Kouzo Moritake

Tentorial cavernous angioma with calcification in a neonate.

A cavernous angioma of the tentorium cerebelli, first disclosed by perinatal serial ultrasonographic studies, was extirpated totally without remarkable neurological deficit in a neonate. The tumor was accompanied by a calcified expansive hematoma in the posterior fossa. To our knowledge, this is the first case not only of cavernous angioma treated surgically and verified histologically in a neonate, but also of a calcified hematoma revealed on a conventional skull x-ray film at birth. This case suggests the possibility of hemorrhage from intracranial cavernous angioma early in life, even prenatally, and emphasizes the necessity for early diagnosis and early treatment of intracranial cavernous angiomas.

The role of hemodynamic factors in arterial wall thickening in the rat

In a study on the pathogenesis of arterial wall thickening, hemodynamic factors in the common carotid artery of the rat were experimentally altered with an autograft. The relationship between flow pattern and wall-thickening was examined in a half-ring bypass model with an induced stenosis, using both flow-visualization in a corresponding in vitro model circuit and observation of the wall by microscopy. Wall-thickening was found in the neighborhood of bifurcations, junctions and curved segments, which corresponded to regions of low-shear in the flow-field. Marked histologic changes in the wall were observed in the post-stenotic segments where the flow field was very disturbed. Histologic changes in the arterial wall correlated well with flow patterns.

Two surgically cured cases of subependymoma with emphasis on magnetic resonance imaging

The authors describe two surgically cured cases of symptomatic subependymomas located in the lateral ventricle and septum pellucidum with emphasis on magnetic resonance imaging study. Both computed tomography and MRI revealed a calcified mass with repeated intratumoral hemorrhages. Cerebral angiograms disclosed rather hypovascular lesions. The histologic diagnosis was proven to be of subependymoma. The pertinent literature of surgically treated subependymomas is reviewed, and the characteristic biologic features are also discussed.

Intracranial cavernous angioma angiographically mimicking venous angioma in an infant

We present a case of a 15-month-old infant with intracranial cavernous angioma in the right frontal lobe in which the cerebral angiogram revealed transmedullary collecting veins characteristic of venous angioma around the lesion. This vascular malformation was histologically confirmed to be a cavernous angioma.

Vanishing cerebral aneurysm in serial angiography

The angiographically documented spontaneous thrombosis of an internal carotid-posterior communicating aneurysm in a 63-year-old woman is reported. Serial angiography performed 10, 17, and 29 days after the initial attack of subarachnoid hemorrhage demonstrated progressive thrombosis of the aneurysm. Clinical analysis of this case and a review of the literature suggest that vasospasm and the relative narrowness of the aneurysmal neck played crucial roles in the spontaneous thrombosis of the aneurysm, although neither is definitely responsible.

Cavernous angioma in the fourth ventricle

A cavernous angioma in the fourth ventricle of a 47-year-old man is reported. Because of a progressive clinical course and a ring-like enhancement on computed tomography, a brain tumor, rather than a vascular disease, was suspected. The lesion was removed totally and verified histologically as a cavernous angioma.

Quantitative analysis of microstructural components of human cerebral arteries.

Microstructural components were analyzed quantitatively by means of a microphotometric technique applied to three kinds of major cerebral arteries and two kinds of extracranial arteries of comparable size obtained from human autopsy subjects. No statistically significant difference was found in the fractions of three structural components, elastin (Fe), collagen (Fc), and smooth muscle (Fm), in the total of fractions of these three components and in the ratio between extracranial arteries. The Fe-values were significantly less in cerebral arteries than in extracranial arteries. The Fc/Fe ratios in cerebral arteries were about triple those in extracranial arteries. Although there was no statistically significant difference in the Fe- and the Fm-values between the two age groups, under 49 and over 50 years old, the Fc/Fe ratio were higher in the older age group. This change of microstructural composition with age was more prominent in cerebral arteries than in extracranial arteries.

Intracerebral malignant lymphoma with fluctuating regression and spatial evolution

Seven patients with histologically proven primary intracerebral malignant lymphoma, characterized by a fluctuating nature with both transient regression and spatial evolution of the tumors without contiguity to the initial lesion, are presented. Although the overall outcome was unfavorable, two cases had a long-term survival of 3 years or more and one of them showed a good quality of life. Correlation among characteristic clinical presentations, computed tomography scans, and prognostic factors after management with surgery, radiation, and chemotherapy, including steroids, is discussed.

STA-MCA anastomosis in patients with skull base tumours involving the internal carotid artery—Haemodynamic assessment by ultrasonic Doppler flowmeter

SummaryThe role of superficial temporal artery -middle cerebral artery (STA-MCA) anastomosis was investigated with an ultrasonic Doppler flowmeter in 3 patients with sphenoid ridge meningiomas and one with a parasellar malignant teratoma, all of which involved the intracranial internal carotid artery. The intraoperative Doppler flow study revealed a remarkable increase in flow volume of the STA after trial occlusion of the middle cerebral artery in one case and permanent occlusion in two cases. These results substantiate the effectiveness of STA-MCA anastomosis. We also discuss surgical and other contrivances for obtaining sufficient blood supply from this bypass to prevent cerebral ischaemia in the acute phase after elective or accidental occlusion of a major cerebral artery. This is the first report of STA-MCA anastomosis in cases with brain tumour.

Malignant Melanoma Metastatic to Sphenoid Bone with an Unknown Primary Origin: Report of a Case with an Immunohistochemical Analysis of the Infiltrating Lymphocytes

A rare case of hemorrhagic malignant melanoma from an unknown primary origin to the right sphenoid bone in a 37-year-old woman is presented. The tumor occupied an extensive intracranial extradural space with a mild orbital infiltration, but little involvement of the leptomeninges and parenchymal tissues. Immunohistochemical analysis of the tumor-infiltrating lymphocytes showed that the majority expressed pan-T or Leu-1 surface antigens and that the lymphocytes bearing the Leu-3 antigen, or helper phenotype, were predominant compared to the Leu-2 population representing both suppressor and cytotoxic T cells. Furthermore, most of the T lymphocytes stained with HLA-DR antigens. Because few B cells were seen, this observation indicates the presence of T cells in an activated state. The literature pertinent to associated organ involvement of metastatic melanomas and the correlations between the tumor and immunological cellular responses are discussed.