Koreaki Mori

Percutaneous transluminal cerebral angioplasty: serial angiographic follow-up after successful dilatation

Abstract The purposes of this study were to determine the optimal time for initial follow-up angiography, the restenosis rate after successful intracranial percutaneous transluminal cerebral angioplasty (PTCBA), and finally to identify lesion-specific characteristics for predicting successful angioplasty. Thirty-five patients underwent PTCBA with follow-up angiography 3 and 12 months later. Although 27 lesions were adequately dilated, permanent complications occurred in 3 patients. The restenosis rate at 3 months was 29.6 %; patients without restenosis at 3 months remained free from vessel narrowing at 12 months. Restenosis occurred on severe, eccentric lesions, total occlusions or extremely angulated lesions. There was a strong correlation between sufficient dilatation and lower re- stenosis rate, and concentric and short lesions (type A). We conclude that the optimal time for initial angiographic follow-up is 3 months after PTCBA. PTCBA is most suitable for type A lesions with higher success, lower morbidity and lower restenosis rates.

Clinical Analysis of Arteriovenous Malformations in Children

28 cases of arteriovenous malformations (AVMs) in children were analyzed and compared with 18 adolescent and 106 adult cases. The findings were: (1) intracerebral hematoma due to rupture of AVMs and focal neurologic deficits were more frequent in children, (2) Operative mortality was higher in children than in adults in cases where total removal was not feasible. (3) Follow-up results suggested that the prognosis in children was less favorable than in adults. (4) When dealing with spontaneous intracerebral hematoma in children care should be taken to search for underlying cryptic AVMs.

Classification of hydrocephalus and outcome of treatment

PURPOSE Retrospective analysis in cooperative study of hydrocephalus at institutions of members of the Research Committee on Intractable Hydrocephalus sponsored by the Ministry of Health and Welfare of Japan was performed to determine the functional prognosis for all types of hydrocephalus and thus to clarify the outcome. METHODS In preparation of this study, we have proposed the definition, clinical classification and diagnostic criteria of hydrocephalus. We have classified non-tumoral hydrocephalus into eight types based on its etiology and the time of onset. To establish the diagnosis in each type of hydrocephalus, we have set up inclusion and exclusion criteria, as well as supplementary criteria which are useful for its diagnosis. RESULTS Analysis of the 1450 cases of hydrocephalus of various etiologies stored in the data base obtained from the study for each type of hydrocephalus revealed that following types and conditions were associated with a neurologic deficit: (1) early fetal hydrocephalus, (2) overt neonatal hydrocephalus, (3) hydrocephalus associated with such severe brain malformations as hydranencephaly, holoprosencephaly and lissencephaly, (4) hydrocephalus associated with severe brain damage, (5) hydrocephalus associated with epilepsy, (6) hydrocephalus shunted late after detection, and (7) hydrocephalus complicated by a shunting operation. CONCLUSION The postnatal functional outcome was significantly poor in fetal hydrocephalus diagnosed in the early gestation. Childhood onset hydrocephalus showed a poorer outcome than adult hydrocephalus.

Subarachnoid fluid collection in infants complicated by subdural hematoma

In the natural history of infantile extracerebral fluid collections, subarachnoid fluid collection itself if regarded as a benign lesion, and surgical treatment is not indicated. As this condition is age-related and self-limiting, spontaneous resolution can be expected in most cases by 2–3 years of age. However, out of 20 cases of infantile subarachnoid fluid collection in an 8-year period, 3 infants developed subdural hematoma. Infantile subarachnoid fluid collection seems to be prone to complicate subdural hematoma. Surgical treatment should be considered when subarachnoid fluid collection is complicated by subdural hematoma due to arachnoid ruptures or tearing of the bridging veins. Therefore, all patients should be observed closely and measures should be taken to prevent head trauma since it may precipitate subdural hematoma.

Tau protein is a potential biological marker for normal pressure hydrocephalus

A biological marker for normal pressure hydrocephalus (NPH) is beneficial for evaluation of its severity and of indications for shunt operation. Tau protein was initially considered as a biological marker in cerebrospinal fluid (CSF) from Alzheimer’s patients. Recently, it has been demonstrated that degeneration in the brain causes elevation of tau in CSF. Therefore, the tau level in CSF from NPH patients was evaluated. Tau levels in CSF from NPH patients were significantly higher than that in controls. The tau levels were correlated with the severity of dementia, urinary incontinence, and gait disturbance in NPH. These results suggest that CSF tau may be useful as a biological marker for NPH to determine the level of neuronal degeneration.

