Release of ciliary neurotrophic factor from cultured astrocytes and its modulation by cytokines

CNTF rescues various types of lesioned neurons in vivo, and it needs to be released from astrocytes into the extracellular space to have the effect. However, direct evidence for CNTF release has not been unequivocally demonstrated. We hypothesized that the rapid sequestration by CNTF receptor present on cultured astrocytes might be the cause of the inability to detect CNTF released into astrocyte-conditioned medium (ACM). Therefore, we measured CNTF immunoreactivity in medium conditioned by astrocytes treated with phosphatidylinositol-specific phospholipase C (PI-PLC) which was used to prevent released CNTF from binding to the CNTF receptor, since PI-PLC cleaves glycosyl-phosphatidylinositol anchor of CNTFR alpha, the unique component involved in CNTF binding. CNTF was not detectable in untreated ACM, but was detectable in PI-PLC-treated ACM. These results together with the evidence that PI-PLC treatment did not have a toxic effect on astrocytes prove the fact that CNTF can be released from astrocytes without cell lysis. Subsequently, the effect of cytokines such as IL-1 beta, TNF-alpha, and EGF on CNTF release was examined. These cytokines increased CNTF protein levels in ACMs without increasing CNTF protein levels in astrocyte-extracts, indicating that they enhanced CNTF release from astrocytes.

Unusual location of intracranial vagus neurinoma--case report

A 55-year-old male presented with hearing disturbance and tinnitus in the left ear. Computed tomography (CT) and magnetic resonance imaging demonstrated a well-defined, homogeneously enhanced mass in the left cerebellomedullary cistern without extension close to the jugular foramen. A three-dimensional image reconstructed from thin-slice CT scans demonstrated that the mass was clearly separated from the jugular foramen. The mass lesion was totally removed surgically. At surgery the tumor was found to originate from one rootlet of the vagal nerve just after its exit from the medulla oblongata. The histological diagnosis was neurinoma. Intracranial neurinomas of the glossopharyngeal, vagal, or accessory nerve usually originate within or close to the jugular foramen. This unusual location made it difficult to achieve a correct preoperative diagnosis.

[Usefulness of 3-dimensional image analysis of skull base lesions]

We have evaluated three-dimensional (3D) images of the skull base lesions for planning cranial base surgery. Fifty 3D images were reconstructed from computed tomographies (CT), and/or magnetic resonance (MR) images or MR angiographic images of 30 patients with skull base lesions. These images have provided useful information for pre-operative evaluation. The 3D image reconstructed from CT provides clear information concerning the bone. Conversely, the 3D image from MR images demonstrates soft tissue very clearly, and that from MR angiography provides a detailed description of the vasculature. For skull base lesions, it is essential to evaluate 3D images from the different modalities, especially CT scan and MR image.

Effect of a neuron-specific actin-binding protein, drebrin A, on cell-substratum adhesion

Drebrin A expression was induced in non-neuronal L cells via transfection with a vector containing the cDNA of rat drebrin A. Following treatment with colcemid (5 micrograms/ml) and cytochalasin D (0.5 micrograms/ml), most L cells collapsed into round cells, while drebrin expressing cells were resistant to the treatment, keeping their cell shapes. Simultaneously, actin filaments and microtubules were disrupted in both cell lines. By quantitative analysis, in the presence of cytochalasin D, the extent of cell spreading and cell attachment in drebrin expressing cells was significantly higher than that in control cells. These results suggest that drebrin A modulates cell-substratum adhesion.

Accumulation of nerve growth factor in cerebrospinal fluid and biological activity following neurosurgery

Perioperative nerve growth factor (NGF) levels in cerebrospinal fluid (CSF) of patients with acoustic neurinoma (14 cases), tentorial meningioma (1 case), or subarachnoid hemorrhage (1 case) were examined. Preoperative NGF levels in CSF were below the level of detection in all patients. However, NGF was found to accumulate transiently in CSF following neurosurgery. Pre- and postoperative CSF obtained from a patient with acoustic neurinoma enhanced the proliferation of astrocytes in neuronal cell cultures derived from embryonic rat cortex grown in serum-free defined medium, and increased choline acetyltransferase activity of cholinergic neurons derived from embryonic rat septal area and brainstem. The effect of postoperative CSF on septal and brainstem neurons was more potent than that of preoperative CSF. These results indicate that NGF and non-NGF-type neurotrophic activities accumulate in the CSF following neurosurgery. These neurotrophic activities are probably important in the regeneration of damaged neural networks in the central nervous system.

