Intraoperative radiation therapy as an adjunctive therapy for huge and highly vascular parasagittal meningiomas

This case presents a 34-year-old man who had a huge parasagittal meningioma. Initial treatment consisted of preoperative external carotid artery embolization and partial tumor resection. During the resection, we found that the tumor invaded the adjacent calvarium, and due to massive hemorrhage, total removal of the tumor was impossible. The patient was treated with intraoperative radiation therapy (IORT) (25 Gy via 16 MeV) as an adjunctive therapy. Eight months after IORT, we were able to remove the tumor completely without surgical difficulties. IORT can be considered an useful adjunctive therapy for the superficially located, huge, and highly vascular meningioma.

Effect of stimulation of cerebellar fastigial Nucleus on focal Cerebral Infaretion in Rat

Electrical stimulation of the cerebellar fastigial nucleus(FN) increases cerebral blood flow(CBF) and reduces brain damage after focal cerebral ischemia. The authors studied whether the neuroprotection elicited from electrical stimulation of the cerebellar FN is attibutable to the elevation in regional CBF(rCBF) or reduction in release of excitatory amino acid sprague-Dawley rats were anesthtized with a mixture of halothane(3% for the indurction and 1% for maintenance) and oxygen and artificially ventilated through a tracheal cannula. Arterial pressure, blood gases and body temperature were monitored. The middle cerebral artery(MCA) was occluded distal to the lenticulostriate branches. The FN was then for 2 hours, over the regions corresponding to the ischemic core and penumbra. Postiischemic release of glutamate and aspartate were measured by microdialysis for 2 hours at the same site of measurement of rCBF. Infarct volume was determined 8 hours later in 2,3,5-triphenyl tetrazolium chloride(TTC)-stained sections FN stimulation(n=12) increased mean arterial pressure by 28+/-16mmHg. In nonstimulated control rats(n=12), mean AP was not changed significantly during the experimental procedures. Compared with nonstimulated animal, stimulation of FN for 1 hour following MCA occlusion siginficantly increased rCBF in ischemic core and penumbra by 53.6% and 67.6% respectively. And the volume of infarction decreased by 42% at 8 hours after MCA occlusion. The concentration of glutamate and aspartate in ischemic core after MCA occlusion increased both in the control group(to 12.2+/-3.3 folds and 10.4+/-4.1 folds respectively) and in the stimulation group(10.5+/-2.8 and 11.2+/-4.1 folds, respectively). The concentration of glutamate and aspartate in penumbra did change significantly neither in the control group(to 2.5+/-1.3 folds and 1.8+/-0.6 folds respectively) nor in the stimulation group(1.9+/-0.5 folds and 2.1+/-0.4 folds, respectively). There was no significant difference between the two groups.

Correlation between Periinfaret Cortical Spreading depression and Ischemic Volume in Rats

Cortical spreading Depression(CSD) is a transient depression of neuronal activity that spreads across the cortical surface and is associated with profound changes in blood flow, extracellular ion concentration. Direct Current(DC) potentials and cell membrane potentials. One of the electrophysiological disturbance in the periinfarct surrounding is spontaneous occurrence of repeated CSD like DC shifts associated with increased energy demand. Due to restricted blood flow to the periinfarct border zone, elevated metabolic demand is potentially hazardous. So the authors designed this experiment to verify the correlation between periinfarct cortical spreading depression and ischemic volume following permanent middle cerebral artery(MCA) occlusion in rats. Sprague-Dawley rats(n=27) were anesthetized with 0.5~1% halothane, and artificially ventilated through a tracheal cannula. Arterial pressure, blood gases and body temperature were controlled. The middle cerebral artery(MCA) was occluded distally to the lenticulostriate branches. Measurements of CSD activity were made for 4 hours in each animal infarct volume was determined 6 hours later in 2,3,5-triphenyl tetrazolium chloride(TTC)- stained section. For 4 hours after MCA occlusion, the CSDs were found in all experimental animals with a range of 2~9 times. Those CSDs were of varying duration: "small"(1min) SDs and mean of total duration of SD was 10.5+/-10.3 min during 4 hours of MCA occlusion. Neuropathological evaluation of brain infarct in the rats, which had been allowed to survive for 6 hours after MCA occlusion showed a mean volume of 89.7+/-45.3 mm3. Serial observation of duration of CSD prologation of duration of CSD nor the frequency of CSD in the penumbral zone correlated with the volume of infarct.However total duration of CSD was slightly related with the infarct volume after 6 hours of the permanent MCA occlusion(r=0.414, p=0.0318) .

