Trigeminal Neuralgia Attributable to Intraneural Trigeminocerebellar Artery: Case Report and Review of the Literature.

BACKGROUND: The trigeminocerebellar artery (TCA) is a branch of the basilar artery supplying both the trigeminal nerve root and the cerebellar hemisphere. Despite its proximity to the trigeminal nerve, only a few cases of trigeminal neuralgia (TN) caused by TCA compression of the trigeminal nerve have been reported. Moreover, TN caused by blood vessel penetration of the trigeminal nerve is very rare. CASE DESCRIPTION: We present a case of an 82-year-old female patient with typical episodes of TN. The radiologic studies showed that the offending artery was a unique branch of the basilar artery originating at a higher level than that of the usual anterior inferior cerebellar artery. During microvascular decompression surgery we were able to identify the offending vessel supplying the trigeminal nerve root and traveling between the sensory and motor root of the trigeminal nerve as an intraneural TCA. To shift the TCA away from the root entry zone, we dissected the epineurium of trigeminal nerve parallel to its axis and anchored the proximal portion of the TCA to the petrous dura. The patient's pain was completely gone immediately after the operation, with no neurologic deficits reported. CONCLUSIONS: The TCA is a potential offending vessel in TN because of trigeminal nerve compression, and the longitudinal dissection of the trigeminal nerve to make space between the vessel and the nerve roots may be an effective procedure to relieve TN caused by pressing intraneural vessels.

Recurrent subdural hematoma secondary to headbanging: A case report.

BACKGROUND: "Headbanging" is the slang term used to denote violent shaking of one's head in time with the music. This abrupt flexion-extension movement of the head to rock music extremely rarely causes a subdural hematoma. CASE DESCRIPTION: A 24-year-old female was admitted to our department because of right sided partial seizure and acute or subacute subdural hematoma over the left cerebral convexity. She had no history of recent head trauma but performed headbanging at a punk rock concert at 3 days before admission. Since, she had a previous acute subdural hematoma on the same side after an accidental fall from a baby buggy when she was 11 months old, the present was recurrent subdural hematoma probably due to headbanging. CONCLUSIONS: Headbanging has the hazardous potential to cause a subdural hematoma.

Delayed cerebrospinal fluid leak after watertight dural closure with a polyethylene glycol hydrogel dural sealant in posterior fossa surgery: case report.

A polyethylene glycol (PEG) hydrogel sealant recently has been approved as an adjunct to sutured dural closure in Japan. We treated consecutive six patients with PEG hydrogel sealant in posterior fossa operation. Three of six cases suffered delayed cerebrospinal fluid (CSF) leak after watertight dural closure with the PEG hydrogel sealant, although there was no leak case which was treated with fibrin glue, before 2 years until the adoption of the new material. These patients underwent posterior fossa craniotomy and discharged without remarkable CSF leak. The pseudomeningocele under the occipital wound caused the CSF leak occurr from 5th to 7th week postoperatively. All CSF leak cases needed surgical repair. At the repair, the PEG hydrogel was liquefied and almost absorbed. A fistula on the closure line and a dead space after the absorption of the PEG hydrogel was observed. When the absorbable PEG hydrogel sealant plugs in small gaps of sutured dura, its properties to prevent adhesion might suppress healing process of dural closure, so that CSF could leak through the gaps and collect as a pseudomeningocele in the dead space after absorption of the PEG hydrogel. In posterior fossa surgery a PEG hydrogel sealant should be applied when dural edges are closed tightly without any gaps.

Growth curve analysis of asymptomatic and symptomatic meningiomas.

Meningiomas sometimes appear to stop growing after attaining a large size. Commonly used exponential growth models do not reflect this phenomenon. We attempted to find the best curve to simulate their growth. Fifty-two patients with meningioma were followed up for 3.1-21.7 years (mean 7.5 years) with four or more imaging studies each. Thirty-one patients had asymptomatic tumors. The other 21 patients with residual or recurrent tumor were followed up after surgery. Time-volume curves for each tumor were plotted. Nonlinear regression analyses were performed against power, exponential, logistic, and Gompertzian curves. Time-volume curves corresponded to the Gompertzian and logistic growth curves better than to power or exponential curves. When simulating time-volume curves with Gompertzian curves, the majority of benign meningiomas began to slow their growth before patient age of 80 years. Twenty-three of 31 asymptomatic meningiomas had already passed the inflection point before diagnosis. In contrast, this happened less frequently in symptomatic tumors. Especially, all six atypical meningiomas continued to grow quasi-exponentially. Sigmoid curves that approach a plateau were better descriptors of the growth of benign meningiomas than were curves of unlimited growth. However, atypical meningiomas were unlikely to slow their growth.

