Postoperative sella: evaluation with fast spin echo T2-weighted high-resolution imaging.

OBJECTIVE: The purpose of this study was to investigate the magnetic resonance features of the postoperative sella with fast spin echo (FSE) T2-weighted high-resolution imaging and to evaluate the benefits of the sequence using a follow-up magnetic resonance imaging protocol after transsphenoidal surgery. METHODS: Coronal spin echo (SE) T1-weighted and FSE T2-weighted images were prospectively obtained in 24 patients after surgery for pituitary adenomas. We observed the signals and the contour of normal structures, fluid collection, implanted materials, and mass lesions, including granulation tissue and adenoma. RESULTS: The pituitary gland was delineated in 51 of 59 FSE T2-weighted images, 90.2% of which presented clear boundaries. Whereas the gland was detected in 49 of 58 SE T1-weighted images, only 20.4% showed the boundaries. A mass lesion was identified in each of 12 patients with good resolution on FSE T2-weighted images. SE T1-weighted images detected mass lesions in 7 of 12 patients without distinctive boundaries. Contrast enhancement had little advantage in clarifying the boundaries between normal and abnormal structures. For the detection of mass lesions in the sella, the kappa values for interobserver agreement were 0.8 for FSE T2-weighted images and 0.25 for SE T1-weighted images. CONCLUSION: FSE T2-weighted imaging is a reliable method with which to assess the sella with sufficient resolution after transsphenoidal surgery. The combination of unenhanced SE T1-weighted and FSE T2-weighted images may reduce the use of contrast material after pituitary surgery.

Lectin binding and bcl-2 protein expression in craniopharyngiomas.

The maturation process of basal cells in craniopharyngiomas was studied using a panel of lectins, and antibodies against cytokeratin 13 and bcl-2 protein, using oral mucosa for comparison. Seven lectins were employed: peanut (Arachis hypogaea) agglutinin, Dolichos biflorus agglutinin (DBA), Ulex europaeus agglutinin-I (UEA-I), soybean agglutinin, Ricinus communis agglutinin-I, succinyl wheat germ agglutinin, and Pisum sativum agglutinin. DBA and cytokeratin 13 stainings of the suprabasal cells in craniopharyngiomas were comparable to those of the oral mucosa, but not to those of the skin. Staining patterns of the basal cells in the oral mucosa and craniopharyngiomas were generally similar, but UEA-I binding and bcl-2 protein expression in suprabasal cells differed. The difference appeared to be due to a disturbance in the differentiation of the basal cells, because only a small fraction of the basal cells followed a normal maturation process in craniopharyngiomas in comparison to the oral mucosa. The expression of bcl-2 protein may be involved in the pathogenesis of craniopharyngiomas.

Proliferating cell nuclear antigen expression in rat glioma model: comparison with bromodeoxyuridine labeling index.

The usefulness of proliferating cell nuclear antigen (PCNA) immunostaining for estimating the growth fraction in glial tumors was evaluated in ethylnitrosourea-induced rat gliomas. The PCNA labeling index was compared with the bromodeoxyuridine (BrdU) labeling index, using alternate serial sections fixed either in 10% formalin or in periodonate-lysine-paraformaldehyde (PLP). The PCNA labeling index was significantly correlated with the BrdU labeling index if cells with only faint PCNA staining were excluded. Differences in PCNA staining were noted between the two fixatives. The number of PCNA-positive cells in PLP-fixed material was greater than in 10% formalin-fixed material, but showed a poorer correlation with BrdU labeling index. Over-fixation in formalin reduced the number of positive cells. Although peritumoral tissue did not exhibit overexpression of PCNA, the ependymal lining was weakly stained even in areas distant from the tumor. PCNA labeling index is a useful method to estimate the growth fraction when the materials are processed in a controlled way. When clinical specimens with uncertain preparation are used, care is required in interpreting the results.

Immunohistochemical localization of glycosaminoglycans in experimental rat glioma models.

