Takashi Andoh

Clinical analysis of a series of vertebral aneurysm cases.

We reviewed 38 cases of aneurysms of the vertebral artery treated over the last 10 years: 26 (68%) located at the junction of the vertebral and posterior inferior cerebellar arteries, 10 (26%) at the vertebral artery, and 2 (5%) at the vertebrobasilar union. There were three distinct forms of aneurysms: 20 saccular (53%), 10 fusiform (26%), and 8 dissecting (21%). Among these 38 aneurysms, 33 (87%) had ruptured: 18 of the saccular aneurysms (90%), all 10 of the fusiform aneurysms (100%), and 5 of the dissecting aneurysms (63%). Computed tomography of the 28 ruptured aneurysms revealed diffuse subarachnoid hemorrhage in the basal cistern combined with intraventricular hemorrhage in 24 cases (86%). Magnetic resonance imaging was useful for differentiating between fusiform and dissecting aneurysms. Abnormalities such as a double lumen of the vertebral artery were demonstrated in four of the dissecting aneurysms. The overall surgical results were good for 22 of the 27 surgically treated cases (81%). New bleeding was observed in 8 (24%) of the 33 ruptured aneurysms. The rate of new bleeding was high (60%) in the patients with dissecting aneurysms, and occurred mostly in the acute stage. The incidence of vasospasm was 27%, and only two patients suffered permanent neurological deficits. These findings indicate that the rate of new bleeding tends to be high in patients with saccular and dissecting aneurysms, and thus, they should be treated as early as possible. A preoperative balloon occlusion test should be conducted if proximal occlusion of the vertebral artery is necessary, since proximal occlusion is not always safe, despite angiographic evidence of sufficient contralateral arterial flow.

Dissecting and fusiform aneurysms of vertebro-basilar systems

SummaryThe magnetic resonance (MR) findings of three cases with vertebro-basilar dissecting aneurysms (DA) were compared with those of two cases with vertebro-basilar fusiform aneurysms (FA). No abnormal findings, excepting a dilatation of a signal-void area corresponding to the arterial blood flow, were shown on the MR images in the patients with a FA. In contrast to the FA cases, various abnormalities were detected by the MR studies in all three DA cases. An intimal flap and a double lumen were demonstrated in one case. An intra-mural hematoma was shown in one case. A hematoma neighboring the parent artery was demonstrated in two cases. MR imaging was thought to be useful for detecting intracranial vascular lesions, such as a DA, and for discriminating between a DA and a FA.

Surgical treatment of cavernous angioma involving the brainstem and review of the literature

SummaryFive cases of symptomatic cavernous angioma involving the brainstem are reported. Magnetic resonance (MR) imaging is of greatest value in the diagnosis and for surgical indication. All cases were treated by radical extirpation. All of them improved postoperatively. The surgical indications for this lesion of the brainstem are briefly discussed with a review of the literature, including 28 previous cases, operated on directly.

Primary Intracranial Germ-Cell Tumors: A Retrospective Analysis with Special Reference to Long-Term Results of Treatment and the Behavior of Rare Types of Tumors

Thirty cases of primary intracranial germ-cell tumors were reviewed with reference to the effect of treatment. Histologically, there were 23 pure germinomas, while the remaining tumors had more unusual histology; 3 of these were teratomas, and 4 germ-cell tumors with the admixture of yolk sac tumor (YST) or embryonal carcinoma (EMC). Three of these rare cases are presented. The performed surgery and radiotherapy, seemed adequate for pure germinomas, and all these cases lived tumor-free after an observation time of 13 to 139 months although 4 patients developed intellectual retardation or cerebral dullness after radiotherapy. Four cases with YST and EMC elements, indicated by the elevation of AFP and HCG values in serum, were resistant to radio- and chemotherapy and developed, despite surgically total removal of the tumor, intra- or extracranial metastases. A review of the literature is included.

The relationship between Moyamoya disease and bacterial infection

To examine the relationship between Moyamoya disease and bacterial infections, authors studied the serum of 85 cases of Moyamoya disease and the influence of Propionibacterium acnes (P. acnes) infection on intracranial arteries in rats. The serum levels of P. acnes antibody, IgM, transferrin (Tf), alpha 2-macroglobulin (alpha 2M) were significantly higher in Moyamoya disease than in normal volunteers. Moyamoya-like changes of the intracranial internal carotid arteries were histopathologically demonstrated in P. acnes infectious rats. These findings suggest that P. acnes and immunological factors might play a role in the pathogenesis of Moyamoya disease.