[The measurement of fractional anisotropy values at the corpus callosum in an irradiated-rat model by 7T-MRI: comparison with quantitative histological evaluation].

Radiation-induced white matter injury has recently been evaluated by fractional anisotropy (FA) values using diffusion tensor image (DTI) data on magnetic resonance (MR) imaging. However, controversy remains as to which histological components affect anisotropy. FA values were compared with histological findings in rat irradiated brains. Forty Gy whole brain radiation was performed on 9 rats, with another 9 rats not subjected to irradiation prepared as the control group. DTI data for the corpus callosum were obtained using a 7.0 Tesla MR scanner at post radiation 18+2 to 48 +/- 2 weeks (p18w-p48w), and the mean FA value (mFA) was calculated. Histological parameters were assessed at p24w, p36w, and p48w in hematoxylin-eosin stained and immunohistochemically processed sections. Numbers of dilated vessels, hypertrophic glial fibrillary acidic protein (GFAP)-positive cells and Olig2-positive cells were quantitatively evaluated. Qualitative assessment of change in neurofilament (NF)-and myelin basic protein (MBP)-positive structures at each time point was also performed. The mFA decreased from p30w to p42w, significantly decreasing at p42w compared to the control group. However, It recovered to control levels at p48w. Histological examination showed that hypertrophic GFAP-positive cells and dilated vessels had increased at p48w. Olig2-positive cells decreased significantly at p48w compared to p24w and p36w (p<0.05). Although NF-positive structures continued to decrease over time, MBP-positive structures recovered at p48w in agreement with the change in mFA. In the subacute/chronic stage, rat irradiated brain FA value in the corpus callosum appears to mainly reflect the change in myelin structure.

Maturational changes in diffusion anisotropy in the rat corpus callosum: comparison with quantitative histological evaluation.

PURPOSE: To determine the main histological components that affect fractional anisotropy (FA) in postnatal development of the rat corpus callosum and compare FA values with histological changes evaluated quantitatively. MATERIALS AND METHODS: Diffusion tensor image (DTI) data of the rat (postnatal 1-10 weeks) corpus callosum were obtained with a 7.0 T MR scanner. Histological parameters were quantitatively assessed in toluidine blue-stained semithin sections. Simple and multiple linear regression analyses were performed to investigate relationships between FA values and histological variables. RESULTS: The mean FA value (mFA) increased significantly in the early growth stages, whereas the change became smaller after postnatal week 4. Simple regression analysis showed a high correlation between the area of myelin sheath and mFA (r = 0.856; P < 0.01). The area of extracellular space correlated negatively with mFA (r = -0.813; P < 0.01). In a forward stepwise analysis, the area of myelin sheath had the strongest influence on mFA (P < 0.001), followed by the number of unmyelinated axons (P = 0.113). Multiple linear regression analysis revealed that both parameters predicted mFA with a highly significant adjusted correlation coefficient (r(2) adj. = 0.738, P < 0.001). CONCLUSION: During the early development stage in the rat corpus callosum, the strongest contribution to FA value is the area of myelin sheath.

Microscopic anatomy of the brain-meningioma interface.

We analyzed the relation between meningioma and the brain in 50 surgical cases. So-called capsule formation was seen in 20 meningiomas, of which 13 were categorized as thin and 7 as thick. In 21 meningiomas the arachnoid membrane was intact, and 10 meningiomas had no underlying arachnoid membrane. The other 19 tumors showed partial disruption of the arachnoid membrane. The degree of arachnoid disruption correlated with the tumor grade, perifocal edema, pial blood supply on angiography, and tumor size. The existence of brain invasion correlated with the tumor grade and partially with tumor size. In case of invasive tumor, GFAP-positive cells were found deep in the tumor, usually in contact with blood vessels. The axons in gliotic brain often showed degenerative changes such as ballooning or varicose swelling. Meningiomas were usually demarcated by a basement membrane that was collagen type 4 (Col4)-positive. However, atypical and anaplastic meningiomas usually lacked Col4 staining at the interface. In two benign meningiomas that looked like an invasive growth, Col4 staining was seen above the brain. A pia mater-like structure covered the tumor surface in both cases. We could not demonstrate a relation between the expression of matrix metalloproteinase (MMP)-2 or MMP-9 and arachnoid disruption or brain invasion.

