Kazutaka Yatsushiro

Natural history of elderly patients with asymptomatic meningiomas

OBJECTIVE For the treatment of elderly patients with asymptomatic meningiomas, it is important to determine their natural history. Based on results of follow up examinations, the natural history of such patients was clarified and prognostic factors concerning the potential of tumour growth in the aged were identified. METHODS The clinical records and imaging studies of 40 elderly (over 70 years) patients with asymptomatic meningiomas were analysed. The patients were followed up with repeated imaging studies, and changes in tumour size, clinical signs, and outcomes were evaluated. RESULTS There were 32 women and eight men with a mean age of 76.1 years. The mean follow up period was 38.4 months, ranging from 6 to 97 months. Six patients died during the follow up period from disorders other than the tumours, and one patient died as a result of the tumour. Twenty six patients (mean follow up period 41.8 months, range 10–97 months) showed no tumour growth. Fourteen patients showed tumour growth (mean follow up period 32.1 months, range 6–88 months). Five (four men and one woman) of these patients became symptomatic. Based on imaging analysis (1) calcification of the tumour was associated with no tumour growth (p=0.036), and (2) the tumour size at the initial diagnosis was related to subsequent tumour growth (p=0.016). Other possible factors related to tumour growth included sex and hyperintensity on MRI T2 weighted images. CONCLUSION In elderly patients with asymptomatic meningiomas, careful clinical follow up with imaging studies is important. The imaging features mentioned may contribute to prediction of tumour growth.

Subfrontal schwannoma mimicking neuroblastoma: case report.

Computed tomography (CT), performed in a healthy 28-year-old man after minor head injury, detected a frontal base tumor. Neurological examination revealed left hyposmia. On magnetic resonance imaging scans, there was a heterogeneously enhanced tumor located in the left paramedian frontal base with extension into the left ethmoid sinus. Angiography showed a hypervascular mass in the left anterior cranial fossa; it was mainly fed by the left ethmoidal artery. Positron emission tomography scanning showed moderate accumulation of 11-methylmethionine and low accumulation of 18-fluorodeoxyglucose (FDG) at the tumor site. Bone image CT disclosed compressive, nondestructive deformation of the left frontal base. The preoperative diagnosis was olfactory neuroblastoma or meningioma. The tumor was totally resected via bifrontal craniotomy. The tumor was histologically diagnosed as typical schwannoma; it was positive for S-100 protein. We report a rare subfrontal schwannoma with extension into the nasal cavity that mimicked neuroblastoma. Low FDG accumulation and compressive deformation of the anterior skull base may help in the differential diagnosis of these tumors.

Improvement in treatment results of glioblastoma over the last three decades and beneficial factors

Abstract Background. The purpose of this study is to elucidate the trend of glioblastoma outcome and scrutinize the factors contributing to better outcome over three decades. Methods. Survival time and the influencing factors were retrospectively analyzed in 223 newly diagnosed primary glioblastoma patients during 1980–2010. Appraised factors included age, sex, tumor site, year of surgery, extent of resections, use of surgery supporting system, Karnofsky Performance Status (KPS), chemotherapy, conventional external beam radiotherapy (EBRT), and CyberKnife stereotactic radiotherapy (CK-SRT) use. Results. The median survival time (MST) in all patients was 13.6 months. The MSTs for 4 periods were 9.8 (1980–1990), 13.7 (1991–2000), 12.9 (2001–2005), and 15.8 months (2006–2010), respectively (p = 0.0047). Total resection, subtotal resection, partial resection, and biopsy had MSTs of 31.8, 13.9, 11.4, and 7.0 months, respectively (p < 0.0001). Regarding chemotherapy, MSTs of the temozolomide base group and nimustine hydrochloride (ACNU) base group were 16.9 and 14.6 months, respectively, whereas the MST of patients without chemotherapy was only 9.8 months (p < 0.0001). The MSTs for 40-Gy EBRT plus CK-SRT and 60-Gy EBRT were 19.1 and 10.7 months, respectively (p < 0.0001). But in sub-selected patients, treated during 2001–2010, whose resection rate was total resection or subtotal resection, EBRT was completed and postoperative KPS was greater than or equal to 70, the MST with and without CK-SRT was 26.6 and 18.3 months, respectively (p = 0.1529). According to the Cox proportional hazards model, degree of resection, KPS, ACNU use, temozolomide use, bevacizumab use, EBRT dose, and CK-SRT use were good prognostic factors. Use of neuronavigation and use of intraoperative magnetic resonance imaging were related to higher resection rate, but not determined as prognostic factors. Conclusions. We observed a gradual improvement in glioblastoma outcome, presumably because of improvements in therapeutic modalities for surgery, anticancer agents, and radiation, but the efficacy of CK-SRT remains unclear.