Decrease of NCAM expression and astrocyte-neurone interaction in long-term cultured astrocytes

In order to assess the characteristics of the older astrocyte, we obtained long-term cultured rat astrocytes (20 months) and examined the features of protein expression in relation to neuronal interaction. In short-term cultured astrocytes, NCAM expressed strongly in contrast to weak expression of laminin by both immunocytochemical and ELISA assay. On the contrary, in long-term cultured astrocytes, a marked decrease of NCAM expression was observed along with increased laminin expression compared with short-term cultured astrocytes. The long-term cultured astrocytes remained positive to anti-GFAP antibody and showed a much lower ability to interact with neurones than the short-term cultured astrocytes. NCAM may be one of the responsible molecules related to the astrocyte-neurone interaction in the developing and ageing nervous system.

[Transcranial magnetic stimulation of the accesory nerve--investigation of the site and mechanism of excitation in the cat]

The site where transcranial magnetic stimulation excites the accessory nerve was studied in 5 cats. Transcranial magnetic stimulation of the accessory nerve was recorded from the right trapezius. The accessory nerve was stimulated electrically at the C1 level, jugular tubercle and jugular foramen. The latencies of the compound muscle action potentials (CMAPs) for each portion were measured and compared with the magnetic response, which was coincidental with that of the jugular tubercle. The accessory nerve was then transected in steps distally from the C1 level, and CMAPs following magnetic stimulation were recorded at each step. The CMAPs disappeared following the nerve transection at the jugular tubercle. The results of both approaches in this study conclude that transcranial magnetic stimulation excites the accessory nerve at jugular tubercle. This stimulation site was anatomically coincidental with that of the facial nerve and trigeminal nerve in being right before the point where the nerve bends. Following the accessory nerve transection at the C1 level, the amputation stump was moved cranially, and CMAPs disappeared. CMAPs recorded after the accessory nerve was returned to its original position. These examinations suggested that sudden alteration of the traveling lie of the nerve participates in the mechanism of transcranial magnetic stimulation.

Transgenic neural plate contributes neuronal cells that survive greater than one year when transplanted into the adult mouse central nervous system

Neural plate cells from the early embryo may have a number of important advantages as donor material for the delivery of foreign genes into the diseased adult central nervous system (CNS). Mesencephalic neural plate from transgenic GT4-2 mice was used as a source of marked donor cells to determine whether transgene-expressing embryonic CNS progenitor cells can be used as donor material for implantation into the adult mouse brain. Transgenic mouse embryos from this line express the Escherichia coli beta-galactosidase (beta-gal) gene throughout early CNS development. At the early somite stage (Embryonic Day 8.5), mesencephalic neural plate tissue from heterozygous embryos was dissected out and either transferred into culture for characterization or immediately implanted into the striatum or lateral ventricle of adult wild-type CD-1 mice. Explants of neural plate tissue possessed intense beta-gal activity and produced extensive outgrowth of neurofilament-positive processes after 6 days in vitro. Many beta-gal-positive cells migrated away from the explanted tissue mass. Grafts of transgenic neural plate tissue in the normal adult mouse striatum, sampled 2 weeks to 1 year after implantation, possessed healthy beta-gal-positive cells. More detailed analysis of grafts 3 months after implantation indicated that most beta-gal-positive cells were also immunoreactive for neurofilament and microtubule-associated proteins, two neuron-specific markers. In addition, extensive neurofilament-positive axonal tangles were evident within the grafts among the beta-gal-positive cells. Electron microscopic (EM) findings of implanted tissue stained with Bluo-Gal revealed many beta-gal-positive neurons received synaptic contacts from other cells. A few donor-derived astrocytes were also found in the grafts by EM analysis. No obvious signs of immunological rejection, or of significant decrease in graft volume, were observed at any age. Some beta-gal-positive cells were observed to lie up to 230 microns away from the main graft mass in both striatal and intraventricular implantations. These data suggest that the neural plate can contribute a long-surviving population of neuronal and astrocytic cells when transplanted into the adult CNS.

