Neurologia medico-chirurgica

Original Articles

Effect of a Platelet-Activating Factor Receptor Antagonist, E5880, on Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage

—Open Clinical Trial to Investigate Efficacy and Safety—

Yutaka HIRASHIMA, Shunro ENDO, Hideaki NUKUI, Naoki KOBAYASHI, Akira T ...

2001 Volume 41 Issue 4 Pages 165-176
Published: 2001
Released on J-STAGE: July 02, 2005

DOIhttps://doi.org/10.2176/nmc.41.165

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The efficacy and safety of a new platelet-activating factor receptor antagonist, E5880, were investigated for preventing cerebral vasospasm after subarachnoid hemorrhage (SAH) in 71 patients with SAH who underwent surgery for ruptured aneurysms within 3 days. Intravenous E5880 administration (300 μg or 1200 μg twice daily) was begun within 4 days and continued for 14 days. The incidence of symptomatic vasospasm, low-density area on computed tomography, and angiographic vasospasm was lower than in placebo groups in previous studies. Clinical outcome was favorable compared with previous studies. No clinically important adverse events were observed. These results suggest that E5880 is safe and effective in the treatment of patients with cerebral vasospasm due to SAH.

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Vasodilatory Effect of Basic Fibroblast Growth Factor in Isolated Rat Cerebral Arterioles: Mechanisms Involving Nitric Oxide and Membrane Hyperpolarization

Yasukazu KAJITA, Masakazu TAKAYASU, Jun YOSHIDA, Hans H. DIETRICH, Ral ...

2001 Volume 41 Issue 4 Pages 177-186
Published: 2001
Released on J-STAGE: July 02, 2005

DOIhttps://doi.org/10.2176/nmc.41.177

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Basic fibroblast growth factor (bFGF), a potent mitogen, acutely dilates cerebral blood vessels and may be effective in reducing cerebral infarction. However, the vasodilatory mechanism, which may involve nitric oxide (NO), is not completely understood. This study investigated whether membrane hyperpolarization is also involved in this mechanism. Membrane potential (MP) of smooth muscle cells and vessel diameter of isolated intracerebral arterioles were simultaneously measured following extraluminal application of bFGF in rats. The involvement of NO and adenosine triphosphate-sensitive potassium (K_ATP) channels in bFGF-induced vasodilation and membrane hyperpolarization was evaluated using specific inhibitors, N^G-monomethyl-L-arginine (L-NMMA, 10^-4 M) and glibenclamide (GB, 10^-5 M), respectively. The resting MP was recorded at a mean value of -31.9 ± 4.5 mV. bFGF (1 to 1000 ng/ml) produced significant vasodilation and hyperpolarization. Treatment with L-NMMA caused vasoconstriction and significantly attenuated bFGF-induced vasodilation without affecting membrane hyperpolarization. In the presence of GB, the membrane potential was significantly depolarized but the vessel diameter was only marginally reduced, so bFGF-induced membrane hyperpolarization was inhibited while arteriolar dilation was attenuated. These results suggest that bFGF-induced vasodilation is mediated by a mechanism involving both NO and membrane hyperpolarization, and that membrane hyperpolarization is caused by the activation of K_ATP channels.

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Expression of Nuclear Factor-κB, Tumor Necrosis Factor Receptor Type 1, and c-Myc in Human Astrocytomas

Shuji HAYASHI, Masaaki YAMAMOTO, Yushi UENO, Kohichi IKEDA, Koichi OHS ...

2001 Volume 41 Issue 4 Pages 187-195
Published: 2001
Released on J-STAGE: July 02, 2005

DOIhttps://doi.org/10.2176/nmc.41.187

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Tumor necrosis factor receptor type 1 (TNFR1) and c-Myc are important in signal transduction in tumor necrosis factor-α (TNF-α)-induced cytotoxicity, whereas activation of nuclear factor-κB (NF-κB) protects against TNF-α-induced apoptosis. This study investigated the expression of NF-κB, TNFR1, and c-Myc in human astrocytoma tissues by reverse transcriptase-polymerase chain reaction (PCR) and immunohistochemical analysis. TNFR1 messenger ribonucleic acid (mRNA) and c-Myc mRNA were frequently expressed in malignant astrocytomas, especially in glioblastomas, compared with low-grade astrocytomas by PCR analysis. TNFR1 and c-Myc mRNAs were barely detectable in normal brain tissues. NF-κB p50 and p65 subunit mRNAs were detected in various grades of astrocytomas, with frequent expression in malignant astrocytomas. The presence of activated NF-κB was confirmed by nuclear localization in neoplastic astrocytes as determined by immunohistochemistry. Both p50 and p65 subunits were inhomogeneously expressed in neoplastic astrocytes of glioblastoma, but only in a few scattered tumor cells in low-grade astrocytoma, and almost undetectable in normal brain tissues. These results indicate that TNFR1 and c-Myc are overexpressed in malignant astrocytomas, and this may increase the cellular sensitivity to the cytotoxic action of TNF-α. NF-κB p50 and p65 were simultaneously induced and activated in malignant astrocytomas. Our results suggest that the constitutive activation of NF-κB subunits in malignant astrocytoma, especially in glioblastoma, could be associated with the resistance to TNF-α immunotherapy, and indicates new therapeutic strategies for malignant astrocytomas.

