Eiichiro Honda

Subarachnoid hemorrhage after preoperative embolization of a cystic meningioma

We present a case of cystic meningioma accompanied by hemorrhage in the cyst and adjacent subarachnoid space that occurred while preoperative embolization in feeders of the tumor was being applied. The possible reason for the hemorrhage was the sudden dynamic changes in blood flow triggered by the embolization. The changes could have caused multiple ruptures of pathologic small vessels. We recommend that preoperative embolization should be used cautiously in treating cystic meningiomas because of a possible increase in bleeding from pathologic weak vessels.

Astroblastoma with unusual signet‐ring‐like cell components: A case report and literature review

We report a case of astroblastoma with unusual signet‐ring‐like cell components. A 33‐year‐old‐woman presented with occasional partial seizures of the face. Radiological studies revealed an enhanced frontal mass lesion. At surgery, a gray, soft, well‐circumscribed mass was seen and shelled out. Histologically, the tumor showed a perivascular arrangement and papillary‐like patterns with compact cellularity. The tumor cells radiating from the hyalinized vessels showed broader, shorter, less tapered processes. A part of each tumor cell displayed prominent islands of signet‐ring‐like cells. Glial fibrillary acidic protein reaction revealed strongly positive staining of tumor cells and signet‐ring‐like cells. Eight years after the operation the patient remains well with no tumor recurrence. It remains to be determined whether, in this astroblastoma, the unusual signet‐ring‐like cell components were related to benign biological characteristics or to the tumors low‐grade form with incidental signet‐ring‐like cell appearance.

Cerebrospinal fluid ferritin in glioblastoma: Evidence for tumor synthesis

Ferritin concentrations in cerebrospinal fluid (CSF) of 16 patients with glioblastoma were found to be very high (mean, 103.0 ng/mL) relative to 29 patients with viral meningitis and 20 patients with headache (mean concentrations, 5.4 and 4.3 ng/mL respectively). Simultaneous measurement of ferritin in CSF and serum revealed CSF concentrations exceeding those in serum in 11 of 16 patients with glioblastoma (CSF vs. serum ratio, 132.6%), contrasting with very low ratios in patients with meningitis (7.9%) or headache (4.9%). Ferritin was detected immunocytochemically in tumor cell cytoplasm in a resected glioblastoma. Thus, ferritin in CSF appears to be produced by glioblastoma cells, with a biologic significance requiring further investigation.

Changes in Intraventricular Pressure and Brain Lipids in Experimental Hydrocephalus

Experimental hydrocephalus was produced by intracisternal injection of kaolin in 8-week-old rats, and body weight was measured consecutively (3, 5, 7, 9 days and 2, 3, 4, 5 weeks following the injection). These hydrocephalic rats were divided into three groups, i. e. mild, moderate and severe hydrocephalus on the basis of the changes of body weight and ventriculomegaly. The intraventricular pressure (IVP) was measured by stereotaxic puncture of the right lateral ventricle. After decapitation, lipids were extracted from the specimens taken from the frontal and parietal lobes. Phospholipids, cholesterol and fatty acids were quantitatively analysed by thin layer chromatography (TCL) and gas chromatography (GC), and thiobarbituric reactive substance (TBA-RS) was measured by the method of Yagi et al. The changes in body weight correlated with the degree of ventricular enlargement. Increase in IVP also correlated with the severity of hydrocephalus. Although the peak increment of IVP preceeded the development of ventricular dilatation for 3 to 7 days, the higher the IVP in the acute stage the larger the ventricles was observed. On the other hand, IVP fell in the chronic stage of the group of severe hydrocephalus in spite of a tendency to ventricular enlargement persisted.

Thoracic and Lumbo-sacral Spinal Lipoma in an Infant

We reported a case of thoracic and lumbosacral spinal lipoma in an 8 month-old boy. He was born in asphyxia. Six months after birth, spastic paraparesis developed gradually at both lower extremities and secondary funnel chest due to shallow thoracic movement and scoliosis in the thoracic region was observed. MRI was then performed where tumor mass demonstrated by the high signals in both T1 and T2 in ages was confirmed in the thoracic and lumbo-sacral regions. Surgery was performed only for the thoracic lesion which was considered primary. The tumor in the Th3-4 level had developed subdurally, while the tumor in the Th5-10 extradurally. Only partial removal could be done for the subdural tumor because its boundary with the spinal cord was not clearly identified. Postoperative histological study revealed it as lipoma. During the following 6 months only slight recovery from paraparesis was observed. Surgical intervention against the mass in the lumbosacral region was not performed for the conus medullaris was found located in its normal position and no concomitant symptoms could be observed. In summary, it is considered that spinal lipoma is rare (1% of total spinal tumor) and commonly associated with other types of congenital anomalies (in 31% of spinal lipoma). Particularly in infants, spinal lipoma in the thoracic region as experienced in our case is extremely rare and any medical treatment started after clinical symptoms once developed seems ineffective.

Analysis of Intracranial Pressure in Infantile Hydrocephalus

In infantile hydrocephalus the measurement of ICP is important for surgical treatment. However, the evaluation of ICP is still controversial (1,3). The ICP measurements with our aplanation transducer, via the anterior fontanelle, were analysed according the stage of the disease in infantile hydrocephalus.