temporal lobe resection and in 33% (4/12) of pediatric patients versus 25% (7/28) of adult patients receiving extratemporal resection. Among patients suffering from drop attacks and generalized convulsive seizures, 42% (5/12) of pediatric patients versus 25% (6/24) of adult patients receiving corpus callosotomy became seizure-free. The most prominent histological diagnoses in temporal lobe resections were three cases of mesial temporal sclerosis, four of ganglioglioma, and two of neuronal migration disorders. Neuronal migration disorders were the main histology in extratemporal resections. Four of five patients with behavioral problems treated by corpus callosotomy exhibited improved hyperactivity and/or attention deficits. There was no surgical morbidity or mortality. The outcome of pediatric patients was at least as favorable as that of adult patients, and improvement of behavioral disturbances could be expected after surgery. Surgical treatment is an effective and safe procedure for children with medically intractable epilepsy.

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The petrosal approach has become a routine procedure for petroclival lesions, but there are some disadvantages such as the time-consuming craniotomy during surgery and depressed deformity of the mastoid area after surgery. To solve these disadvantages, we modified the petrosal approach. Before surgery, the three-dimensional points of the sigmoid sinus and semicircular canals are calculated on computed tomography scan and are input to a computer. A single temporooccipital bone flap is made, and the outer table of bone overlying the mastoid is preserved by forming a narrow groove with a small air drill and cutting the outer table with a chisel. After removing these two free bone flaps, mastoidectomy is performed guided by NEURO-SAT (neuronavigation by computer-assisted frameless stereotaxy). The mastoid bone can be drilled out safely and quickly. The two bone flaps are connected and replaced at the end of the procedure. Osteoplastic petrosal craniotomy guided by NEURO-SAT can achieve a quick craniotomy and satisfactory cosmetic result.

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A 30-year-old male presented with subarachnoid hemorrhage, due to a rare peripheral posterior inferior cerebellar artery aneurysm located in the spinal canal. Angiography and magnetic resonance imaging disclosed the aneurysm of 15 mm diameter at the C-1 level. After aneurysmal neck clipping and ventriculoperitoneal shunt implacement, he was discharged without neurological deficit. Histological examination revealed no layer formation, only hemorrhage and organization in the aneurysmal wall. This case may be an example of giant aneurysm formation caused by repeated bleeding and organization.

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A 30-year-old male presented with a large calcified intraventricular mass. The tumor was completely resected via the transventricular route. Light microscopy showed the tumor was composed of small round cells with perinuclear halo, typical of oligodendroglioma. Electron microscopy revealed marked neuronal differentiation, including neurosecretory granules, well-formed numerous synapses, and lipofuscin granules. The tumor was diagnosed as well-differentiated central neurocytoma.

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A 15-year-old boy presented with a cervical ventral epithelial cyst manifesting as intractable cervical pain. Neurological examination revealed weakness of his left grasp and increased deep tendon reflexes. The anterior approach was selected because the lesion was located directly ventral to the spinal cord. He underwent C4-5 anterior corpectomy and subtotal resection of the cyst wall. He made a good recovery without additional deficits. Most previously reported cases have been treated using the posterior approach despite the ventral location of the lesion. The anterior approach offers a safer and more effective means of treating such lesions because it allows direct access to the lesion without manipulation of the spinal cord.

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As with other specialized services there is an ever increasing gap in neurosurgical care between developed and developing countries. The need for neurosurgery has always been present in developing countries, but the recent introduction of computed tomography has identified many previously undetected cases, increasing the number of patients seeking treatment. However, developing countries suffer severe shortages of trained manpower, proper equipment, and expertise to initiate the services to meet this demand. In contrast, some developed nations are experiencing a surplus of neurosurgeons leading to problems in case exposure. A well-designed cooperative project between these countries can answer some of these problems, becoming an ideal example of mutual benefit.

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