Chronic Spinal Subdural Hematoma in Infants: Case Report

Spinal subdural hematoma is an uncommon entity having a higher incidence in patients with bleeding diathesis or receiving anticoagulant therapy. Lumbar puncture should be done meticulously especially in patients with a bleeding tendency. Spinal subdural hematoma should be considered as a possible diagnosis in patients with coagulopathy, having sustained a minor trauma, or having had a recent lumbar puncture, showing progressive neurological deficits suggestive of a spinal disorder. In such patients, early diagnosis and proper treatment is imperative in order to minimize any neurological sequelae. We report a case of a 7-month-old infant in a septic condition diagnosed with chronic spinal subdural hematoma that had occurred following repeated lumbar punctures.

Relationship between tissue plasminogen activator, plasminogen activator inhibitor and CT image in chronic subdural hematoma

The present study was performed to investigate the relationship between the concentrations of tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI) and the CT images in 23 cases of chronic subdural hematomas (SDHs). The concentrations of t-PA and PAI-1 were quantified by enzyme-linked immunosorbent assay (ELISA). Chronic SDHs were divided into five groups according to their appearance on computed tomography: high-density (n = 4), isodensity (n = 8), low-density (n = 5), mixed-density (n = 3), layering (n = 3) types. The volume of hematoma was measured with an image analyzing software program. The concentrations of t-PA were higher in layering (41.2 +/- 0.3 ng/ml, mean +/- standard error of the mean) and high-density (40.0 +/- 1.1 ng/ml) types compared to those of low-density (23.3 +/- 4.1 ng/ml) and iso-density (25.1 +/- 3.7 ng/ml) types. The concentrations of PAI-1 were lower in layering (95.9 +/- 1.0 ng/ml) and high-density (103.4 +/- 34.5 ng/ml) types compared to that of low-density (192.5 +/- 2.6 ng/ml) type. So the ratio between t-PA and PAI-1 (t-PA/PAI) was greater in layering and high-density types. The volume of hematoma was larger in mixed-density and layering types but statistically insignificant. These results presumably suggest that the ratio between t-PA and PAI concentration may contribute to the pathogenesis of the chronic SDH.

A Case of Bilateral Simultaneous Hypertensive Intracerebral Hemorrhage in Basal Ganglia

Spontaneous intracerebral hemorrhage is one of the most devastating forms of cerebrovascular disease in the field of neurosurgery, and is most frequently associated with the hypertension in the distribution of the penetrating vessels, or can be secondary to other factors, like aneurysm, arteriovenous malformation, glial tumor, metastasis, infarction, anticoagulation therapy, coagulation disorders such as leukemia or thrombocytopenia. Although many cases of recurrent hypertensive intracerebral hemorrhage have been reported, bilateral simultaneous hemorrhage has not been reported. The authors report a case of bilateral simultaneous hypertensive intracerebral hemorrhage in a 62-year-old male, which was treated by conservative management.

Expression of Nucleoside Diphosphate Kinase(Nm 23) in Pituitary Adenoma

No abstract available.

Preliminary experiences with intraoperative radiation therapy (IORT) for the treatment of brain tumors

Ten brain tumor patients underwent wide resection of the tumor followed by Intraoperative Radiation Therapy (IORT) at the first surgery or at the second salvage surgery after failure of conventional external beam irradiation. Two patients(1 meningioma, 1 glioblastoma multiforme) were treated at the first surgery and 8 patients(3 anaplastic astrocytoma, 3 glioblastoma multiforme, 1 meningioma, 1 gliosarcoma) were treated after salvage surgery. The IORT doses were ranged from 15-25 Gy depending on the tumor volume and previous radiation therapy. The neurological status(Karnofsky performance status) was improved in 4 cases, not changed in 6 cases after IORT. There were several complications after IORT; radiation necrosis, communicating hydrocephalus, wound infection, and abnormal CT findings such as diffuse low density area in an around operation site. The radiation necrosis was confirmed by operation in a recurrent meningioma patient 12 months after IORT. At follow-up, ranging from 1 to 16 months, there was no deaths. Based on our limited experiences, the IORT might be one of the adjuvant therapeutic modalities especially for the malignant brain tumors and unresectable huge meningioma.