Changes of glycosaminoglycan distribution in and around C6 glioma and ethylnitrosourea(ENU)-induced glioma in rats were investigated using monoclonal antibodies that specifically recognize epitopes on chondroitin-0-sulfate proteoglycan (C-0-S), chondroitin-4-sulfate proteoglycan (C-4-S), dermatan sulfate proteoglycan (DS), chondroitin-6-sulfate proteoglycan (C-6-S) and keratan sulfate proteoglycan (KS) after chondroitinase ABC digestion. In the normal brain tissues, C-0-S was located on the surface of the neurons. In addition, extracellular staining in the cerebral cortex and axoplasmic staining in the brain stem and the reticular thalamic nucleus were seen. C-0-S was negative, however, both in the C6 and ENU-induced gliomas. C-4-S or DS was detected only in some of the neurons in the normal brain tissues. They were detected in the peripheral part of the ENU-induced gliomas, but not in the C6 gliomas. C-6-S was located on the surface of some neurons and in the white matter of the normal brain, but it was not detected in C6 gliomas. In all ENU-induced gliomas, C-6-S was identified in the adventitia of the vascular structures within the tumor. In some of them, C-6-S appeared in the peripheral part of the tumor. KS was immunostained in the glial cells in the hippocampus, corpus callosum, brain stem, and the floor of the third ventricle. It was also detected in the peritumoral brain tissues both in the C6 and ENU-induced rat gliomas. The significance of glycosaminoglycans in these glioma models was discussed.

bcl-2 protein expression in tumors of the central nervous system.

bcl-2 protein (BCL-2) expression was immunohistochemically studied in 140 varied central nervous system tumors. The protein was most frequently expressed in neurinomas and ependymomas, and in normal ependymal cells and Schwann cells. Most pituitary adenomas could be classified into one of two subgroups, diffusely positive or diffusely negative tumors, while BCL-2 localized heterogeneously in normal pituitary glands. Although the protein was not detected in normal astrocytes, it was positive in reactive hypertrophic astrocytes observed in various pathological conditions. Similarly, astrocytic tumor cells often expressed BCL-2. Since low-grade astrocytomas more often exhibited the protein than malignant gliomas, the degree of BCL-2 expression appeared to be related to the degree of malignancy of the gliomas. On the other hand, 7 out of 17 recurrent gliomas and medulloblastomas showed an increase in the frequency of protein expression compared with specimens from initial treatments. One recurrent astrocytic tumor which demonstrated anaplastic change showed a decrease in the frequency of BCL-2-positive cells. It is concluded that the frequency of BCL-2 expression in CNS tumors is increased when the non-neoplastic counterparts of the tumors exhibit the protein. Although it has been reported that overexpression of BCL-2 protects cells from damage by radiation and/or chemotherapy, we could not find any significant relationship between the degree of BCL-2 expression and the length of survival of patients with glioblastomas or medulloblastomas.

Lectin histochemistry of dermoid and epidermoid cysts of the central nervous system.

The binding affinities of seven lectins to four epidermoid and three dermoid cysts were studied and the results were compared with the epidermis and the oral mucosa. The reactivity of four epidermoid cysts of the fourth ventricle and the frontal lobe, and one dermoid cyst in the sylvian fissure was consistent with that of the skin, whereas the binding profile of one parasellar dermoid cyst was identical to that of the keratinized oral mucosa. Another parasellar dermoid cyst also showed close similarity to the buccal mucosa. These results indicate that cells of these cysts develop same glycoconjugates as do normal epithelial cells, and some of these cysts around the sellar region might be derived from the cells of the oral mucosa.

Lectin histochemistry of normal and neoplastic peripheral nerve sheath. 1. Lectin binding pattern of normal peripheral nerve in man.