Results of Treatment for Craniopharyngioma

A review of the results of treatment for 155 cases of craniopharyngioma during the past 47 years by the palliative operation was made. Steroid and operative microscope reduced operative mortality and gave more chance of total extirpation, but survival rate was almost unchanged. It is noteworthy that 3 cases who underwent palliative operation more than 30 years ago are still alive and leading useful lives. The quality of survival was somewhat less favorable in pediatric than adult cases. Morbidity frequently encountered in pediatric cases was growth retardaton. Craniopharyngioma is a benign tumor pathohistologically, but it should be considered as malignant because of the region it occurs in. Therefore, no forceful attempt to total extirpation should be made and the operations should, as a rule, be palliative.

Computed tomography of cerebral cavernous hemangiomas.

Four cases of histologically verified cerebral cavernous hemangiomas are presented. In one case, computed tomography (CT) showed well demarcated areas of high density, with slight enhancement and no significant mass effect. However, in the other three cases, the CT findings were similar to those encountered in hematomas, low grade gliomas, or meningiomas. Thus, although CT in cerebral cavernomas is informative in most cases, it does not offer specific diagnostic signs.

The significance of periventricular lucency on computed tomography: Experimental study with canine hydrocephalus

SummaryIn order to investigate the pathogenesis of periventricular lucency (PVL) in hydrocephalus, CT scans were performed with monitoring of the epidural pressure in a series of dogs with hydrocephalus induced with kaolin. PVL of various degrees was detected in the experimental animals, which disappeared immediately after a shunting operation. Correlations have been attempted between PVL on CT scans and histological examinations, contrast enhancement studies, metrizamide ventriculography, and measurement of regional cerebral blood flow in the periventricular white matter. PVL in hydrocephalus is considered to represent acute edema or chronic CSF retention in the periventricular white matter caused by an increase of water content. In other words, it is regarded as a sign of existing or preceding intraventricular hypertension on CT scan, and seems to be a reversible phenomenon to some extent. PVL may therefore became an indication for a shunt.

Brain tumors in childhood: statistical analysis of cases from the Brain Tumor Registry of Japan.

This paper attempts to summarize and statistically analyze 2,361 pediatric brain tumors out of a total of 20,192 human brain tumors from about 250 institutes in Japan during the period 1969–1978 in order to obtain an idea of their incidence and results of treatment. This report uses the classification and nomenclature adopted by UICC (Unio Internationalis Contra Cancrum) in 1965. Survival rate was computed as relative survival rate by the method reported by Cutler in 1964 [3]. Interestingly, germinomas (7.8%) are still frequent tumors in Japan. Astrocytoma (19.7%), medulloblastoma (16.6%), craniopharyngioma (12.5%), germinoma (7.8%) and ependymoma (6.6%) occurred in that order of frequency. Five-year survival rate of medulloblastoma was 35.7% in subtotal and 55.3% in “total” removal. Radiotherapy was an effective therapeutic adjunct for the treatment of medulloblastoma. The germinoma prognosis was good, with a 5-year survival rate of 42.4% without and 69.1% with radiation therapy, revealing radiotherapy as a statistically significant treatment. Radiotherapy, with or without shunt, is thus the treatment of choice. The survival rate of patients with craniopharyngiomas was also high, with a 5-year survival of approximately 75% in partial and 76.3% in total removal. Most of the craniopharyngiomas were treated by partial removal of the tumor, with or without radiotherapy. Patients treated with radiotherapy survived a little longer than patients without.

Percutaneous transluminal angioplasty for total occlusion of middle cerebral arteries

Abstract Although it is controversial whether total occlusions of intracranial arteries can safely be opened by angioplasty, we treated six patients with total occlusions of the middle cerebral artery by percutaneous transluminal cerebral angioplasty (PTCBA) in the chronic stage after a stroke, on average 10 weeks. We successfully opened four total occlusions less than 3 months old, while two total occlusions more than 3 months old could not be opened. No complications occurred. Even in the chronic stage, PTCBA for total occlusion of intracranial arteries can be done safely.