Studies on cytomegalovirus and Epstein-Barr virus infection in Moyamoya disease

In this study, measurement of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) viral antibody titers and analysis of both viral genomic sequences using polymerase chain reaction (PCR) were performed to clarify the correlation of viral infection and Moyamoya disease. Serum samples were obtained from 64 patients with Moyamoya disease. The ages ranged from 5 to 66 years, with a mean age of 35.1 years. There were 23 males and 41 females. The serum antibody titers to CMV and EBV were measured by means of compliment fixation test and fluorescent antibody method respectively. Those titers of the patients were compared with those of 13 patients of atherosclerotic internal carotid occlusion and 34 normal volunteers. On the other hand, CMV and EBV genomic sequence using PCR, which was utilized with specific primer pairs, were performed in 22 patients of Moyamoya disease and ten normal volunteers. The following results were obtained; The antibody titer of EBV in Moyamoya disease was significantly higher than that in controls. However, no significant difference of antibody titer against CMV was detected. In EBV DNA analysis by use of PCR, EBV DNA was proved in 15 out of 20 patients with Moyamoya disease and four out of nine normal controls. Namely, EBV DNA was seen more frequently in patients with Moyamoya disease, compared with normal controls. In inverse, CMV DNA was not seen in patients with Moyamoya disease nor normal controls. In conclusion, the antibody titer of EBV revealed high levels in Moyamoya disease and EBV DNA was also detected more frequently in patients with Moyamoya disease. These results suggested a possibility that EBV infection might be involved in the pathogenesis of Moyamoya disease.

Intracranial cavernous angioma in the 1st year of life and a review of the literature

Three cases of symptomatic cavernous angioma occurring in the 1st year of life are presented. All three patients were treated with radical extirpation. Postoperatively, two of them improved, but the third died due to cerebral herniation secondary to recurrence of bleeding of the lesion. The clinical characteristics of cavernous angioma in the 1st year of life are briefly discussed and a review of the literature presented, including 16 previous cases operated on directly.

Long-term survival in malignant intracranial germ-cell tumors: a report of two cases and a review of the literature

The authors report the successful treatment of two cases of malignant germ-cell tumor. A 12-year-old patient with a pineal immature teratoma and increase of α-fetoprotein serum levels was treated with total excision and cisplatin, vinblastine, and bleomycin (PVB) in combination given twice. One year later, he had a recurrence of tumor in the right occipital lobe, which was totally removed, and yolk sac tumor was verified. As subsequent adjuvant chemotherapy, PVB was given in four courses over 1.5 years, together with one course of cisplatinetoposide (PE) therapy. The patient is well 5 years and 9 months after the first operation. In the second case, a 19-year-old patient with a pineal mixed germ-cell tumor, composed of germinoma, yolk sac tumor, and embryonal carcinoma, was treated with total excision, followed by four courses of PVB therapy and one of PE. She has done well in the 4.5 years since the initial treatment. Thus, aggressive extirpation of the lesion and subsequent combination chemotherapy using cisplatin and other multiple drugs, given in at least four courses over 1.5 years, even if tumor markers return to within normal limits, might provide successful treatment for malignant germ-cell tumors.

Membrane phospholipid composition and membrane fluidity of human brain tumour: a spin label study

Membrane fluidity in membrane phospholipids of brain tumours was investigated and compared with those of white and grey matter. Fifteen brain tumours including 5 gliomas, 5 meningiomas and 5 metastatic cancers were examined. These samples were frozen immediately after extirpation in liquid nitrogen. After extraction of total lipids from the tumour tissues, membrane phospholipids were separated and analysed by thin-layer and gas-liquid chromatography. The fluidity of the phospholipid membrane was studied by electron spin resonance (ESR) spectroscopy, using a stearate spin probe. The fatty acid composition of total phospholipid of brain tumours was characterized by an increase in linoleic and arachidonic acids when compared to the control brain. The percentage of palmitoleic acid was higher in gliomas and metastatic tumours than in meningiomas. Furthermore, in the brain tumour tissues, the decreases of phosphatidylethanolamine and phosphatidylserine and the increase of phosphatidylcholine were observed when compared with grey or white matter with the exception of meningioma. There was some difference in phospholipid membrane fluidity between brain tumour and control brain tissue. The order parameter calculated from ESR spectra became higher in the following order: metastatic brain tumour, less than meningioma, less than grey matter, less than glioma, less than white matter. These results suggest that the phospholipid metabolism in the brain tumour is different from that of the normal brain, and this difference may affect the alteration of membrane physical properties which exhibit in part the character of the transformation.

Central neurocytoma presenting with gigantism: Case report

We report a case of central neurocytoma presenting with gigantism. The patient was a 19-year-old man with a 2-year history of rapid growth. Computed tomography revealed a round, slightly enhancing calcified tumor in the septal region. This lesion was resected, and postoperative radiotherapy was given. The preoperative serum growth hormone level was 20.7 ng/mL, and postoperatively this fell to 0.9 ng/mL. Pituitary dysfunction was not noted either before or after the operation. A low level of production of growth hormone releasing factor was detected when tumor cells obtained during surgery were cultured.