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Case Reports

Chronic Subdural Hematoma With Vasogenic Edema in the Cerebral Hemisphere

—Case Report—

Seikou KUWAHARA, Masui KAWADA, Shigetoshi UGA

2001 Volume 41 Issue 4 Pages 196-200
Published: 2001
Released on J-STAGE: July 02, 2005

DOIhttps://doi.org/10.2176/nmc.41.196

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An 80-year-old male with a history of hypertension presented with chronic subdural hematoma manifesting as progressive consciousness disturbance and left hemiparesis. T₁-weighted and fluid attenuation inversion recovery (FLAIR) magnetic resonance imaging showed a fresh hematoma in the right subdural space with a midline shift of 15 mm. FLAIR and diffusion-weighted imaging showed a hyperintense area in the right paraventricular white matter compressed by the hematoma. Apparent diffusion coefficients (ADCs) corresponding to the hyperintense area in the central area of the affected cerebral hemisphere on FLAIR images were measured before and one month after the operation. The motion probing gradient was applied in the right-left direction to the body axis. Since the central area in the cerebrum includes nerve fibers perpendicular to the direction of the gradient, the measured ADC appeared to be anisotropic. Preoperative ADC in the right paraventricular white matter was anisotropic and greater than in age-matched normal subjects, so the edema was identified as the vasogenic type. The edema in the right paraventricular white matter resolved promptly with improvement of the midline shift and normalization of the ADC.

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Tentorial Vascularization in Solid Hemangioblastoma

—Case Report—

M. Faik OZVEREN, Cahide TOPSAKAL, Fatih S. EROL, Metin KAPLAN, Koichi ...

2001 Volume 41 Issue 4 Pages 201-205
Published: 2001
Released on J-STAGE: July 02, 2005

DOIhttps://doi.org/10.2176/nmc.41.201

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A 40-year-old female was admitted to the hospital with complaints of headache worsening gradually over a 1-month duration. Her past history included surgery to treat a left cerebellar cystic lesion 3 years before, and an untreated small solid right supracerebellar lesion of 1 cm diameter. On admission, magnetic resonance imaging showed that the right cerebellar lesion had grown to approximately 4 cm diameter abutting the tentorium and causing obstructive hydrocephalus. She also had two more small lesions, a right supratentorial solid lesion with cystic component near the splenium and an intramedullary cystic lesion at the C-2 level. Right suboccipital craniectomy was done. The vascular attachments between the superior aspect of the tumor and the tentorium were coagulated and the tumor was totally removed. C1-2 laminectomy was also performed to drain the intramedullary cyst. The patient deteriorated and lost consciousness with respiratory arrest 6 hours postoperatively and was reoperated for intracerebellar hematoma due to oozing from the tentorial vessels. Histological investigation revealed hemangioblastoma. Dural tentorial vascular attachments in solid hemangioblastomas located subjacent to the tentorium may cause early postoperative complications of hematoma at the site of vascular attachment following the resection. Computed tomography study in the early postoperative period is helpful to identify this problem.

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Primary Ewing's Sarcoma of the Occipital Bone

—Case Report—

Fatih S. EROL, M. Faik OZVEREN, Ibrahim H. OZERCAN, Cahide TOPSAKAL, I ...

2001 Volume 41 Issue 4 Pages 206-209
Published: 2001
Released on J-STAGE: July 02, 2005

DOIhttps://doi.org/10.2176/nmc.41.206

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A 17-year-old female presented with a very rare case of primary Ewing's sarcoma of the skull involving the occipitotemporal region. Systemic examination found no evidence of metastasis. The tumor was surgically removed, and the patient underwent radiotherapy and chemotherapy. Fourteen months after surgery there has been no recurrence of the tumor. Cranial primary Ewing's tumor has a good prognosis after radical surgery and adjuvant therapy.

