The C2 ganglion sectioning epidural approach to craniocervical junction chordoma: a technical case report.

In chordoma, complete surgical removal of the epidural tumor should be the first choice of treatment. Numerous surgical approaches to clival chordoma have been described: anterior approaches, lateral approaches, and posterolateral approaches. A multistaged operation with a combination of these approaches is generally performed. We used three approaches to remove a clival chordoma extending from the lower clivus anteriorly to the anterior perivertebral space and inferiorly to the C2 level. The epidural posterolateral approach through the vertebral artery (VA)-C2 interval space after resection of the C2 dorsal ganglion was the most effective. To our knowledge, the epidural posterolateral approach below VA, referred to as C2 ganglion sectioning epidural approach has not been reported as an independent approach in detail. We report a two-year-old girl with a lower clival chordoma which has been excised using C2 ganglion sectioning epidural approach.

[A case of long-term remission of small-cell lung cancer with multiple brain metastases].

The prognosis for patients with brain metastases of small-cell lung cancer is particularly dismal. We present a case of a 47- year-old man diagnosed with multiple brain tumors which, following surgery, were revealed to be metastatic small-cell lung carcinoma through a pathological examination and a subsequent post-operative chest CT. Whole brain irradiation (50 Gy) with ten courses of systemic chemotherapy (carboplatin 200 mg/m2 day 1; etoposide 60 mg/m2 day 1-5) was applied. On the radiological examination, the lesions of the lung and brain gradually disappeared three and five years after the diagnosis, respectively. Sixteen years after diagnosis of the metastatic small cell carcinoma, the patient is disease-free and his ADL is excellent. This is an extremely rare case of small-cell lung cancer with multiple brain metastases in terms of showing a long- term remission.

Partially thrombosed vertebral artery aneurysm with wall enhancement treated by stent-assisted coil embolization.

A 50-year-old man presented with a 2-month history of dysarthria caused by a partially thrombosed vertebral artery (VA) aneurysm. Magnetic resonance imaging showed enhancement of the thickened wall and angiography detected staining. Stent-assisted coil embolization with protection of the parent artery patency was performed. The patient's clinical course was unremarkable and shrinking of the aneurysm was obtained. The stent-assisted coil embolization promoted intra-aneurysm flow disruption and stabilized the wall environment, suggesting another strategy for the treatment of partially thrombosed VA aneurysm.

Coexistence of cranial and spinal subdural hematomas: case report.

A 47-year-old man presented with chronic cranial subdural hematomas (SDHs) associated with spinal SDH manifesting as onset of severe lumbago revealed in the follow up for bilateral subdural effusions after trauma. Left chronic cranial SDH was first identified. Two months after evacuation of the left chronic cranial SDH, he complained of severe lumbago. Magnetic resonance imaging detected spinal SDH, prior to the diagnosis and treatment of right chronic cranial SDH. The present case of concomitant occurrence of cranial and spinal SDHs suggests that the possibility of spinal SDH should be investigated with magnetic resonance imaging in patients with chronic cranial SDH.

[Case of an idiopathic dissecting aneurysm of the superficial temporal artery: a case report].

Aneurysms of the superficial temporal artery are usually traumatic in origin an are pseudoaneurysms. We present a rare case of an idiopathic dissecting aneurysm of the superficial temporal artery in a 40-year-old man without history of trauma. The patient had a pulsatile mass in the left temporal region. Angiography showed a fusiform dilatation at the left superficial temporal artery and both the true lumen and the false lumen were recognized. Resection of the aneurysm was performed. Postoperatively, the patients complaints disappeared completely. Histopathological examination of the specimen revealed a dissecting aneurysm. We investigated the histological findings by comparing them to angiographical findings.

A case of brain metastasis from pulmonary giant cell carcinoma.

