Clinical Analysis of Traumatic carotid Cavernous Fistula

We analyzed 20 cases of traumatic carotid cavernous fistula(CCF) during the recent 10 years The results are summarized as follows: 1) In 18 cases(90%), the clinical symptoms & signs of CCF occurred within 2 months after trauma. 2) The sites of fistulae were common in horizontal segment(40%) and at the junction(30%) between horizontal segment and posterior ascending segment of cavernous portion of internal carotid artery. 3) The main draining veins of CCF were the superior ophthalmic vein(90%) and the inferior petrosal sinus(70%). 4) The methods of treatment were occlusion of fistula with balloon(9 cases), occlusion of cavernous ICA with balloon(2 cases), ligation of cervical ICA with Poppen's clamp(4 cases) and trapping(2 cases). Two patients were not treated and another patient was healed spontaneously. 5) The frequency and severity of complication was significantly decreased in cases treated by detachable balloon occlusion than by direct cervical ICA ligation or trapping procedures. 6) The procedure using the self-sealed goldvalve balloon was simple, but had a risk of premature separation and premature deflation.

Histopathologic Study of the Intracranial Meningioma on the basis of Immunohistochemical Staining and Polymerase Chain Reaction

Meningioma is the most common primary intracranial neoplasm that originates from the meningothelial cells. It occurs mainly in adults, and has a female preponderance. It is classically classified into three main types: meningotheliomatous or syncytial type, fibrous or fibroblastic type, and transitional type. Transforming growth factor alpha(TGF-alpha) was known as a neoplastic transformer found in the neoplastic tissue of the brain rather than in normal tissue in the neoplastic tissue, the expression of the TGF-alpha was more intense in the malignant rather than benign tumor, but the expression of the TGF-alpha on the meningioma was not reported. Transforming growth factor-beta (TGF-beta) was known as a peptide which is involved in the proliferation of the mesenchymal cells and the other many physiologic processes. Tumor necrosis factor(TNF) has a selective necrotic action of the neoplastic cells without influence on normal tissues. Epidermal growth factor (EGF) and epidermal growth factor receptor(EGR) have a control effect on cellular proliferation and differentiation and the expression of the EGR in breast cancer has a reverse correlation to the expression of the estrogen receptor(ER). The meningioma is the most common host tumor of breast cancer among the intracranial neoplasm, so, presence of some estrogen receptors in the meningioma is suspected. The correlation of the estrogen receptor expression to EGR expression in the meningioma is the concern of this study. Therefore, the authors have observed the meningioma on the basis of the expression of the ER, TGF-alpha, TGF-beta, TNF-beta, EGF and EGR according to the immunohistochemical stain and polymerase chain reaction(PCR), and the results obtained were as follows. The expressions of the TGF-alpha, TGF-beta were weakly positive in 4 out of 25 examined cases, and the expressions of the EGF and EGR, were more intensely positive in 2 out of 25 examined cases, especially in the vascular wall and perivascular area. TNF-beta expression was weakly positive to focal area only in one case of the meningotheliomatous type. The ER expression was weakly positive to focal areas. The subtypes of meningioma expressing positivity were meningotheliomatous and transitional type, which wer not related to tumor aggressiveness or poor prognosis. In conclusion, ER,EGF-alpha, TGF-beta, TNF-beta, EGF and EGR were experssed in the meningionma, and it is suspected that these factors may be involved in the tumorigenesis or "host" tumor action rather than in tumor aggressiveness.