The binding patterns of lectins to normal peripheral nerves were examined. Twelve biotinylated lectins were used in this study; Canavalia ensiformis (Con A), Pisum sativum (PSA), Lens culinaris (LCA), Ricinus communis 1 (RCA-1), Arachis hypogaea (PNA), Glycine max (SBA), Sophora japonica (SJA), Bandeiraea simplicifolia 1 (BSL-1), Triticum vulgaris (WGA), succinylated WGA (s-WGA), Ulex europaeus 1 (UEA-1) and Helix pomatia (HPA). Cytoplasm of Schwann cells and perineurial cells was stained by Con A, PSA, LCA, s-WGA and WGA. PNA showed specific binding to perineurial cells, while after neuraminidase treatment stain with this lectin was demonstrated also in Schwann cells. Myelin sheaths were stained with fewer lectins. SBA and HPA with sialic acid removal rarely showed reactivity to the peripheral nerve structure in surgical specimens, in contrast to clear staining of Schwann cells, perineurial cells and myelin sheaths in autopsy specimens. The present study shows distinct lectin stainings of specific structures of the normal human peripheral nerves, and provides important basic information on the alterations of lectin binding patterns during pathological processes in the peripheral nerves.

Lectin histochemistry of normal and neoplastic peripheral nerve sheath. 2. Lectin binding patterns of schwannoma and neurofibroma.

Lectin binding patterns of 31 schwannomas and 6 neurofibromas were examined using 12 lectins, and the results were compared with those of normal peripheral nerves. Tumors obtained from 10 cases of neurofibromatosis and 4 recurrent schwannomas were included. Changes of glycoconjugates were observed in association with a neoplastic transformation of Schwann cells; Arachis hypogaea (PNA) staining after neuraminidase treatment seen in normal Schwann cells was reduced in schwannoma of Antoni type A, and bindings with Glycine max (SBA) and Helix pomatia (HPA) after sialic acid removal, which were not seen in normal Schwann cells, appeared in schwannoma cells. Intensities of staining of tumor cells with each lectin were higher in Antoni type B than those in Antoni type A. No differences in lectin binding patterns were observed between schwannomas in patients with neurofibromatosis or recurrent schwannomas and ordinary, primary schwannomas in patients without stigmata of neurofibromatosis. Lectin binding patterns of Schwann cells and perineurial cells in neurofibroma were almost similar to those in normal peripheral nerves with an exception of faint stain of Schwann cells with HPA after neuraminidase pretreatment. This result suggests differences in extent of differentiation between schwannoma cells and neoplastic Schwann cells in neurofibroma. Specific PNA binding to perineurial cells in neurofibroma indicates the significance of this lectin as a marker of these cells.

Mechanism of mutism following the transcallosal approach to the ventricles.

Transient mutism has been known as a common manifestation following callosotomy for medically intractable epilepsy, but its cause has not been clearly elucidated. In this paper, we report three cases of mutism following a transcallosal approach to tumours in the lateral and third ventricles and retrospectively analyze the surgical, neurological and radiological features which may suggest the cause of this type of mutism. Mutism may be a result of division of the corpus callosum. Suppression of the limbic system caused by lesions in the anterior cingulate gyrus, septum pellucidum, and fornix may have been of importance in at least two of these three cases. Impairments of the supplementary motor cortex, thalamus and basal ganglia may also be factors reducing speech production. The mechanism of such transient mutism seems to be a complex of two or more of these factors, and their combinations may be different from one case to the other.

Aspergillosis of the central nervous system causing subarachnoid hemorrhage from mycotic aneurysm of the basilar artery--case report.

The authors present an extremely rare case of aspergillosis of the central nervous system (CNS) causing subarachnoid hemorrhage (SAH). A 78-year-old female developed facial pain, progressive deterioration in left visual acuity, and left total ophthalmoplegia. Computed tomography demonstrated a heterogeneously enhanced mass extending from the sphenoid sinus to the left cavernous sinus and left orbit, and angiography showed luminal narrowing and irregularity of the left internal carotid artery at its siphon. Biopsy of the left orbital and sphenoid sinus mass resulted in the diagnosis of Aspergillus granuloma. Despite combined administration of amphotericin-B and 5-FC, she became comatose from brainstem infarction and finally, suddenly died. Postmortem examination revealed massive SAH due to a ruptured mycotic aneurysm of the basilar artery. Aspergillosis of the CNS is a growing problem with the wider use of immunosuppressants and antibiotics. To the authors' knowledge, however, only 13 cases of CNS aspergillosis causing SAH have been reported. The prognosis is absolutely bad, with all patients dying from rupture of major intracranial arteries such as the internal carotid artery and basilar artery. Early diagnosis and vigorous chemotherapy are important.