A 74-year old female was admitted to our hospital due to sudden right hemiparesis. Precontrast brain computed tomography (CT) revealed multiple high-density masses consistent with multiple hemorrhage, and chest CT scan demonstrated a mass in the left lung field without hemorrhage. Follow-up CT showed enlargement of the multiple intracerebral hemorrhages. A diagnosis was made of brain metastasis from a rare pure giant cell carcinoma (GCC) of the lung.

Photophobia as the visual manifestation of chiasmal compression by unruptured anterior communicating artery aneurysm. Case report.

A 37-year-old woman presented with photophobia without visual loss associated with chiasmal compression by an unruptured anterior communicating artery (AcomA) aneurysm. She had suffered progressive photophobia for one year. Neuroimaging indicated an AcomA aneurysm attached to the chiasm. Photophobia was resolved following clipping of the aneurysm. AcomA aneurysm should be considered in patients who experience photophobia without visual loss.

Simultaneous occurrence of subarachnoid hemorrhage due to ruptured aneurysm and remote brainstem hematoma--case report.

A 48-year-old woman presented with simultaneous aneurysmal subarachnoid hemorrhage (SAH) and remote intracerebral hemorrhage manifesting as sudden onset of severe headache, left hemiparesis, and diplopia. Emergent computed tomography revealed localized SAH in the interpeduncular cistern, and a remote brainstem hematoma in the right dorsolateral tegment. Neuroimaging found no signs of vascular anomaly in the brainstem. The aneurysm at the basilar artery and superior cerebellar artery bifurcation was successfully embolized using coils. Her postoperative neurological status was improved except for slight diplopia. The causes of this extremely rare case of simultaneous occurrence of aneurysmal SAH and remote brainstem hematoma in the dorsolateral tegment remain obscure.

Disproportionately large communicating fourth ventricle with syringomyelia: case report.

A 13-year-old boy presented with syringomyelia associated with disproportionately large communicating fourth ventricle (DLCFV) manifesting as symptoms attributable to hydrocephalus and characteristic posterior fossa symptoms. Magnetic resonance imaging demonstrated remarkable dilation of the fourth ventricle and syringomyelia. Ventriculoperitoneal shunting completely resolved all symptoms as well as the ventricular and spinal cord abnormalities. Pre- and postoperative cine magnetic resonance imaging revealed the change of cerebrospinal fluid flow signal in the area of the foramen magnum. We concluded that the syringomyelia could be described as enlargement of the central canal with DLCFV.

[A case of hydrocephalus in follow-up of post-traumatic subdural effusion].

We report an interesting case of hydrocephalus following traumatic subdural effusion. A 50-year-old male was diagnosed as a traumatic subdural effusion. Three months later, he was transferred to our hospital again because of conscious disturbance and incontinence. Emergent CT showed characteristic hydrocephalus. The lateral ventricle and the third ventricle were remarkably enlarged. After Ventriculo-peritoneal shunt, the symptoms and radiographical findings were resolved. Both the compression of arachnoid villi around the superior saggital sinus and stenosis of the aqueduct by subdural effusion could be associated with the cause of hydrocephalus in this case.

Histologically classified venous angiomas of the brain: a controversy.

The term "venous angioma" (VA) usually refers to a developmental venous anomaly (DVA). However, a group of vascular malformations called VAs shows no venous abnormalities on angiography. The clinical and histological features of histologically classified VAs were studied in eight patients who presented with hemorrhage or seizures to reevaluate these venous anomalies. Angiography showed no venous abnormalities in six patients. Histological study included immunostaining for smooth muscle actin and glial fibrillary acidic protein. Surgical specimens of 10 cases of cavernous angiomas, 10 cases of arteriovenous malformations, and two cases of capillary telangiectasias were studied to compare these types of VAs. Angiographically occult VAs were surgically removed safely, whereas removal of DVAs was complicated by brain swelling and hemorrhagic infarction of the brain. Histological examination found angiographically occult VAs contained malformed and compactly arranged vessels with partly degenerated walls, whereas DVAs had dilated thin-walled vessels that were diffusely distributed in the normal white matter. This study of our cases and a review of the reported cases of VAs suggests that two different clinical and pathological entities are commonly categorized as "VA," angiographically occult VAs and DVAs. These two entities should be carefully distinguished.