Planning and surgical strategies for early management of vertebral artery and vertebrobasilar junction aneurysms

Selection of the approach and technique for surgical repair of aneurysm of the vertebrobasilar artery system is mainly based on angiographic features. This report emphasizes that planning the surgical procedure should also include preoperative evaluation of the individual skull base configuration, as well as the relationship between aneurysm site and surrounding bony structures. These features are evaluated on thin slice CT scans using bone tissue algorithms and are particularly important for adequate exposure of distal vertebral artery (VA) or midline aneurysms, because these cases require drilling of the jugular tubercle. For the use of lateral approaches, the surgeon must be familiar with the extradural and intradural anatomy of the foramen magnum region and may rely on at least five anatomical landmarks for orientation during surgery: 1) the dural entrance of the vertebral artery; 2) the posterior condylar emissary vein; 3) the medial rim of the distal sigmoid sinus; 4) the hypoglossal canal; 5) the jugular tubercle. To increase the safety of the procedure, the authors recommend an individualized tailoring of the surgical approach according to the variable morphological situation of each patient.

Cell growth suppression of astrocytoma C6 cells by glial fibrillary acidic protein cDNA transfection

The cellular functions of the intermediate filament family including glial fibrillary acidic protein (GFAP) are not well known yet beyond their roles as structural elements of cells. Expression of GFAP, which is specific in astrocytes and regulated developmentally, suggests its involvement in cell growth and differentiation of astrocytes. We transfected murine GFAP cDNA into a rat astrocytoma C6 cell line to assess the specific effect of GFAP on cells. Two stable GFAP-transfected cell lines, GFC6-5 and GFC6-6, exhibited a series of morphological and growth characteristics that distinguish them from their counterparts, i.e., NeoC6 cells transfected only with the neomycin-resistant gene, and native C6 cells. Both GFC6-5 and GFC6-6 cells showed elongated cell shapes with extended processes rich in GFAP, markedly suppressed cell growth, and decreased bromodeoxyuridine uptake. Western blot analysis revealed a remarkable increase of GFAP expression in GFC6-5 and GFC6-6 compared with that in NeoC6 and C6, in contrast to similar vimentin expression in all cell lines. The results indicate that the expression of GFAP has dramatic effects on cell morphology and cell growth suppression in C6 cells, suggesting that GFAP may function as a tumor suppressor in astrocytoma.

GFAP transfected cells produce laminin, leading to neurite outgrowth promotion

Accumulating evidence indicates the importance of astrocytes in neuronal development and regeneration. While glial fibrillary acidic protein (GFAP) is believed to mediate the morphology of developing astrocytes, its precise function remains unknown. To analyse the function of GFAP in astrocytes, we established GFAP-expressing cell lines by transfection of mouse GFAP cDNA into mouse fibroblast L cells. Stable transfectants expressed GFAP uniformly in the cytoplasm with no phenotypic changes and exhibited extended processes rich in GFAP. GFAP-expressing cells significantly promoted the neurite outgrowth of rat cerebral cortex neurones in the co-culture system. Analysis of the products of GFAP-expressing cells revealed an increase in production of laminin, but not fibronectin. These results suggest that L cells expressing GFAP increase laminin production, leading to promotion of neurite outgrowth.

A wrapping clip combined with silastic sheet for emergent hemostasis: technical note

The attachment of a thin silastic sheet combined with the use of Sugita's fenestrated aneurysm clip was developed for the emergency repair of vascular perforation during surgery. The sheet is flexible and tailored in the operating room, corresponds to the vascular curve, and is semitransparent, allowing observation of the area of perforation. The device can be applied under severe bleeding conditions without temporary clipping. It may be useful as an emergency tool for vascular repair in the operating room.

Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas. Selective pyramid resection and radicality

Forty-two patients with petroclival meningioma were operated upon by the middle fossa transpetrosal-transtentorial approaches since 1977. Half of those showed tumour extension into the middle fossa and one-third in the cavernous sinus. Seventeen (40%) had a large tumour of 40 mm in diameter or larger, and 8 of those had a broad attachment from the clivus to petrous pyramid of the temporal bone. The site of pyramid resection was selected from three types, depending on the tumour location and the patients' pre-operative hearing. There was no surgical mortality. Significant risk of lower cranial nerves palsy was minimal and useful hearing was preserved in 18 out of 21 patients. The follow-up, an average of 4 and a half years, showed tumours were completely eradicated in 32 patients (76%) and there was regrowth in 3 (7%). Thirty-four patients (81%) were independent, 3 disabled and only one died of rapid tumour regrowth. The most influential factor on surgical results was the extent to which the tumour had invaded the brain stem. The presence or absence of arterial encasement and of peritumoural oedema on MRI were important in the selection for radical surgery.

Peripheral myelin P0 protein mediates neurite outgrowth of cortical neurons in vitro and axonal regeneration in vivo

Peripheral myelin P0 protein is a homophilic adhesion molecule of immunoglobulin superfamily to compact myelin structure. In addition to its roles in formation and maintenance of myelin, P0 shows neurite-outgrowth promotion activity of dorsal root ganglions. In this paper, we examined biological activity of P0 in central nervous system (CNS). Neurite outgrowth of cortical neurons of rat embryo was markedly promoted in the co-culture on C6 transformants expressing P0 protein. The neurite outgrowth was not inhibited by the P0-glycopeptide but specifically inhibited by the anti-P0 monoclonal antibody recognizing the extracellular peptide of P0. In in vivo studies, we observed significant axonal regeneration into grafts only in animals implanted with P0-expressing transformants after spinal one-third transection. These results suggest that P0 protein has promoting activity on the neurite elongation in CNS as well as in peripheral nervous system.

Colocalization of growth hormone (GH) and glycoprotein subunit alpha in GH-producing pituitary adenomas in acromegalic patients

Thirty-one consecutive cases of pituitary adenoma in acromegalic patients were studied by immunohistochemistry. All adenomas contained cells immunoreactive with the anti-alpha-subunit of gonadotropic hormones (alpha; 0.6-53% of tumor cells) as well as with anti-growth hormone (GH; 4-74% of tumor cells). In serial section study, most cells immunoreactive with anti-alpha were identical to cells immunoreactive with anti-GH. There was a positive correlation between the percentages of cells immunoreactive for alpha in GH cells [alpha (%)/GH(%)] and those for prolactin (PRL) in immunoreactive tumor cells (PRL(%)/[PRL(%) + GH(%)]) in mixed GH cell-PRL cell adenomas, suggesting that the alpha-subunit may play a role in emergence of PRL cells.

Mixed germ cell tumor of the basal ganglia: a case report

A case of mixed germ cell tumor (germinoma and immature teratoma) of right cranial basal ganglia is presented. We followed the natural course for 8 months, and the change in his clinical, radiologic, and endocrinologic features was remarkable.

[Neurophysiological study of hemifacial spasm--F wave of the facial muscles]

We studied the F wave of the facial muscles on both the normal side and the spastic side in 14 patients with hemifacial spasm. The purpose of this study was to determine if the mechanism of hemifacials spasm originates in ephaptic transmission in the facial nerve at the site of vascular compression or in a hyperexcited facial motor nucleus. Larger amplitude, longer duration and shorter latency F waves in the peripheral nerves than in normals indicate anterior horn cell hyperexcitability. We found abnormal potentials exhibiting synkinesis (lateral spread), a typical electrophysiological finding in hemifacial spasm, in the facial nerve evoked electromyograms of the 14 patients, none of whom had experienced facial palsy or facial nerve block. Electrical stimulation was delivered transcutaneously to the most distal portion of the marginal mandibular branch of the facial nerve. Using surface electrodes the F waves were obtained over the mentalis muscle as the second response after the M wave. While the F waves were normal on the patients' normal side, on the spastic side, their duration was longer (mean duration about 1.9 times that of the normal side), their onset latency was slightly shorter, and their F/M amplitude latency was greater than on the normal side. After microvascular decompression, the facial spasm and abnormal F-wave findings resolved. Onset latency was not increased, and on the spastic side some patients displayed facial spasm clinically and electrophysiologically for one year after MVD. In other words, there was hardly any focal demyelination of the facial nerve, so it is possible that ephaptic transmission and ectopic excitation are the mechanism of HFS.(ABSTRACT TRUNCATED AT 250 WORDS)

A new model for in vivo observation of the feline spinal microcirculation: the closed spinal window

