Ryota Mashiko

Small unruptured cerebral aneurysms presenting with oculomotor nerve palsy.

OBJECTIVESymptomatic unruptured aneurysms have been considered at relatively high risk for future rupture, and the majority of aneurysms that cause symptoms of mass effect are large. Unruptured aneurysms smaller than 1 cm in diameter sometimes cause neurological symptoms, but their clinical aspects remain obscure. In this article, we review our experience with small unruptured aneurysms presenting with oculomotor nerve palsy. METHODSSixteen patients with unruptured aneurysms smaller than 1 cm presenting with oculomotor nerve palsy were included in this study. The patients’ clinical profiles were reviewed, and factors affecting the recovery of oculomotor function were determined. RESULTSThe mean size of the aneurysms was 5.8 ± 1.4 mm. Eleven patients (68.8%) had preceding retrobulbar pain. Fifteen patients underwent successful microsurgical clipping or intravascular embolization, but one patient died of aneurysm rupture before surgery. Seven patients (43.8%) had a complete recovery of oculomotor function, six (37.5%) had an incomplete recovery, and two (12.5%) remained unchanged after treatment. The mean interval between the onset of oculomotor nerve palsy and treatment was 4.7 ± 3.3 days in patients with complete recovery, 24.2 ± 15.5 days in patients with incomplete recovery, and 41.0 ± 12.7 days in unchanged patients. Early surgery resulted in more complete recovery of neural function (P < 0.01). CONCLUSIONUnruptured aneurysms smaller than 1 cm can cause neurological symptoms of mass effect. We recommend timely surgery, preferably within 5 days, to avoid not only aneurysm rupture but also functional disability even in patients with unruptured aneurysms smaller than 1 cm.

Detection of failure of bevacizumab treatment for malignant glioma based on urinary matrix metalloproteinase activity

Although antiangiogenic treatment for malignant glioma using bevacizumab in combination with irinotecan chemotherapy has a promising effect on survival, the high incidence of increasing infiltrative tumors can be a problem in resistance to antiangiogenic therapy. In this study, we detected failure of bevacizumab treatment for malignant glioma through upregulation of metalloproteinase activity in the urine, as well as infiltrative tumors on MRI. In addition, MMP9 has been proved as a molecule that facilitates its infiltrative behavior in vivo in the brain animal model.

Metronomic treatment of malignant glioma xenografts with irinotecan (CPT-11) inhibits angiogenesis and tumor growth

Irinotecan (CPT-11) has shown emerging promise in the treatment of malignant gliomas. It is believed the mechanism of action of irinotecan is to sensitize glioma cells to the cytotoxic action of radiation therapy and alkylating agents. However, clinical trials using weekly or three-weekly doses of CPT-11 have demonstrated imaging responses in only 10–15% of patients. In this study, we evaluated another mechanism of action, angiosuppression by CPT-11 of ACNU-resistant gliomas, using a metronomic administration schedule. Two different types of treatment, (1) conventional and (2) metronomic, were applied to the subcutaneous U87 model. We found that metronomic administration of CPT-11 significantly inhibited malignant glioma growth by inhibiting angiogenesis; this treatment procedure reduced the number of tumor vessels and the area of hypoxic lesions and reduced expression of VEGF and HIF-1α, the most important angiogenic factors in gliomas. Metronomic treatment was superior to conventional treatment with regard to the severe systemic side effect of body weight loss. The growth inhibitory effect was very similar for both low and high doses of CPT-11. These angiosuppressive effects of CPT-11 show promise for another use of CPT-11 in metronomic and scheduled angiosuppressive chemotherapy with low dose and long-term administration for malignant gliomas without systemic side effects.

Cerebellar metastasis with the cavity of both components of lung adenosquamous cell carcinoma

66 The 2 components of the surgically resected tu‐ mor were precisely separated by manual microdis‐ section under microscope to avoid contamination of each sample by different components. An epi‐ dermal growth factor receptor (EGFR) exon 19 de‐ letion, but not the T790M mutation, was identified in both components. Thereafter, the patient devel‐ oped several small cavitary metastases (<10 mm in size) in both lungs (FIGURE 1B). She was admin‐ istered EGFR ‐tyrosine kinase inhibitors and cy‐ totoxic chemotherapies (gefitinib for 23 months; 4 cycles of carboplatin, pemetrexed, and bevaci‐ zumab; 15 cycles of pemetrexed and bevacizumab for 15 months; afatinib for 13 months; and 17 cy‐ cles of docetaxel and bevacizumab for 15 months), A 72 ‐year ‐old woman with no history of smok‐ ing presented to our hospital with dizziness for the past 3 weeks. Nine years earlier, she had he‐ moptysis, and a large tumor in the left lung was revealed by chest computed tomography (FIGURE 1A). The patient underwent a lobectomy of the left lower lung and mediastinal lymph node dissection. The resected tumor consisted of the components of adenocarcinoma as well as squamous cell carcinoma, each comprising more than 10% of the tumor. The final pathological di‐ agnosis was lung adenosquamous cell carcino‐ ma, and the tumor was staged as pT3bN1M1a according to the TNM classification. CLINICAL IMAGE

Intracranial infection caused by minor skin contusion associated with previous craniotomy

Minor damage to the scalp may lead to intracranial infection. Moreover, the postoperative state of the scalp, skull and meninges is especially noteworthy with respect to invasion of pathogens into the skull. Therefore, a detailed medical history should be obtained from patients with even minor scalp injuries to avoid intracranial infection. We herein report a case of intracranial infection caused by a minor scalp injury associated with previous craniotomy, which was missed at first.

True Accessory Anterior Cerebral Artery: A Newly Reported Anterior Cerebral Arterial Anomaly and a Proposal for Its Classification.

If we use the same naming policy of middle cerebral arterial anomalies, then accessory anterior cerebral arteries (ACAs) should be applied for ACA anomalies originating from the ACA. We experienced such a rare ACA anomaly, which we referred to as true accessory ACA.

Quadrigeminal cistern lipoma mimicking intracranial air.

Intracranial lipoma concomitant with traumatic pneumocephalus is very rare and, to the best of our knowledge, there has been no report describing this condition. It may be difficult to distinguish lipoma from intracranial air only with CT, but it is necessary to avoid overtreatment. We report a case of quadrigeminal cistern lipoma mimicking intracranial air in a patient with traumatic pneumocephalus.