Experimental Studies of Hydroxyl Radical Generation in Reperfusion Injury after Cerebral Ischemia

The time course of hydroxyl radical generation in the brain and the intensity of brain hydroxyl radical(OH) generation were examined in rat during the first four hours after postischemia reperfusion. Hydroxyl radical production was measured using the salicylate trapping method in which the production of 2, 3-dihydroxybenzoic acid(DHBA) in hippocampus(CA1) 5 minutes after salicylate administration was used as an index of OH formation. The interstitial concentration changes of salicylate and 2, 3-DHBA were detected by intracerebral microdialysis following the intraperitoneal administration of salicylate(150mg/kg) using high pressure liquid chromatography-electrochemical(HPLC-EC) and -ultraviolet(-UV). Adult Sprague-Dawley rats were subjected to 20 minutes of bilateral carotid artery occlusion(BCAO) in either normotensive or hypotensive state. Serial changes of cerebral blood flow(CBF) were monitored by H2 clearance method. CBF of normotensive BCAO group(n=6) was found to be decreased only to 52% of baseline value, and OH production after reperfusion did not develop in this group. Rats in the BCAO hypotensive group(n=10) showed remarkable reduction of CBF to 27% of baseline(p<0.05) and 2~4 folds increase of 2, 3-DHBA/salicylate during the first 40 minutes of recirculation . Hydroxyl radical production in rats died(n=5) after the insult was significantly higher and lasted longer than that in rats survived(n=5)(p<0.05). Concentration of salicylate in perfusate increased during 100 minutes after the peritoneal injection and before reaching to a plateau, which lasted for 3 hours. The changes of cerebral tissue concentration of 2, 3-DHBA differed from those of salicylate. In 2, 3-DHBA, the plateau was reached rather slowly than that of salicylate and lasted for 2 hours. These data indicate that lobal cerebral ischemia could be induced by temporary BCAO only if the systemic hypotenion is accompanied, it can not be induced in normotensive group. The hydroxyl radical produced brain damage is prone to develop early in the reperfusion period and is correlated with the severity of ischemic insult.

Metastatic Thoracic Intramedullary Small Cell Carcinoma: Case Report

The incidence of metastasis to the spinal cord in patients with systemic carcinoma has been extimated to be 0.9 to 8.5%. Attempts to aggressively remove intramedullary spinal cord tumor may cause increased neurologic deficits and a worsend outcome. The authors present the case of a multiple intramedullary meetastatic spinal cord tumor which had metastasized from the lung to the thoracic spinal level. Pathologic diagnosis of the small cell carcinoma was made from the tumor specimen obtained by stereotaxic-guided neddle biopsy after which the patient was treated with radiotherapy and chemotherapy.

Lhermitte-Duclos Disease(Dyslastic Gangliocytoma of the Cerebellum): A Case Report with Review of the Literature

No abstract available.

A Case of Large Sacral Chordoma

Chordoma is a relatively rare primary osseous tumor arising from the remnants of the primitive notochord and located along the axial skeleton. It is characterized by is slow growth, hight frequency to invade and destroy bone by direct extension, local recurrence after surgical excision and distant metastasis. It accounts for 1 to 4% of all malignant bone tumors. Approximately 50% of chordomas arise in the sacrococcygeal region, 35% at the clivus, and 15% in the vertebral column above the sacrum. The tumor tends to predominate in males, with roughly a 2 : 1 male-female ratio, and occurs predominantly in the fifth through seventh decades of life. Pain is the most common symptom in the chordomas of the spine, and symptoms of constipation, urinary frequency, or nerve root compression may appear before patients present to their physician. Many patients, therefore, are misdiagnosed as having degenerative disc disease, coccygodynia, or hemorrhoids. A firm, fixed presacral mass can usually be palpated on rectal examination. Surgical extirpation of the tumor is the only curative procedure and the indicated surgical procedure for sacrococcygeal chordoma is a high sacral amputation, maintaining a cuff of normal tissue over the tumor. Radiation therapy seems to be effective with adjuvant or palliative aims. We report a case of large sacral chordoma detected in a 60-year-old female in the course of a clinical examination, which was successfully treated by high sacral resection by a posterior approach and repair of the sacral bone defect with bone cement.