A new experimental model is described that uniquely allows the in vivo observation and quantification of vascular caliber changes on the dorsal surface of the feline spinal cord. The model consists of a rectangular Plexiglas window that is sutured to the lumbar dura and is supported by a special holder. Inlet and outlet tubes attached to the window serve for topical applications of mock cerebrospinal fluid or vasoactive agents to the surface of the cord and for continuous monitoring of intrathecal pressure. Pial vessels below the window were observed at 200-fold magnification with the aid of a microvideo camera. Spinal arterioles reacted to hypercarbia and superfusion with acetylcholine solution in a manner similar to cerebral arterioles. Tests with increased intrathecal pressure showed that the window remained watertight between 25 and 130 mm Hg, with an average leakage pressure of 57.8 +/- 33.5 mm Hg. To promote the use of this model in other laboratories, the authors give a detailed description of the closed spinal window preparation and report their experiences gained from 50 experiments. It is concluded that the closed spinal window is a highly reproducible model, suitable for the study of the feline spinal microcirculation for several hours in vivo.

Glial conditioned medium alters the expression of amyloid precursor protein in SH-SY5Y neuroblastoma cells

The effect of conditioned medium from astroglia or microglia cultures on the mRNA expression of amyloid precursor protein (APP) in SH-SY5Y human neuroblastoma cells was examined. When incubated with conditioned medium of glial cells, SH-SY5Y cells expressed a larger amount of APP mRNA than the control cells. Reverse transcription followed by the polymerase chain reaction showed marked induction of expression of APP isoforms containing a Kunitz-type protease inhibitor domain. Our results suggest that glial cells may contribute to the regulation of expression of APP in neurons.

Serious adverse effects induced by simultaneous administration of two nonsteroidal anti-inflammatory drugs

We have described the case of a 58-year-old woman in whom acute hemolytic anemia, renal failure, and granulocytopenia developed after intake of mefenamic acid and diclofenac. Results of direct and indirect Coombs' tests were negative, but the lymphocyte transformation test was positive for these two nonsteroidal antiinflammatory drugs (NSAIDs). We suggest that the immune complex mechanism could have induced these adverse reactions. Although these drugs are very popular, simultaneous administration should be avoided because serious adverse effects can potentially occur.

Molecular cloning of cDNA encoding human drebrin E and chromosomal mapping of its gene

Drebrins are novel actin-binding proteins in the brain which are developmentally regulated. Three isoforms: two embryonic types (E1 and E2) and an adult type (A) are generated by alternative RNA splicing from a single debrin gene in the chicken brain. A full length cDNA clone of human drebrin E has been isolated from a cDNA library of human fetus brain. The clone is 2596 base pairs in length and contains an open reading frame of 1947 nucleotides encoding a protein of 649 amino acids. The deduced amino acid sequence, except for the internal 138-nucleotide sequence (ins2), exhibits 88% homology with rat drebrin A. Spot blot hybridization using flow-sorted human chromosomes provides evidence that the gene encoding human drebrin protein locates on human chromosome 5.

Epidermoid cysts of the callosal region--three case reports

Three patients with rare epidermoid cyst in the callosal region are described, two adjacent and one in the corpus callosum. Computed tomography revealed atypical features, i.e. a large, well-defined high-density mass unenhanced postcontrast and a well-defined hypodense mass with marginal calcification in one case each. Such a diffuse high-density mass may be caused by hemorrhage, highly concentrated protein or calcification of keratinized debris within the cyst. Marginal calcification may occur for unknown reasons. The cysts were subtotally removed.

Immunohistochemical analysis of 61 pituitary adenomas with a monoclonal antibody to the neuron-specific beta-tubulin isotype

Pituitary adenomas surgically resected from 61 consecutive patients and 9 normal pituitary glands were studied by immunohistochemistry to determine the localization of the class III beta-tubulin isotype(neuron-specific) which is recognized by the monoclonal antibody TUJ1. In normal pituitary glands only a few cells were weakly immunopositive for TUJ1, whereas, in 43(73%) of 61 adenomas, more than 5% of tumor cells were immunopositive. The result may indicate that this neuron-specific beta-tubulin isotype may be either expressed de novo or enhanced under the transformation of pituitary acinar cells to tumors.

