[Intracranial malignant glioma presenting as subarachnoid hemorrhage].

Cerebral aneurysms are the predominant cause of spontaneous subarachnoid hemorrhage (SAH). However, if an aneurismal cause has been excluded, there remains but a short list of meningiomas or metastatic lesions as possible causes. This article details a case of neoplasm that presented exclusively with SAH. A 31-year-old male presented with a SAH with normal cerebral angiography. The initial magnetic resonance image (MRI) revealed a lesion in the left uncus thought to be recovering hemorrhage. Subsequent MRI, however revealed the mass to be expanding. A neuroendoscopical biopsy of the lesion established a diagnosis of glioblastoma. An affirmation is made that patients experiencing "angiographically-negative" SAH should undergo MRI, occasionally on a serial basis, to exclude other etiologies for hemorrhage, including neoplasma.

Pineal germinoma with a prominent epithelioid cell granuloma component: case report.

A 20-year-old man presented with a rare case of germinoma with a large component of epithelioid cell granuloma manifesting as oscillopsia. Magnetic resonance imaging demonstrated a mass in the pineal region with homogeneous enhancement with gadolinium. Craniotomy was performed, ending in biopsy. The initial histological diagnosis was epithelioid cell granuloma, but systemic investigation detected no evidence of granulomatous disorder. A revised diagnosis of germinoma was based on positive immunohistochemical staining for placental alkaline phosphatase (PLAP) and c-kit. Histological diagnosis is sometimes incorrect if granulomatous reaction is dominant. Immunohistochemical staining for PLAP and c-kit should be performed if germinoma is clinically suspected.

[Huge facial nerve schwannoma extending into the middle cranial fossa without facial palsy: case report].

The facial nerve schwannoma is a rare tumor and it seldom extends into the middle cranial fossa. The typical clinical presentations are progressive facial paralysis and hearing disturbance. We report here a case of huge facial nere facial nerve schwannoma extending into the middle cranial fossa without facial palsy. A 50-year-old man presented with left hearing disturbance. Neurological examination on admission revealed no deficits except for sensorineural hearing loss. MRI demonstrated a cystic tumor extending into the ddle cral fossa from the petrous bone CT the middle cranial fossa from the petrous bone. CT of the temporal bone showed destruction of the surrounding bone around the geniculate ganglion and invasion of the tumor into the tympanic cavity and internal auditory canal. The intracranial tumor was totally removed and the operative specimen demonstrated that the tumor was a schwannoma. The patient was discharged without neurological deficit. The facial nerve schwannoma extending into the middle cranial fossa without facial palsy is rare and only 4 cases have been reported in the literature. The tumor origin was in the greater superficial petrosal nerve and geniculate ganglion. The symptom is conductive hearing loss caused by the tumor extending into the tympanic cavity. We should bear in mind that there is a also rare type of facial nerve schwannoma manifesting hearing disturbance alone.

[Olfactory neuroblastoma with spinal metastasis: case report].

Olfactory neuroblastoma is a rare tumor of the nasal cavity. It is a locally aggressive tumor with local recurrence, and distant metastasis occurs in 22-40% of patients. We report a case of olfactory neuroblastoma with cauda equina metastases. A 49-year old male had undergone surgery twice previously; the first for olfactory neuroblastoma in October, 1990, and the second for its intracranial and orbital metastasis in September, 1999. He complained of lumbago in autumn, 2005 and MRI showed two enhanced lesions in the cauda equina. The mass was partially removed and histologically diagnosed as olfactory neuroblastoma metastasis. Whole-spine irradiation of 32 Gy and lumber-spine irradiation of 10 Gy were performed. The mass at L2/3 was disappeared after the irradiation although the mass at L4/5 was not changed in size. The patient was discharged without neurological deficit and is now kept under observation as an outpatient. Olfactory neuroblastoma with spinal metastasis is rare and only 11 cases have been reported in the literature. A very poor prognosis was observed in the patients of olfactory neuroblastoma with spinal metastasis. Olfactory neuroblastoma is a radiosensitive tumor, and radiotherapy for spinal metastasis was reported to be effective. However, effectiveness of chemotherapy was still uncertain. The patient with olfactory neuroblastoma should be observed carefully even though no local recurrence had been detected over 10 years. Radiotherapy and further treatment including chemotherapy should be considered in case of spinal metastasis.

Construction of a high-tech operating room for image-guided surgery using VR.

This project aimed to construct an operating room to implement high dimensional (3D, 4D) medical imaging and medical virtual reality techniques that would enable clinical tests for new surgical procedures. We designed and constructed such an operating room at Dai-san Hospital, the Jikei Univ. School of Medicine, Tokyo, Japan. The room was equipped with various facilities for image-guided, robot and tele- surgery. In this report, we describe an outline of our "high-tech operating room" and future plans.

[A case of falcotentorial meningioma with visual allesthesia].

Visual allesthesia, in which visual images are transposed from one homonymous half-field of visual field to another, is a rare phenomenon. Palinopsia is the persistence or recurrence of visual images after the exciting stimulus object has been removed. Some authors have reported these phenomena, but these pathophysiology has not been understood. We report a right-handed 63-year-old woman, with a right falcotentorial meningioma. She paroxysmally experienced illusory transpositions of objects viewed in the right homonymous visual field into the left, and she recognized her face in it. The illusory images were palinoptic, persisting for up to a few minutes after the real objects were no longer in view. Administration of anticonvulsant medications resulted in the decrease of frequency of this phenomenon. Radiological and surgical findings revealed that the tumor was compressing the very localized visual cortex, especially the Brodmann's area 18 and 19. After resection of the tumor, visual allesthesia and palinopsia completely disappeared. These areas are associated with memory and recognition of visual images as visuopsychic area. This case provides some insight into the mechanisms of this phenomenon, and we consider that it could be caused by seizure activity in this lesion.