31P-Magnetic Resonance Spectroscopic Study on the Effect of Glycerol on Cold-Induced Brain Edema

The aim of the present study was to determine the effects of a hyperosmotic agent, 10% glycerol, on both brain energy metabolism and intracellular pH (pHi) in experimental vasogenic brain edema. Vasogenic brain edema was induced by cold injury applied to bilateral parietal portions in 13 mongrel dogs (7 glycerol, 6 control) while, 3 dogs were used as control. Before and at 24 hours after the injury, sequential phosphorous-31 magnetic resonance spectroscopy (31P-MRS) was performed for 2 hours in order to determine phosphocreatine (PCr), beta-adenosine triphosphate (beta-ATP), inorganic phosphate (Pi) levels and pHi. At 24 hours following cold injury, both PCr/Pi and ATP/Pi ratios significantly decreased from 7.75 to 3.97 and from 2.26 to 1.25, respectively. Furthermore, a moderate decrease in pHi of 7.16 to 7.01 was significantly demonstrated during the same experimental period. Administration of glycerol for 30 minutes significantly increased PCr/Pi from 3.97 to 5.06 and ATP/Pi from 1.25 to 1.72, respectively. Also, glycerol administration caused a significant increase in pHi from 7.01 to 7.11. This study indicates that cryogenic injury, in which formation and expansion of vasogenic brain edema a known to occur, results in disturbed brain energy metabolism and in intracellular acidosis; moreover, the administration of glycerol can ameliorate either or both of these derangements.

Effect of Vagus Nerve Stimulation on Intractable Epilepsy

Purpose: Since 1993, we have studied the efficacy and safety of vagus nerve stimulation (VNS) with a Neurocyberhetic Prosthesis (NCP) (Cyberonics, U.S.A.) against medically intractable epilepsy first in Japan. We summarize the intermediate results so far acquired in this report.

Magnetic Resonance Study of Brain Oedema Induced by Cold Injury — Changes in Relaxation Times Before and After the Administration of Glycerol

Experiments were carried out to determine the ability of magnetic resonance systems to assess change in relaxation times following the induction of experimental brain oedema and subsequent administration of hypertonic glycerol. Nine small mongrel dogs were used for these experiments. Twenty-four hours after producing a cold lesion, magnetic resonance (MR) studies were performed and physiological data were measured. Thirty min after beginning the administration of glycerol, serum osmotic pressure was raised 88 mOsm/l. After administering glycerol a small reduction in long spin echo images was observed in the periventricular high intensity area. The T1 and T2 values appeared to be decreased from 30 min after glycerol administration. This decrease continued until the period of observation ended. Statistically significant changes in the T2 values, especially in the white matter of the opposite side, were seen. The changes in T1 were generally not statistically significant. We conclude that the changes in water content of the oedematous brain following the administration of glycerol can be detected by magnetic resonance systems, that these changes become appreciable 30 min after administration of glycerol and continue at least two more hours, and that the changes in T2 were larger than those in T1.

Sex Differences in Gamma Band Functional Connectivity Between the Frontal Lobe and Cortical Areas During an Auditory Oddball Task, as Revealed by Imaginary Coherence Assessment

We studied sex-related differences in gamma oscillation during an auditory oddball task, using magnetoencephalography and electroencephalography assessment of imaginary coherence (IC). We obtained a statistical source map of event-related desynchronization (ERD) / event-related synchronization (ERS), and compared females and males regarding ERD / ERS. Based on the results, we chose respectively seed regions for IC determinations in low (30-50 Hz), mid (50-100 Hz) and high gamma (100-150 Hz) bands. In males, ERD was increased in the left posterior cingulate cortex (CGp) at 500 ms in the low gamma band, and in the right caudal anterior cingulate cortex (cACC) at 125 ms in the mid-gamma band. ERS was increased in the left rostral anterior cingulate cortex (rACC) at 375 ms in the high gamma band. We chose the CGp, cACC and rACC as seeds, and examined IC between the seed and certain target regions using the IC map. IC changes depended on the height of the gamma frequency and the time window in the gamma band. Although IC in the mid and high gamma bands did not show sex-specific differences, IC at 30-50 Hz in males was increased between the left rACC and the frontal, orbitofrontal, inferior temporal and fusiform target regions. Increased IC in males suggested that males may acomplish the task constructively, analysingly, emotionally, and by perfoming analysis, and that information processing was more complicated in the cortico-cortical circuit. On the other hand, females showed few differences in IC. Females planned the task with general attention and economical well-balanced processing, which was explained by the higher overall functional cortical connectivity. CGp, cACC and rACC were involved in sex differences in information processing and were likely related to differences in neuroanatomy, hormones and neurotransmitter systems.

Magnetic Resonance Studies in Human Brain Oedema Following Administration of Hyperosmotic Agents

Changes of proton relaxation times (T1 and T2) and proton Magnetic Resonance Spectroscopy (MRS) were studied in patients with brain oedema following administration of hyperosmotic agents. Relaxation times of oedema tended to decrease following infusion of hyperosmotic agents. In most patients examined, changes of relaxation times tended to achieve their lowest value at 30–60 minutes after infusion. However, the changes of relaxation times were not uniform. In some patients, relaxation times continued to decrease for more than 2 hours, while in other patients relaxation times which had earlier decreased subsequently had increased at 2 hours. The peak of water components, obtained by SIDAC (Spectroscopic Imaging by Dephasing Amplitude Changing) method was observed to change as did relaxation times. Changes of relaxation times and the peak of water component may vary depending upon factors including the kinds of lesions causing oedema, phase of oedema (acute or chronic), etc. Proton relaxation times and the peak of water component obtained by proton MRS were useful in evaluating the changes of oedematous area.