Tissue plasminogen activator levels after single intracisternal injection in patients with subarachnoid hemorrhage.

Tissue plasminogen activator (tPA) levels were investigated in the cisternal fluid of patients with subarachnoid hemorrhage treated with single intracisternal injection of recombinant tPA during radical surgery for ruptured aneurysms. Seven patients received different doses of tPA: two of 400 microg/ml, three of 500 microg/ml, one of 700 microg/ml, and one of 800 microg/ml in a total amount of 20 ml distilled water at pH 7. Cerebrospinal fluid samples were taken directly from the cisternal fluid at 15-minute incubation after injection, immediately after irrigation during surgery, and by lumbar tap 2 days after surgery. Cisternal tPA levels decreased to about 60% of the mean injected doses after 15-minute incubation. Simple linear regression analysis showed these tPA levels after incubation correlated with the initial doses. After copious irrigation with Ringer solution at pH 8, tPA levels decreased rapidly without correlation with the initial doses. After spinal drainage for 2 days, tPA levels further decreased by an order of 10(-4) to 10(-6) from the initial dose. These values were still greater than normal controls. The final values of tPA levels were not related to the initial dose. None of the patients suffered from systemic or wound complications. Cisternal tPA injection with increased doses and irrigation may be beneficial for the selective rapid removal of blood clots with controllable safety.

[A case report of a scalp dermoid cyst containing watery-clear fluid].

We report a case of a 7-month-old female with a dermoid cyst on the anterior fontanelle. She was born with a vacuum extractor. Two weeks later, her scalp on the anterior fontanelle bulged. A doctor was consulted when she was 3 months old, because the tumor was enlarging. Magnetic resonance image (MRI) showed a cystic mass on the anterior fontanelle. She was brought to our institute. At the first medical examination, she was alert and had no neurological deficit. The tumor was suspected to be a sinus pericranii or a pseudo meningocele. She was observed as an out patient, but the tumoral size become more enlarged. When she was seven months old, we punctured the cystic tumor and the tumor collapsed. But, two weeks later, it enlarged again. The cystic fluid was watery clear and the composition differed from cerebrospinal fluid (CSF). The tumor was resected totally. The histological examination revealed a dermoid cyst which involved ducts of the eccrine glands and folliculi pili. The cystic fluid was thought to be secreted from the eccrine glands.

Intrathecal and intraperitoneal germinomas occurring 20 years after total removal of a pineal teratoma. Case report.

In 1980, a 10-year-old boy was admitted to the authors' hospital with consciousness disturbance and vomiting. Computerized tomography (CT) scans revealed a pineal mass lesion and hydrocephalus. The tumor was totally removed and a ventriculoperitoneal (VP) shunt was inserted. Histological investigation of a surgical specimen revealed that it was a teratoma. Five years later, the patient was readmitted to the same institution with polyuria. Magnetic resonance (MR) imaging revealed a mass lesion in the suprasellar region. The patient received systemic chemotherapy, and the tumor disappeared; however, 2 years after the chemotherapy, MR imaging demonstrated a right lateral ventricular mass. The tumor was totally resected, and histopathological investigation revealed a teratocarcinoma. Three years after the chemotherapy, CT scanning revealed suprasellar and right lateral ventricular tumor recurrences, for which the patient received irradiation and chemotherapy. The tumors disappeared and the patient achieved complete remission that lasted longer than 10 years. On January 25, 2000, however, he noticed hip pain. Lumbar MR imaging demonstrated a spinal tumor below L-4 and also an abdominal tumor. The abdominal tumor was totally removed, and the histological findings identified it as a germinoma. The patient received systemic chemotherapy and the tumor disappeared completely. The authors believe that the suprasellar tumor was a metachronous germinoma and that it had metastasized through the intrathecal route and the VP shunt.