Neurologia medico-chirurgica

Morphological Effects of Tumor Necrosis Factor-α on the Blood Vessels in Rat Experimental Brain Tumors

Toshihiko ISAKA, Toshiki YOSHIMINE, Motohiko MARUNO, Toru HAYAKAWA

1996 Volume 36 Issue 7 Pages 423-427
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.423

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The morphological changes in the vascular endothelium caused by the administration of tumor necrosis factor-α (TNF-α) were studied in an experimental model of rat brain tumors. Wistar rats bearing implanted C6 glioma received human natural-type TNF-α (1.7 × 10⁵ U/m2) through the carotid artery and were sacrificed 3 or 24 hours later. The endothelial cells of the tumor blood vessels, demonstrated by the immunoreaction to factor VIII-related antigen, were enlarged after TNF-α administration. Morphometry demonstrated that the nuclei of these endothelial cells were also increased in size. The endothelial cells in the brain remote to the tumor were not affected. An in vitro binding study demonstrated that TNF-α binding sites were distributed in the vascular endothelial cells within the tumor but not in the brain remote to the tumor. The selective effect of TNF-α on the tumor blood vessels in experimental brain tumors may be related to the selective distribution of the TNF-α binding site.

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Peripheral Nerve Regeneration in a Silicone Tube: Effect of Collagen Sponge Prosthesis, Laminin, and Pyrimidine Compound Administration

Katsumi OHBAYASHI, Hiroshi K. INOUE, Akira AWAYA, Satoshi KOBAYASHI, H ...

1996 Volume 36 Issue 7 Pages 428-433
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.428

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Regeneration of transected peripheral nerve with a 10-mm gap encased in a silicone tube was evaluated in the presence of collagen sponge with or without laminin, or with systemic administration of a pyrimidine compound, MS-818. The sciatic nerve of 20 adult rats was transected and the proximal and distal nerve stumps were fixed in a silicone tube. The lumen of the silicone tube was empty, or filled with a collagen sponge alone or with a laminin-soaked collagen sponge. Also, a pyrimidine compound was injected intraperitoneally after implantation of the empty silicone tube. Three weeks later, the contents of the silicone tubes were processed for histological examination of regenerated nerve fibers. Other animals were observed 6, 12, and 18 months after surgery to examine the long-term effects of the collagen sponge on nerve regeneration. All animals had regenerated tissue within the tube 3 weeks after nerve transection. The diameter of the tissue decreased toward the distal stump in the empty tube, but was the same throughout the full length in the collagen sponge-containing tube. Immunohistochemical studies revealed that the nerve fibers extended beyond the midline of the regenerated tissue in animals treated with a laminin-containing collagen sponge or receiving a pyrimidine compound. Long-term observation showed the regenerated nerve was thick as the proximal stump and many neurofilament and peripheral myelin-positive fibers were observed around the collagen sponge. Collagen sponge assists the progress of regenerated tissues in silicone tubes, and laminincontaining prostheses and administration of a pyrimidine compound enhance peripheral nerve regeneration.

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Usefulness of Thallium-201 Single Photon Emission Computed Tomography to Quantify the Malignancy Grade of Brain Tumors

Keiji IGASE, Yoshihisa OKA, Shinsuke OHTA, Yoshikazu MURAKAMI, Yoshiak ...

1996 Volume 36 Issue 7 Pages 434-439
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.434

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Preoperative thallium-201 (²⁰¹Tl) single photon emission computed tomography (SPECT) was used to evaluate the histological malignancy in 24 patients with brain tumors. A corrected L/E ratio was calculated based on the ratio of thallium uptake in the tumor on early images versus the tumor in the delayed images (L/E ratio) corrected for thallium uptake in the contralateral cerebral hemisphere. The corrected L/E ratio in benign brain tumors was 0.79 ± 0.23, significantly different to 1.32 ± 0.25 in high grade astrocytomas (p < 0.01) and 1.19 ± 0.05 in metastatic brain tumors (p < 0.01), respectively. The corrected L/E ratio in low grade astrocytomas was 0.64 ± 0.32, significantly lower than that in high grade astrocytomas (p < 0.01) and metastatic brain tumors (p < 0.05). There was one false positive result among 24 patients using a threshold of 1.0 to separate malignant and benign tumors. ²⁰¹Tl SPECT using the corrected L/E ratio is effective for determining the malignant viability of tumors.

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Intraoperative Electrocorticography in Children with Medically Intractable Epilepsy

Tatsuya TANAKA, Kiyotaka HASHIZUME, Masayuki KUNIMOTO, Yukichi YONEMAS ...

1996 Volume 36 Issue 7 Pages 440-446
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.440

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Intraoperative electrocorticography (ECoG) was performed to localize epileptic foci in 20 children undergoing temporal and extratemporal surgery for intractable epilepsy under modified neuroleptanalgesia. Nitrous oxide gas was discontinued at least 15 minutes before and during preresection ECoG recording, whicji lasted for 30 minutes. Seventeen patients showed epileptiform discharges on preresection ECoG. Hyperventilation loading, monitored by electroencephalography or ECoG in all patients, induced enhanced or induced epileptiform activities in 17 patients and provoked electroencephalographic seizures in 10 patients. All foci in non-eloquent areas were resected. Fifteen patients have been seizure-free with reduced medication, and two patients have achieved worthwhile improvement. Habitual seizures have remained in three patients. Two of these patients had foci in eloquent areas which could not be resected. Intraoperative ECoG can improve the outcome of surgery for intractable epilepsy by localizing epileptic foci for resection.

