Hiromu Yamada

Prognosis of intracranial germ cell tumours: effectiveness of chemotherapy with cisplatin and etoposide (CDDP and VP-16).

SummaryA co-operative study for patients with intracranial germ cell tumours was performed to analyze their prognosis and the effectiveness of Cisplatin/Etoposide (CDDP/VP-16) chemotherapy.A total of 46 patients; 30 primary and 16 recurrent cases were registered from 15 participating neurosurgical institutions in Japan. Based on histological criteria and tumour markers, they were classified into three groups; germinoma, germinoma with syncytiotro-phoblastic giant cell (STGC), and non-germinomatous malignant tumour.Sixteen patients were treated with CDDP/VP-16 chemotherapy alone and the other 30 patients were treated by a combination of surgery and/or radiation in addition to chemotherapy. Eleven out of 13 patients (85%) with germinoma showed a complete (n=10) or partial (n=1) response to CDDP/VP-16 chemotherapy even if their tumours were recurrent and there was evidence of CSF dissemination. For the germinoma with STGC and non-germinomatous malignant tumour, a high response rate; 100% for the former and 78% for the latter, could also be achieved in both the primary and the recurrent cases except in those cases of immature teratoma. Their survival times were still different between them. Two-year survival was 50% in germinoma with STGC and 48% in non-germinoma, while it was 88% in germinoma cases.

Temporal profile of nuclear DNA fragmentation in situ in gerbil hippocampus following transient forebrain ischemia

To determine the time course of nuclear DNA damage in the gerbil hippocampus following transient ischemia, brain sections 48, 72, 96 h and 7 days following 5 min ischemia were evaluated by a specific in situ labeling method of DNA breaks. After 72 h, only the neurons located in the medial part of the CA1 sector were labeled. And then, DNA damage extended to the lateral part of the sector with time.

Clinical analysis of a series of vertebral aneurysm cases.

We reviewed 38 cases of aneurysms of the vertebral artery treated over the last 10 years: 26 (68%) located at the junction of the vertebral and posterior inferior cerebellar arteries, 10 (26%) at the vertebral artery, and 2 (5%) at the vertebrobasilar union. There were three distinct forms of aneurysms: 20 saccular (53%), 10 fusiform (26%), and 8 dissecting (21%). Among these 38 aneurysms, 33 (87%) had ruptured: 18 of the saccular aneurysms (90%), all 10 of the fusiform aneurysms (100%), and 5 of the dissecting aneurysms (63%). Computed tomography of the 28 ruptured aneurysms revealed diffuse subarachnoid hemorrhage in the basal cistern combined with intraventricular hemorrhage in 24 cases (86%). Magnetic resonance imaging was useful for differentiating between fusiform and dissecting aneurysms. Abnormalities such as a double lumen of the vertebral artery were demonstrated in four of the dissecting aneurysms. The overall surgical results were good for 22 of the 27 surgically treated cases (81%). New bleeding was observed in 8 (24%) of the 33 ruptured aneurysms. The rate of new bleeding was high (60%) in the patients with dissecting aneurysms, and occurred mostly in the acute stage. The incidence of vasospasm was 27%, and only two patients suffered permanent neurological deficits. These findings indicate that the rate of new bleeding tends to be high in patients with saccular and dissecting aneurysms, and thus, they should be treated as early as possible. A preoperative balloon occlusion test should be conducted if proximal occlusion of the vertebral artery is necessary, since proximal occlusion is not always safe, despite angiographic evidence of sufficient contralateral arterial flow.

Dissecting and fusiform aneurysms of vertebro-basilar systems

SummaryThe magnetic resonance (MR) findings of three cases with vertebro-basilar dissecting aneurysms (DA) were compared with those of two cases with vertebro-basilar fusiform aneurysms (FA). No abnormal findings, excepting a dilatation of a signal-void area corresponding to the arterial blood flow, were shown on the MR images in the patients with a FA. In contrast to the FA cases, various abnormalities were detected by the MR studies in all three DA cases. An intimal flap and a double lumen were demonstrated in one case. An intra-mural hematoma was shown in one case. A hematoma neighboring the parent artery was demonstrated in two cases. MR imaging was thought to be useful for detecting intracranial vascular lesions, such as a DA, and for discriminating between a DA and a FA.