[Surgical management of syringomyelia associated with Arnold-Chiari malformation, primary IgA deficiency and chromosomal abnormality--a case report].

A rare case of syringomyelia associated with Arnold-Chiari malformation, primary IgA deficiency and sex chromosomal abnormality is reported. A 26-year-old Ethiopian black male was admitted with a complaint of hypalagesia of his left arm and face for 10 years. Neurological examination on admission revealed dissociated sensory loss of his left arm and face. Mild motor weakness of his hand and rotatory nystagmus on left gaze were also noticed. Plain craniogram of lateral view showed small posterior cranial fossa with low positioned inion and platybasia. MRI with T1-weighted images in sagittal plane revealed tonsillar herniation reaching C1 and syrinx extending from C2 to lumbar region. Although no episode of infectious disease nor allergy were experienced, blood analysis disclosed low serum level of IgA (7 mg/dl). The values of other immunoglobulins were within normal range. IgA in saliva was not detected, too. According to the clinical history and symptoms, a diagnosis is of primary asymptomatic IgA deficiency was obtained. Karyotype analysis showed inversion of Y chromosome. In an attempt to avoid anaphylactic shock on blood transfusion in a patient with IgA deficiency, autologous blood was prepared before surgery. Decompressive craniectomy of the posterior fossa with posterior arch of C1 and C2 was performed together with syringosubarachnoid shunt at Th 6-7 level. Postoperative course was successful and slight improvement of sensory disturbance was obtained. No respiratory or wound infection was occurred. The association of these three anomalies is very rare and genetical relationship is not known. From surgical point of view, it is conceivable that preoperative management in a case of asymptomatic IgA deficiency is uneventful.

[Olfactory neuroblastoma with intracranial extension. Report of two cases].

Two cases of olfactory neuroblastoma with intracranial extension are described. The radiological features, including those of magnetic resonance (MR) imaging, are emphasized. On plain X-rays, the nasal cavity, ethmoid, sphenoid, and/or frontal sinuses were opacified. Erosion of the bony confines of the sinuses and orbit was seen in Case 1, but no bony destruction was observed in Case 2 despite intracranial tumor invasion via the seemingly intact cribriform plate. Angiography showed tumor staining in the ethmoid sinus, and in Case 1 tumor vessels were also found in the base of the frontal lobe. Computed tomography (CT) disclosed a large, soft, enhanced tissue mass occupying the nasal cavity and paranasal sinuses and extending into the anterior cranial fossa. In Case 1, MR images (0.5 Tesla) with a short spin echo sequence (repetition time [TR], 600 msec; echo time [TE], 26 msec) and a long spin echo sequence (TR, 2100; TE, 30, 60, 90) were obtained. T1-weighted images delineated the tumor accurately in relation to the normal architecture. T2-weighted images revealed widespread brain edema, with the tumor recognizable as a mass of low signal intensity within the high-intensity region of brain edema. The CT and MR imaging findings are by no means specific to olfactory neuroblastoma. However, both modalities, particularly MR imaging, are of special value in demonstrating the precise extent of the tumor in three dimensions.

[Pineal metastatic tumor from lung cancer initially caused by neurological abnormalities of pineal body tumor].