The Difference of Membrane Permeability of Chronic Subdural Hematoma Related to Attenuation on computerized Tomography

No abstract available.

Cathepsin D in Glial Tumors: Comparative Study with PCNA and Cell Cycle Analysis

No abstract available.

The Effect of Halothane-induced Acidosis on Focal Cerebral Ischemia in Rat

The current study was performed to investigate the influence of acidosis on focal cerebral ischemia in view of morphometric assay and neuropathological examination. The acidosis was induced by increment of halothane concentration and by decreasing respiratory rate. The mean pH were 7.423+/-0.012 in control group and 7.184+/-0.038 in acidosis group. Twenty-four hours after MCA occlusion(MCAO), neutral red staining and perfusion fixation was performed. The ischemic area was measured and morphometric analysis was undertaken. In acidosis group, the infarct area was 25.23+/-4.78% of the total cerebral area;in control group, the infarct area was 27.69+/-4.05%. The histopathological findings were examined under light microscopy, in which the field scanning was carried out from the midline by 0.5mm interval at cortical and basal ganglia levels. These results indicated that although there was no satistically significant difference in infarct area between acidosis and control group, increased acidosis aggravated the extent of histopathologic ischemic neuronal damage.

A Case of Live Sparganum in Spinal Epidural Space

Clinical experience with a rare case of sparganosis invading the spinal epidural space was reported with review of the literatures. A 58-year-old man who had food hakit of eating raw snakes was hospitalized with chief complaint of low back and left leg pain.

Reperfusion Models of Rat Middle Cerebral Artery Occlusion:Extracranial and Transcranial Methods

The author described a comparative study of 2 different experiemental methods of reperfusion models in rat;1) transcranial method(TC) and 2) extracranial method(EC). The transcranial method was performed by a direct approach to the middle cerebral artery(MCA) after temporozygomatic craniotomy in which a wire was hooked on the proximal portion of middle cerebral artery(MCA) and pulled it to make occlusion of MCA. For the extracranial method, a nylon surgical thread was inserted intraluminally along the internal carotid artery(ICA) to reach the anterior communicating artery. Recirculation of blood was accomplished by removal of the hook or of the thread after 4 hours occlusion of MCA. Two different models were subdivided into 4 chronological groups:pre-reperfusion, 30 minutes, 2 hours, and 48 hours after reperfusion. The differences were evaluated with morphometric analysis after neutral red(NR) or tetrazolium salt(TTC) staining. From the evaluation of initial ischemic area, the extracranial method showed a larger infarct volume as compared to the transcranial method(p=0.013). Mean value(SD) of infracted area of EC and TC were 28.7%(4.4%) and 14.4%(8.1%) respectively. Recovery from the initial ischemia after reperfusion was gradually achieved in both of two groups(p<0.05). The restoration of blood flow after reperfusion was more rapid in EC group and only 2 hours' reperfusion was enough to show no difference between two methods. In TC group followed by 48 hours' reperfusion, 40% of animals resulted in gross infarction of MCA territory as noted with TTC stain, most probably due to reperfusion failure. EC group showed only one such a case(12.5%). But this difference was not in the range of significance statistically. From a technical point of view, EC was more simple, needed less time since a craniotomy was not performed, and required no manipulation of the brain or any intracranial vessels. From these results the author concluded that the extracranial method is a more reliable and technically more manageable one to be used as a reperfusion model for investigating the focal cerebral ischemia.

