Yasuhiko Tokuriki

Brainstem glioma: An analysis of 85 cases

SummaryThe study analyses 85 cases of brainstem glioma in the past 35 years, 69 of which include patients under 16 years of age. The incidence of brainstem glioma was 2.4% of all intracranial tumours, and 9.4% of intracranial tumours in children. There were two peaks in age distribution, in the first and in the fourth decades.In children, the tumours were located mainly in the pons, so VIth and VIIth cranial nerve palsies, and pyramidal and cerebellar signs were frequently seen. In adult cases, the tumours ranged in location from the midbrain to the medulla, so neurological symptoms caused by lesions of the whole brainstem axis were seen. The left side was dominant in both age groups.The choice of treatment was steroid administration and radiation. Chemotherapy was not effective. Even after these treatments, the median survival period from onset was no longer than 10.5 months.We conclude that the treatment of brainstem gliomas in children should be distinguished from adult cases, which in the latter may be considered to be merely one of the gliomas which may occur at any other sites. Since brainstem gliomas in children may be congenital, we must redirect our treatment of these lesions to treatment of congenital tumours.

Deep sylvian meningiomas

A case of deep Sylvian meningioma in a 35-year-old woman was precisely diagnosed preoperatively with the aid of computed tomography and stereoscopic cerebral angiography. On reviewing the literature, it appears to be the first case that has been accurately diagnosed preoperatively and successfully treated by a total excision without serious complication. We report this case in detail together with another, similar case which we had encountered previously.

Vertebral Angiography in Diagnosis of Traumatic Hematomas of the Posterior Fossa

Nine cases of traumatic hematoma of the posterior fossa are reported and the diagnostic value of the vertebral angiography is emphasized. 1. The diagnosis of an acute posterior fossa hematoma by physical examination is known to be difficult. It is our practice to perform emergency vertebral angiography, when the patients with occipital bone fracture develop disturbances of consciousness and changes of vital signs. We prefer preoperative vertebral angiography to exploratory trephination without angiography. 2. In five of our nine cases there were combined supra and infratentorial hematomata, all of which were found by preoperative angiographies. On the other hand there were two cases of frontal intracerebral hematoma diagnosed by angiography, whose clinical diagnosis had been posterior fossa hematoma. Retrograde right brachial angiography is an excellent mean to see both supra-and infratentorial lesions simultaneously. 3. One can differentiate a posterior fossa epidural hematoma from a subdural hematoma by angiography since an avascular area. of the subdural hematoma does not extend the cerebellar tentorium. 4. In one case extravasation of contrast medium from the posterior inferior cerebellar artery during angiography clearly demonstrated the bleeding point. In some other cases the deformity of the lateral sinus suggested the site of lateral sinus injury. In another case extravasation of contrast medium from the lateral sinus was suspected. Some surgeons feel that one should perform immediate exploratory trephination without vertebral angiography, when posterior fossa hematoma is suspected. However, we are of opinion that an emergency vertebral angiography can be performed without wasting time, while the emergency operation is being prepared. Vertebral angiography can provide invaluable informations for planning the operation about the site, size and multiplicity of the hematoma. In conclusion, it is important to have the neurosurgical service system in which emergency vertebral angiography can be performed without delay in any circumstances.