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Akinetic Mutism and Involuntary Movements Following Radical Resection of Hypothalamic Glioma —Case Report—

Yoshiaki KADOTA, Tomoyoshi KONDO, Kiyoshi SATO

1996 Volume 36 Issue 7 Pages 447-450
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.447

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A 3-year-old boy presented with an unusual consciousness disturbance accompanied by involuntary movement disorder after radical surgical removal of a huge hypothalamic glioma. Postoperative computed tomography and magnetic resonance imaging revealed a lesion in the bilateral basal ganglia. Marked neurological improvement was obtained by treatment with dopamine agonists, suggesting that the disruption of the dopaminergic pathway via the hypothalamus was the cause of these neurological symptoms.

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Herniation of the Third Ventricle into Empty Sella Caused by Surgery for Pituitary Apoplexy —Case Report—

Satoshi KOBAYASHI, Akiyoshi OTSUKA, Tadao TSUNODA

1996 Volume 36 Issue 7 Pages 451-454
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.451

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A 46-year-old male presented with acute visual loss in the right eye, high fever, nausea, and vomiting. This was caused by herniation of the third ventricle into empty sella at 15 months of surgery for pituitary apoplexy. The sellar-suprasellar tumor was totally removed via a transcranial approach. Histological examination showed chromophobe adenoma with necrotic tissue, indicating pituitary apoplexy. His visual field defect worsened 15 months after the operation, and magnetic resonance imaging revealed moderate hydrocephalus and protrusion of the dilated anterior inferior portion of the third ventricle into the sella. The optic nerve, optic chiasm, and pituitary gland were compressed onto the sellar floor. Ventriculoperitoneal shunt relieved the visual impairment. A decompressive procedure such as ventriculoperitoneal shunts is a reasonable treatment for such a marked herniation of the third ventricle.

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Acute Cerebellar Edema Following Intra-arterial Tissue Plasminogen Activator Thrombolysis for Basilar Artery Occlusion —Case Report—

Katsumi MATSUMOTO, Amami KATO, Eiji KOHMURA, Toshiyuki FUJINAKA, Ryuta ...

1996 Volume 36 Issue 7 Pages 455-457
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.455

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A 61-year-old male developed acute cerebellar swelling after thrombolytic therapy for basilar artery occlusion. He was treated with intra-arterial tissue plasminogen activator 12 hours following symptomatic onset, and did well in the immediate post-treatment period but deteriorated the next day. Computed tomography demonstrated acute cerebellar edema and hydrocephalus. Suboccipital external decompression and ventricular drainage were performed. He survived and 1 year later he could perform daily activities at home. Computed tomography and angiography are essential to monitor the posttreatment course following thrombolysis of vertebrobasilar occlusive disease.

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Eosinophilic Granuloma Associated with Intratumoral Hemorrhage —Case Report—

Ryunosuke URANISHI, Yuji NIKAIDO, Takahiko EGUCHI, Hironobu BESSHO, Ta ...

1996 Volume 36 Issue 7 Pages 458-461
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.458

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A 2-year-old boy presented with a rapidly growing soft scalp mass in the left parietal region. Surgical exploration and histological examination demonstrated an eosinophilic granuloma associated with intratumoral hemorrhage. Eosinophilic granuloma should also be considered when a scalp mass lesion exhibits rapid growth.

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Malignant Schwannoma Metastasizing to the Dura Mater —Case Report—

Toshihiko HAISA, Tatsuya KONDO, Nobusada SHINOURA, Tetsuo HARA, Michiy ...

1996 Volume 36 Issue 7 Pages 462-465
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.462

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A 58-year-old female, with a previous history of radical resection of malignant schwannoma arising in the maxillary sinus, presented with a metastasis to the dura mater following lung metastases 15 years after the initial diagnosis. A large mass at the left temporal region was totally removed immediately after an intratumoral hemorrhage. She subsequently died of massive hemoptysis. Although the prognosis is poor for patients with malignant schwannoma, aggressive treatment including radical surgery combined with radiotherapy and chemotherapy is recommended.

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Multiple Intramedullary Schwannomas —Case Report—

Raj an BHAYANI, Atul GOEL

1996 Volume 36 Issue 7 Pages 466-468
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.466

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A 15-year-old boy with von Recklinghausen''s disease presented with two very rare symptomatic cervical intramedullary schwannomas manifesting as slowly progressive weakness. The tumors were totally resected and he made a complete recovery.

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Uterine Leiomyosarcoma Metastasis to the Skull —Case Report—

Masafumi UCHINO, Go ENDO, Iekado SHIBATA, Hideo TERAO, Tohru KURAMITSU ...

1996 Volume 36 Issue 7 Pages 469-471
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.469

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A 54-year-old female presented with a rare uterine leiomyosarcoma metastasis to the skull appearing as a gross mass beneath her scalp. She had no neurological or other physical symptoms on admission. Computed tomography and magnetic resonance imaging demonstrated an enhanced dumbbell-shaped mass at the mid-frontal region beneath the scalp. The tumor was totally removed with normal surrounding bone and dura. The histological diagnosis was leiomyosarcoma. Her postoperative course was uneventful, and she received adjuvant chemotherapy. However, multiple distant bone metastases developed 1 year later. Immediate and radical resection of such tumors is recommended.

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