Review of Constant Infusion Method of Cerebrospinal Fluid Outflow Resistance Study

The author has performed the experimental study to define the validity of the constant infusion technique used in determining the outflow resistance(Ro) of cerebrospinal fluid(CSF). The reduced formula of the constant infusion technique in clinical setting assume that the initial resing Ro and the post-infusion equilibrium Ro are equal, which means that the Ro value is constant regardless of CSF pressure or infusion rate. Although this assumption allows such measurement to be simply and readily applicable in clinical situation, these two Ro values are practically different. So the effect such assumption on calculated Ro data has been investigated. Using 2 different methods Ro was measured simultaneously on each of 20 adult cats;one method was clinically using reduced formula(RoFc) and the other derived from the data of CSF formation rate which was calculated by modified Masserman's method(RoFm). Constant infusion was performed with varying state of infusion(0.01 to 0.2 m/min). Mean values of resting CSF pressure and superior sagittal sinus pressure were 8.8+/-2.9 mmHg and 5.7+/-1.2 mmHg respectively. Mean calculated rate of CSF formation of integrative modifiying Massereman method was 0.0183+/-0.003 ml/min. The maximum Ro was achieved between the rate of infusion of 0.02 and 0.03 ml/min achieved between the range of CSF pressure of 14 and 18 mmHg. Either in level of low CSF pressure or in rate of low infusion, RoFc showed remarkable higher values than RoFm. But this difference did not distinguished in the higher range of CSF pressure or infusion rate. The minmum and maxmum value of RoFc differed the more and RoFm, the less. These findings suggest that in order to obtain more accurate Ro data with constant infusion technique, it must be corrected in low range of CSF pressure or the rate of infusion should be increased several times as that of CSF formation at the risk of possibility of induction of a pressure wave.

The Effect of Allopurinol and Deferoxamine on Postischemic Lipid Peroxidation

It has been hypothesized that ischemia, followed by reperfusion, facilitates peroxidative free radical chain process in brain. This study was undertaken to investigate the effect of allopurinol and deferoxamine on cerebral lipid peroxidation, estimated by a thiobarbituric acid test, following transient bilateral forebrain ischemia in the rat model of four vessel occlusion. Sprague-Dawley rats fed ad libitum were subjected to transient but severe forebrain ischemia by permanently occluding the vertebral arteries and 48 hours later temporarily occluding the common carotid arteries for 20 minutes. Carotid artery blood flow was restored and rats were decapitated after 48 hours. We assessed the lipid peroxidation capacity of cerebral homogenates obtained from hippocampus, basal ganglia, cortex and thalamus. The homogenates were subjected to 30 minutes of aerobic incubation. The production of lipid peroxides were decreased in all sampled area in the treated groups compared with the control group. Allopurinol and deferoxamine-treated groups showed decreased lipid peroxide levels in all the sampled area, but especially more in the hippocampus(p=0.02), (p0.05). The results suggest that allopurionl and deferoxamine play a role in protecting ischemic cellular damages by scavenging free radicals and subsequently lipid peroxides formed by oxygen supply through blood reperfusion.

The Influence of Hyperglycemia on the Extent of Focal Cerebral Ischemia

The present study was undertaken to investigate the influence of hyperglycemia on focal cerebral ischemia in view of morphometric assay and neuropathological examination. Forty Sprague-Dawley rats were divided into two groups of 20 each. Rat MCA occlusion model was used for induction of focal ischemia. Hyperglycemia(20 rats, mean(SEM plasma glucose concentration 378(97.6 mg/dl) was established 30 minutes before MCA occlusion by intraperitoneal injection of 50% dextrose in water;the control group(20 rats, mean(SEM plasma glucose concentration 121(24.9 mg/dl) received normal saline only. Twenty-four hours after MCA occlusion neutral red staining and perfusion fixation was performed and ischemic area were measured using computerized image analysis on cortical surface and coronal cut surface. There was no significant difference on coronal cut surface, but on cortical surface showed increase of non-stained area(infarct core) and decrease of lightly stained area(transitional zone) in hyperglycemic rats(p<0.05) and the sum of two area was not different between two groups. Pathological findings were evaluated under light microscopy, in which the field scanning was carried out from the midline by 0.5 mm interval at cortical and basal ganglia level. There showed no significant difference at basal ganglia level, but at cortical level ischemic transitional zone was decreased in hyperglycemic rats(p<0.05). We conclude that hyperglycemia may worsen the brain from severe, focal ischemic neuronal damage.