A rare case is reported of pineal metastasis from lung cancer initially caused by neurological abnormalities of pineal tumor. A 70-year-old female suffering from headache and deterioration of consciousness for 1 week was admitted. She also had a tumor on both sides of her neck. On admission, neurological examination revealed disturbance of upward gaze, and CT scans showed hydrocephalus and pineal tumor. The tumor was seen as a slightly high density mass on non-contrast CT, and was homogeneously enhanced after administration of contrast material. Right V-P shunt and excision of the left neck tumor were performed at the same time. Pathological diagnosis of neck tumor was undifferentiated carcinoma metastasized to cervical lymph nodes. Extensive study was made, by bronchial fiberscope and biopsy, in order to find the origin of the malignancy and disclosed a small cell lung cancer of left lower lobe. The patient took radiation therapy for both the whole brain (60 Gy) and for the bilateral cervical regions (45 Gy). Two courses of chemotherapy using CDDP, ADR, VCR and CY were administered. Both the neck and the pineal tumors were markedly reduced in size at the termination of radiation therapy. However, she was readmitted 3 months later because of dyspnea. Chest X-P revealed enlargement of the left-lung tumor. She died on April 22, 1987. General autopsy disclosed invasive enlargement of left lung cancer, however, no remote metastasis was found. Examination of pineal region showed only necrotic pineal tissue, and no tumor cell was seen in either macroscopic or microscopic study.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epithelial cysts of the central nervous system: report of two cases].

Two cases of epithelial cyst are reported. Case 1. A 68-year-old female visited our hospital with a complaint of decreased visual acuity, 0.04 in the left eye, in September 1986. Visual field examination showed bitemporal hemianopsia. CT scan demonstrated nonenhancing cystic lesion involving the suprasellar region. By a right frontotemporal craniotomy, the suprasellar cyst was explored. The wall of the cyst was partially removed to relieve pressure against both optic nerves and chiasma. Histologically, the cyst wall was lined with a single layer of non-ciliated cuboidal epithelium. Electron microscopic study revealed a number of microvilli, continuous basement membrane and desmosomes. Case 2. A 40-year-old female was admitted to our hospital because of sensory disturbance in the left hand for several years. She had an episode of convulsive seizure with a loss of consciousness. Neurological examination revealed hypesthesia of the left hand. CT scan showed non-enhancing right frontoparietal cystic lesion compressing the right lateral ventricle to the left. By a right frontoparietal craniotomy, the cystic lesion was explored. The cyst existed beneath an arachnoid membrane and contained CSF-like clear fluid. The cyst wall was resected, as far as possible, to obtain communication with normal subarachnoid CSF space. Histologically, by light and electron microscopic study, the cyst was considered to be an epithelial cyst. A correct diagnosis is difficult because other cystic lesions such as arachnoid cysts and craniopharyngioma are of similar low density and appear the same on CT scan. It is impossible to diagnose such an epithelial cyst by relying on neuroradiological study alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Clivus chordoma in childhood.

A 9-year-old boy with mild left hemiparesis and left abducens nerve palsy was found to have chordoma of the clivus. Magnetic resonance imaging (MRI) was most useful not only for diagnosis but also for selection of operative approaches. The tumor was subtotally resected by a transoral-transpharyngeal approach followed by a retroauricular retromastoid craniotomy, and postoperative radiation therapy was administered. Intracranial chordomas are rare in children; only 12 cases have previously been reported in detail. Eleven patients were male and one was female. Progressive cranial nerve involvement and long tract signs without increased intracranial pressure constitute the cardinal symptomatology of intracranial chordomas, but a separation of cranial sutures and enlargement of the head may be seen in children. The role of MRI in diagnosis and patient management cannot be overemphasized.

[Oligodendroglioma of the lateral ventricle--report of 2 cases and a review].

Oligodendrogliomas rarely grow primarily in the ventricles. When compared to more common hemispheric counterparts, such intraventricular oligodendrogliomas, or oligodendrogliomas of the midline group (Martin), present distinct clinical features, namely, (1) they occur in the younger age, (2) an interval between clinical onset and diagnosis or operation is shorter, and (3) initial symptoms are most often limited to those of increased intracranial pressure, although the patient may occasionally present mild organic dementia, callosal disconnection syndrome, and/or mild gait ataxia. Two cases of oligodendroglioma primarily involving the lateral ventricle are reported in female patients, aged 29 and 19, respectively, with sole complaints of an increased intracranial pressure. Magnetic resonance imaging proved to be most useful as a radiologic diagnostic procedure. The tumor was radically removed via a para-falcine transcallosal approach without causing any persistent neurological deficits. Merit and demerit of the approach are briefly discussed.