Correlation between nucleolar organizer region staining and Ki-67 immunostaining in human gliomas

Fourteen cases of various grades of gliomas were investigated by an immunohistochemical method using a monoclonal antibody, Ki-67, which reacted with a nuclear antigen in proliferating cells, and the correlation between Ki-67 labeling index and the number of nucleolar organizer regions stained by an argyrophilic method. Four normal brain tissue samples without neoplastic cells, which were obtained at surgery, were also examined for nucleolar organizer region staining. Both the mean number of nucleolar organizer regions and the percentage of Ki-67 positive cells well reflected the histological grade of gliomas (astrocytoma grade 2: Ki-67, 0.5% and nucleolar organizer regions, 1.6; astrocytoma grade 3: Ki-67, 3% and nucleolar organizer regions, 2.5; astrocytoma grade 4: Ki-67, 5.2% and nucleolar organizer regions, 2.8). Also, the percentage of Ki-67 positive cells and the mean number of nucleolar organizer regions were found to be linearly related (r = 0.91). Both values of high-grade astrocytomas were significantly greater than those of low-grade astrocytomas (p less than 0.01 and p less than 0.001). Thus, the mean number of nucleolar organizer regions as well as Ki-67 labeling index reflect the proliferating potential of gliomas.

Surgical treatment of cavernous angioma involving the brainstem and review of the literature

SummaryFive cases of symptomatic cavernous angioma involving the brainstem are reported. Magnetic resonance (MR) imaging is of greatest value in the diagnosis and for surgical indication. All cases were treated by radical extirpation. All of them improved postoperatively. The surgical indications for this lesion of the brainstem are briefly discussed with a review of the literature, including 28 previous cases, operated on directly.

Postnatal development and enlargement of primary middle cranial fossa arachnoid cyst recognized on repeat CT scans

The etiology and mechanism of expansion of primary intracranial arachnoid cysts have been much debated. A rare case of an 8-month-old boy is reported, in which postnatal development and enlargement of a middle cranial fossa arachnoid cyst was detected on follow-up CT scans. Based on intraoperative and histological findings, the cyst was found to be intra-arachnoid. The wall was excised completely, and the lobe adjacent to the cyst appeared normal apart from signs of atrophy. Histological study of the excised cyst revealed a common arachnoid membrane with neither ependymal nor inflammatory cells; the cyst fluid was similar to CSF. The etiology of the lesion remains unclear, but it was considered that the expansion of the cyst might have occurred through a ball-valve mechanism of the membrane in communication with the general subarachnoid space.

Primary Intracranial Germ-Cell Tumors: A Retrospective Analysis with Special Reference to Long-Term Results of Treatment and the Behavior of Rare Types of Tumors

Thirty cases of primary intracranial germ-cell tumors were reviewed with reference to the effect of treatment. Histologically, there were 23 pure germinomas, while the remaining tumors had more unusual histology; 3 of these were teratomas, and 4 germ-cell tumors with the admixture of yolk sac tumor (YST) or embryonal carcinoma (EMC). Three of these rare cases are presented. The performed surgery and radiotherapy, seemed adequate for pure germinomas, and all these cases lived tumor-free after an observation time of 13 to 139 months although 4 patients developed intellectual retardation or cerebral dullness after radiotherapy. Four cases with YST and EMC elements, indicated by the elevation of AFP and HCG values in serum, were resistant to radio- and chemotherapy and developed, despite surgically total removal of the tumor, intra- or extracranial metastases. A review of the literature is included.

The relationship between Moyamoya disease and bacterial infection

To examine the relationship between Moyamoya disease and bacterial infections, authors studied the serum of 85 cases of Moyamoya disease and the influence of Propionibacterium acnes (P. acnes) infection on intracranial arteries in rats. The serum levels of P. acnes antibody, IgM, transferrin (Tf), alpha 2-macroglobulin (alpha 2M) were significantly higher in Moyamoya disease than in normal volunteers. Moyamoya-like changes of the intracranial internal carotid arteries were histopathologically demonstrated in P. acnes infectious rats. These findings suggest that P. acnes and immunological factors might play a role in the pathogenesis of Moyamoya disease.

Endothelin-1 induces intracellular calcium rise and inositol 1,4,5-trisphosphate formation in cultured rat and human glioma cells

The effects of endothelin-1 (ET) on the signal transduction in rat and human glioma cell line cells have been investigated. ET was found to initiate the increase of intracellular calcium ([Ca2+]i) levels in both C6 and A-172 cells, which was concurrent with the formation of inositol 1,4,5-trisphosphate (IP3(1,4,5)). In the presence of [ethylenebis(oxyethylenenitrilo)]tetraacetic acid (EGTA) in the incubation media, the duration of the intracellular calcium response was reduced, indicating that the ET-induced increase of intracellular calcium in glioma cells may be mediated by a dual mechanism, intracellular calcium mobilization and influx of extracellular calcium. These results suggest that ET may also act as a neuropeptide in the central nervous system.