Toshifumi Hirata

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.

Analysis of reruptured cerebral aneurysms and the prophylactic effects of barbiturate therapy on the early stage

During the past seven years, we have studied 661 cases of ruptured intracranial aneurysms. Rebleeding occurred in 65 cases (10%) and, within this group, 43 cases (70%) rebled within the first 6 hours after initial subarachnoid haemorrhage (SAH). Analysis of these 43 cases led to the following conclusions: 22 patients incurred rebleeding from causes such as transfer (6 cases), neuroradiological examinations (13 cases), and tracheal intubation during anaesthesia etc. (3 cases), while no special causative factors were discovered in the other 21 cases. Rebleeding occurred in 19 patients even while on absolute bed rest and in 11 patients who had induced systemic arterial hypotension (under 140 mmHg) through treatment. Six cases experienced rebleeding while undergoing angiography within 6 hours after the first subarachnoid haemorrhage. Eight of 17 reruptured anterior cerebral complex (Acom) aneurysm cases and 8 of 11 reruptured middle cerebral artery (MCA) aneurysm cases had an intracerebral haematoma on initial CT-scan following the first attack, demonstrating that the risk of rebleeding was very high in cases of intracerebral haematoma. The mortality rate for these rebleeding cases was high i.e. 65%. Therefore, because the time factor could precipitate rebleeding, early transfer and operation was considered optimal for minimizing rebleeding soon after an aneurysm rupture, even though angiography within 6 hours of the first SAH was a serious risk. Barbiturate therapy, performed as early as possible for serious cases, was considered to be effective in preventing rebleeding.

Malignant cerebellar astrocytic tumours in children

SummaryThe authors reviewed 5 cases of histopathologically verified malignant cerebellar astrocytic tumours (2 anaplastic astrocytomas and 3 glioblastomas) in children admitted to our department. All cases exhibited symptoms and signs of increased intracranial pressure and of a cerebellar lesion. Brain stem symptoms were present in 4 cases. All of the tumours were located in or near the midline of the cerebellum with no large cyst. Surgical removal (70 to 90% removal) of the tumour was performed in 4 cases. In one case only a biopsy was done. Even with subsequent follow-up treatment including radiotherapy, chemotherapy, and/or immunotherapy, the course of the disease could not be reversed, and all of the children died 3 to 13 months (mean 7 months) after admission due to tumour re-growth or recurrence. Tumour dissemination along the walls of the ventricular system was seen in 2 cases, and was considered to be a peculiar, fatal form of tumour recurrence in patients with this type of tumour. Malignant cerebellar astrocytic tumours in children have an extremely poor prognosis. Until, improved therapy is available to counteract this tragic consequence, it will remain so.

Hypertensive putaminal hemorrhage. A comparative evaluation of surgical and non-surgical treatment.

高血圧性被殻出血 (222例) を手術群 (146例), 非手術群 (76例) に分け生命予後および機能予後について比較検討した.1) 神経学的分類によるgrade I は原則として保存療法でよく, grade Vは両群とも予後不良で手術適応外である. grade IVは生命予後の面から手術群が良好であった.2) 毛様体脊髄反射消失などの眼症状を認めても, 手術により十分救命しうる可能性がある.3) CT上血腫径4cm, 第III脳室偏位6mm, 上下への進展4cm以上のものは予後不良であった.又, 脳室穿破はあきらかに生命予後を不良にする.4) 非優位側血腫例は優位側に比し機能予後は良好であるが, 生命予後には差を認めなかった.5) 手術時期については必ずしも早期程良好とはいえない.しかしながら, 待機中の増悪例を救命するには超早期手術が必要である.6) 機能予後については, 筋力高度障害例では両群とも回復困難例が多いが, やや手術群で良好である.しかし中等度~軽度障害例では両群間に差がみられなかった.