Extracellular Bad fused to toxin transport domains induces apoptosis.

Bad, a proapoptotic member of the Bcl-2 family, is inactivated by phosphorylation, and this loss of activity may contribute to the malignancy of certain types of tumors such as glioblastoma and prostate cancer. To determine whether extracellular Bad can be delivered into cells via cell surface receptor binding and induce apoptosis, we genetically fused the mouse Bad gene to the gene for the translocation and receptor-binding domains of diphtheria toxin (DTTR). The purified Bad (wild-type)-DTTR protein showed cytotoxicity to human glioma cells in a dose-dependent manner. Bad phosphorylation sites at codons 112 and 136 were mutated from serine to alanine to prevent Bad inactivation by kinases and to increase the toxicity of Bad. The Bad (S112A S136A)-DTTR protein was at least 5 times more toxic than Bad (wild-type)-DTTR with an IC(50) of 5 x 10(-8) M. The Bad (S112A S136A)-DTTR protein altered the subcellular distribution of Bcl-X(L), indicating that it enters the cell cytoplasm and binds Bcl-X(L). Bad (S112D S136A)-DTTR, mutated to mimic phosphorylation of Bad, showed lower toxicity than either Bad (wild-type)-DTTR or Bad (S112A S136A)-DTTR, additionally indicating that Bad-DTTR must bind Bcl-X(L) to stimulate apoptosis. We conclude that extracellular Bad can be delivered into cells via the transport domain of a bacterial toxin and may be used to induce apoptosis.

Expression of vascular endothelial growth factors and their receptors in and around intracranial arteriovenous malformations.

OBJECTIVE: The precise mechanisms responsible for the development and growth of intracranial arteriovenous malformations (AVMs) remain unclear, but it has been hypothesized that vascular endothelial growth factors (VEGFs) might be involved in their pathogenesis. The aim of this study was to examine immunohistochemically the presence of the VEGF family (VEGF-A to -D) and their receptors (Flt-1, Flk-1, and Flt-4) in the surgically resected AVM nidus. METHODS: The AVM nidus was surgically obtained from 31 patients with AVMs (mean age, 40.5 yr, range 13-73 yr). The mean size of the nidus was 31.6 mm (range, 15-60 mm). Formalin-fixed, paraffin-embedded specimens were stained immunohistochemically by the labeled streptavidin-biotin method with antibodies against VEGF-A to -D, as well as Flt-1, Flk-1, and Flt-4. RESULTS: Positive staining for VEGF-A to -D was observed in the endothelial cells of the abnormal vessels involved in the AVM nidus and in the cytoplasm of astroglia surrounding it. Samples from 30 (96.8%) of 31 patients stained positive for VEGF-A, 4 (9.7%) for VEGF-B, 17 (54.5%) for VEGF-C, and 16 (51.6%) for VEGF-D. Flt-1, Flk-1, and Flt-4 were also positive chiefly, but not exclusively, in the cytoplasm of vascular endothelium and smooth muscle cells of the vascular wall. With regard to VEGF receptors, it was found that among the 31 patients studied, 19 (61.3%) were immunohistochemically positive for Flt-1, 6 (19.4%) for Flk-1, and 19 (61.3%) for Flt-4. A comparison of mean nidus size and average age at operation revealed significant differences between patients positive for VEGF-C, VEGF-D, Flt-1, or Flt-4. In contrast, there were no significant differences in nidus size and age in patients positive for VEGF-A, VEGF-B, and Flk-1. CONCLUSION: These results strongly suggest a possible contribution of the VEGF-VEGF receptor system to the growth of intracranial AVMs.