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Mazindol Administration Improved Hyperphagia After Surgery for Craniopharyngioma

—Case Report—

Takashi SADATOMO, Katsuaki SAKODA, Masami YAMANAKA, Munenori KUTSUNA, ...

2001 Volume 41 Issue 4 Pages 210-212
Published: 2001
Released on J-STAGE: July 02, 2005

DOIhttps://doi.org/10.2176/nmc.41.210

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A 54-year-old man presented with visual disturbance and polydipsia. Magnetic resonance imaging disclosed a cystic mass which extended from the intrasellar to the suprasellar region. Bifrontal craniotomy was performed and the tumor was totally removed. Histological findings confirmed the diagnosis of craniopharyngioma. Postoperatively, the patient suffered from transient disorientation. About one month after the operation the patient manifested hyperphagia and he gained 15 kg in one month. Mazindol, a non-amphetaminergic anorectic agent, was administered for 3 weeks. His appetite normalized and his weight fell and stabilized even after mazindol administration was ceased.

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Squamous Cell Carcinoma Arising in an Intracranial Dermoid Cyst

—Case Report—

Hitoshi TSUGU, Takeo FUKUSHIMA, Shuji HAYASHI, Mitsutoshi IWAASA, Tosh ...

2001 Volume 41 Issue 4 Pages 213-216
Published: 2001
Released on J-STAGE: July 02, 2005

DOIhttps://doi.org/10.2176/nmc.41.213

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A 47-year-old male presented with headache. Magnetic resonance imaging revealed an enhanced mass lesion in the cerebellar vermis and left cerebellar hemisphere and in the cisterna magna. Gross total removal of the tumor was performed. Histological examination demonstrated squamous cell carcinoma in the dermoid cyst. The patient subsequently received localized radiation therapy of total 55 Gy. He has been without tumor recurrence for 6 years since the surgery. We recommend local radiation therapy over 50 Gy following surgery.

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Transverse Sinus-Tentorium Splitting Approach for Pineal Region Tumors

—Case Report—

Hiroichi BECK, Eiji MORIYAMA

2001 Volume 41 Issue 4 Pages 217-221
Published: 2001
Released on J-STAGE: July 02, 2005

DOIhttps://doi.org/10.2176/nmc.41.217

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A 15-year-old boy with a large pineal region mass was admitted to our institute. The tentative diagnosis was mixed germ cell tumor. Tumor resection was carried out via a transverse sinus-tentorium splitting approach. The tumor tissue was completely resected, and no operative complication other than transient vertical gaze paresis was noted. The histological diagnosis was mixed germ cell tumor composed of mature and immature teratoma, germinoma, and embryonal carcinoma. After three courses of chemotherapy, the patient underwent external irradiation. He remained asymptomatic with no signs of recurrence 42 months after the surgery. The combination of the infratentorial supracerebellar approach and the occipital transtentorial approach provides excellent views and work space above and below the tentorial notch. Transverse sinus section is not mandatory for this approach, but sectioning of the unilateral transverse sinus and the tentorium along the rectal sinus allows retraction of the falx and the underlying brain to the opposite side. Thus, a much wider horizontal and vertical projection is obtained. This approach enables safer and more extensive tumor removal for large pineal region tumors.

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Transoral Transclival Approach for Intradural Lesions Using a Protective Bone Baffle to Block Cerebrospinal Fluid Pulse Energy

—Two Case Reports—

Junichi IMAMURA, Yukihide IKEYAMA, Eiji TSUTIDA, Junta MOROI

2001 Volume 41 Issue 4 Pages 222-226
Published: 2001
Released on J-STAGE: July 02, 2005

DOIhttps://doi.org/10.2176/nmc.41.222

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The transoral transclival approach for the treatment of intradural lesions of the clivus is often associated with serious complications such as cerebrospinal fluid (CSF) leakage and meningitis. CSF pulse energy may be the most significant factor in CSF leakage and meningitis, but a bone baffle can block such CSF pulse energy. A 64-year-old female presented with sudden onset of severe headache. She had subarachnoidal hemorrhage due to a rupture of the vertebral-posterior inferior cerebellar artery aneurysm. A 66-year-old female complaining of occipitalgia and numbness of the extremities had a foramen magnum meningioma. Both patients were treated via the transoral transclival route with a protective bone baffle, obtained from the iliac bone, securely fixed in the bone window to protect the repaired dura from injury by CSF pulse energy. Neither patient showed CSF leakage or meningitis, and the period of continuous lumbar CSF drainage was only 7 days. The transoral transclival approach with a bone baffle is still very effective in selected cases.

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