Masakatsu Nagai

EFFICACY OF CLOSED-SYSTEM DRAINAGE IN TREATING CHRONIC SUBDURAL HEMATOMA :A PROSPECTIVE COMPARATIVE STUDY

The authors conducted a prospective comparative study on the recurrence rate of chronic subdural hematoma after the use of two different treatment modalities: burr-hole irrigation of the hematoma cavity with (Group A) and without closed-system drainage (Group B). Thirty-eight patients were studied. Patients were assigned to groups sequentially upon admission. There were no significant differences between the two groups for age, sex, preoperative hematoma volume, and density on computed tomographic scan. One patient in Group A (5%) suffered a recurrence as opposed to 6 in Group B (33%). The difference in recurrence rate between the two groups was statistically significant (P less than 0.05). The authors conclude that closed-system drainage after burr-hole irrigation reduces the recurrence rate of chronic subdural hematoma.

Angiographically occult angiomas: a report of thirteen cases with analysis of the cases documented in the literature

Thirteen cases of angiographically occult angioma (AOA) are reported. Nine of these presented with intraparenchymatous hemorrhage, and the other 4 patients had epilepsy. The pathological diagnosis was arteriovenous malformation in 12 cases and cavernous angioma in 1. All surgical specimens but 2 contained hemosiderin pigment. In addition to these 13 cases, we reviewed 159 cases of AOA reported in the literature and analyzed them in terms of age, sex, symptoms and signs at admission, computed tomographic findings, location and size of angioma, history of previous and recurrent hemorrhage, type of hemorrhage, and outcome of operation to determine the characteristics of AOAs. The results of these analyses are described in detail, and the indications for surgical treatment of suspected AOAs are discussed. Our microsurgical technique for detecting the angioma within or adjacent to the hematoma is also presented.

Postoperative contrast enhancement in brain tumors and intracerebral hematomas: CT study.

Postcontrast cerebral CT was performed sequentially on days 3, 7, and 14 after surgery in 34 patients [11 with gliomas; 6 with metastatic tumors, and 17 with intracerebral hematomas (ICH)]. The purpose of this study was to investigate the natural course and mechanisms of postoperative contrast enhancement (CE) of the brain around the removed lesions. Contrast enhancement was noted on days 3-14 in 10 patients in whom the gliomas were partially or subtotally removed. The intensity of CE appeared to increase with time. Among the six patients in whom the metastatic tumors were totally removed, four showed no CE until day 14 after surgery. Contrast enhancement appeared on day 3 in one and on day 14 in another. In 12 patients with ICH, which had been evacuated during the first 5 days after hemorrhage, CE was not noted on day 3 but began to appear on day 7, and intensified on day 14 after surgery. Contrast enhancement was demonstrated on day 3 in four of the five patients in whom the ICH was removed later than 10 days after the hemorrhage. No CE was observed on days 3 through 14 in the one patient in whom the hematoma capsule was totally removed. The present study suggests that CE noted on day 3 after removal of gliomas and metastatic tumors seems to be caused by extravasation of contrast medium within the residual tumor, which is devoid of blood-brain barrier. Contrast enhancement noted in ICH cases and intensifying CE noted in tumors 7 days after surgery seems likely to be caused by neovascularization in the postoperative brain.

rCBF in brain tumours as measured by xenon enhanced CT

Heretofore, the rCBF of brain tumours has been measured by the 133Xe clearance method, but the resolving power of this method is limited and flow values measured by this method correlate poorly with the anatomical structure. On the other hand, our xenon-enhanced method has several advantages over the conventional isotope method and enables us to evaluate rCBF with a resolving power of 4 mm. With this method, we evaluated rCBF in 15 brain tumour cases and obtained the following results: Mean rCBF value of the tumour is a little lower than that of grey matter and higher than that of white matter with oedematous change. The xenon-enhanced method enables us to distinguish the demarcation between the tumour area and the surrounding oedematous area and offers useful information for determining the extent of resection in surgery. Mean lambda value of the tumour which is not obtainable in vivo by radionuclide scanning, was 1.02 +/- 0.06 for gliomas and 0.72 +/- 0.09 for metastatic tumours.

Expanding intracerebral hematoma from pituitary adenoma: case report.

We report the case of a 53-year-old man presenting with a headache of sudden onset and blurred vision secondary to hemorrhage from a nonfunctioning pituitary adenoma, which had been treated 25 years previously by transcranial surgery and postoperative irradiation. The intratumoral and intracerebral hematoma expanded to three times its initial size because of a recurrent hemorrhage that occurred during a 2-day period while the patient awaited surgery. The mechanisms of hematoma expansion and the management strategy in such a case are discussed, and a review of the pertinent literature is presented.

Effect of interferons and an interferon inducer on malignant brain tumors

Three case reports of long-term administration of human fibroblast interferon-β (Hu IFN-β) and interferon inducer poly ICLC on malignant glioma patients were presented. Regression of the tumor was demonstrated in a case of anaplastic astrocytoma by intravenous administration of Hu IFN-β for more than two and half years. The suppressive effect of intratumoral administration in a glioblastoma patient was also presented. The effects of Hu IFN-β and recombinant IFN-α on glioblastoma multiforme, anaplastic astrocytoma and other gliomas were summarized. The suppressive effect and complications of intravenous administration of poly ICLC on malignant glioma were presented and discussed.