Shoji Bitoh

Chemotherapy of brain metastases from lung carcinoma: a controlled randomized study.

A controlled randomized study was carried out to evaluate the effects of chemotherapy in patients with brain metastases from lung carcinoma. One hundred patients were randomly divided into three groups at the time of diagnosis or after surgery for metastases. Group A received radiotherapy alone; Group B received radiotherapy and chloroethylnitrosoureas (methyl-CCNU, 100-120 mg/m2, or ACNU 80-100 mg/m2, every 6-8 weeks), and Group C received radiotherapy and a combination of chloroethylnitrosoureas and tegafur (300 mg/m2, daily). Of the 100 patients, 88 could be evaluated. The reduction rates of the tumors of the patients in whom tumor was not surgically removed or not totally removed were compared. Complete resolution of the tumor was noted in 29, 69, and 63% of the patients in Groups A, B, and C, respectively. Tumor regression of greater than or equal to 50% was seen in 36, 69, and 74% of the patients in Groups A, B, and C, respectively. The difference in the response rates of Groups A and C was statistically significant (P less than 0.05). Median survival after the start of treatment for brain metastasis was 27, 30.5, and 29 weeks in Groups A, B and C, respectively. There was 1 long-term survivor (more than 5 years) in Group A, 3 in Group B, and 1 in Group C. The main cause of death was deterioration attributable to the primary lesion or systemic metastasis, and no statistical difference was noted in survival time among the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral Neoplasms Initially Presenting with Massive Intracerebral Hemorrhage

In three patients, clinically silent brain tumors led to massive intracerebral hemorrhage. These patients represented 0.6% of 497 consecutive patients with primary or secondary brain tumors and 2.5% of 119 patients with hypertensive or spontaneous intracerebral hemorrhage. Examination by computed tomography and angiography provided no evidence suggestive of the presence of neoplasms. All three patients were surgically treated and the lesions were histologically confirmed to be metastatic bronchogenic carcinoma, metastatic clear-cell carcinoma and low-grade astrocytoma, respectively.

Therapeutic occlusion of the vertebral artery for unclippable vertebral aneurysm: relationship between site of occlusion and clinical outcome.

Six cases of unclippable vertebral aneurysms were treated by therapeutic occlusion of the proximal vertebral artery. In three cases, the vertebral artery was clipped proximal to the posterior inferior cerebellar artery (PICA), and all of these patients had a postoperative embolic complication or a fatal subarachnoid hemorrhage. In two cases, the vertebral artery was clipped distal to the PICA and in one case the PICA was absent and the vertebral artery was clipped proximal to the aneurysm. All three of these patients did well without any neurological deficit. Possible mechanisms of the complications are discussed, and the importance of not clipping the PICA is stressed.

Intracranial epidermoid mimicking meningioma

A case of an epidermoid cyst in the frontal base which showed homogeneous high density in noncontrast computed tomography, simulating a meningioma with calcification, is reported. Operative findings and histological examination suggested that this high density was caused by spontaneous hemorrhage into the cyst.

Irradiation of spontaneous carotid-cavernous fistulas

Two patients with spontaneous carotid-cavernous fistulas were successfully treated with cobalt 60 irradiation to the sellar region. Angiographically, one patient showed combined-type shunts comprising a dural internal carotid-cavernous fistula and a direct internal carotid-cavernous fistula; the other patient had a mixed dural external and internal carotid-cavernous fistula. The respective total radiation dose was 3,200 rads and 3,024 rads. The patients responded satisfactorily to the treatment, with disappearance of the fistulas on angiograms and patency of the internal and external carotid arteries.

Angiographically occult vascular malformations causing intracranial hemorrhage

In 5 patients, angiographically occult vascular malformations led to intracerebral or intracerebellar hemorrhages. Angiographic findings were not suggestive of vascular abnormalities, but signs of a mass were present in 4 patients. Computed tomography (CT) scanning suggested the presence of cryptic vascular lesions accompanied by intraparenchymal hemorrhage in 2 patients. In all patients surgical treatment was successful. Histological examination confirmed these lesions to be venous malformations in the cerebellum in 2 patients and in the left frontal region in 1, and arteriovenous malformations in the cerebellum and right putaminal region in 1 patient each.

Parasellar metastases: Four autopsied cases

Four patients with histologically confirmed parasellar metastases are reported. The main symptoms and signs were persistent right facial pain followed by diplopia (patient 1), headache and minimal right abducens palsy (patient 2), acute, total left ophthalmoplegia (patient 3), and acute, total bilateral ophthalmoplegia (patient 4). Positive radiologic evidence was present only in patient 1: there was bony erosion of the petrous apex and computed tomography scan showed an enhanced parasellar mass. This patient underwent partial surgical removal of the tumor. Patient 3 was treated with irradiation. All patients died within 14 weeks of the onset of the initial symptoms and all were autopsied. Their primary lesions were hepatoma, stomach cancer, lung cancer, and mesenteric liposarcoma.

Meningeal neoplasms associated with cerebral vascular malformations

Two patients with meningeal neoplasms and nearby vascular anomalies are reported. The lesions were excised and histologically confirmed. One patient had a meningotheliomatous meningioma and an arteriovenous malformation involving the right frontal lobe; the other, a hemangiopericytoma and an arteriovenous malformation in the right parietooccipital region.

Cryptic vascular malformation of the choroid plexus

A 45-year-old man and a 47-year-old woman with cryptic vascular malformations of the choroid plexus in the lateral ventricle are reported. Each patient had an intraventricular hematoma, located in the right trigone and in the anterior part of the left lateral ventricle, respectively. The vascular lesion of one patient was angiographically visualized as find abnormal vessels communicating with the right anterior choroidal artery; in the other, angiography did not reveal the lesion. In the former patient, histological examination of the excised specimen led to a diagnosis of arteriovenous malformation; in the latter, a diagnosis of venous malformation was made. Both patients were successfully treated surgically.

Primary ectopic extracalvarial meningioma

Abstract A 62-year-old woman with a primary ectopic meningioma that developed extracranially from the calvarial periosteum is reported. The relevant literature on ectopic meningioma is reviewed.