In vivo effect of visible light on feline cortical microcirculation

The present study was designed to test the hypothesis that prolonged illumination of the cerebral cortex, for instance during neurosurgical interventions, may affect the pial microcirculation. Experiments were performed with the closed window technique in cats. The cortical surface below the window was exposed to visible, cold light of 61,000 lumens/m2 (lux) over a period of 1 to 5 hours. Pial arterioles reacted with a slight initial dilatation to 106.8 +/- 2.6% of their resting diameter after switching to the high intensity light. Measurements of the cortical surface temperature showed an average temperature increase of 1.5 +/- 0.34 degrees C within the first 10 minutes of illumination. For assessment of pial vascular function, the responses to topical application of acetylcholine (ACh) were tested before and during the illumination period. The effect of sustained illumination on the cortical microcirculation consisted of abolition of the endothelium dependent relaxation due to ACh, and of intravascular thrombus formation, the latter, however, only in the presence of topically applied ACh. The suspected mechanism responsible for these functional alterations is light-induced generation of free oxygen radicals which are known to inactivate or destroy the endothelium-derived relaxing factor (EDRF). Further studies are recommended to elucidate the practical and clinical relevance of these findings to neurosurgical procedures.

Propentofylline (HWA285) inhibits the release of dopamine during transient ischemia and modulates its metabolism in rat striatum

Propentofylline (HWA285) has been reported to protect neuronal cells through the inhibition of glutamate release during transient ischemia. We studied whether HWA285 inhibits dopamine (DA) release, and how HWA285 modulates DA metabolism in the rat model. HWA285 was perfused through a microdialysis probe placed in the rat striatum during 20 min transient ischemia. In rats perfused by HWA285, ischemic DA release was significantly inhibited, and DA metabolism showed better recovery in contrast with unperfused rats.

[Transcranial magnetic stimulation of the facial nerve--identification of the actual excitation site in the cat]

The site where transcranial magnetic stimulation excites the facial nerve was studied in 6 cats. Transcranial magnetic stimulation of the facial nerve was recorded from the left mentalis muscle. A figure-of-eight shaped magnetic coil was used, and coil induction direction had more influence on the facial nerve evoked compound muscle action potentials (CMAPs) than the coil position. No change could be detected in the CMAPs before and after craniotomy, after cerebellar lobectomy and after exposure of the facial nerve in the facial canal. The facial nerve was stimulated electrically at the porus, meatal portion, geniculum and horizontal portion. The latencies of the CMAPs for each portion were measured and compared with the magnetic response, which was coincidental with that of the meatal portion. The facial nerve was then transected distally from the porus, and CMAPs following magnetic stimulation were recorded at each step. The CMAPs disappeared when the nerve was transected at the fundus. The results of both approaches in this study led to the conclusion that transcranial magnetic stimulation excites the facial nerve at the meatal portion.

Prolactin presents in all pituitary tumors of acromegalic patients

Twenty-two consecutive cases of adenoma in acromegalic patients were studied immunohistochemically. All the tumors contained prolactin (PRL)-reactive cells (3% to 53% of the total number of tumor cells) as well as growth hormone (GH)-reactive cells (4% to 74% of the total number of tumor cells). All acromegalic cases studied were thus plurihormonal adenomas containing GH and PRL; no pure GH cell adenoma was present. Twenty cases were further examined at the ultrastructural level in conjunction with postembedding double-labeling immunoelectron microscopy; 15 of these cases were diagnosed as mixed GH cell-PRL cell adenomas. The previously diagnosed pure GH cell adenomas possibly may have contained PRL cells and thus should be considered as mixed GH cell-PRL cell adenomas. Mammosomatotroph adenomas were rare in this series. Double-labeling immunoelectron microscopy, using protein A gold particles of two different sizes, greatly facilitated the distinction among GH, PRL, and mammosomatotroph cells.

[Traumatic intracranial aneurysms after removal of tuberculum sellae meningioma: case report]

Two cases of traumatic aneurysms (TA) of the internal carotid artery (IC) due to removal of tuberculum sellae meningioma (TSM) are presented, and ideal treatment of those aneurysms is discussed. The tumor, compressing the IC laterally, was removed out without arterial injury in case 1. Though the patient's postoperative course was uneventful, frontal and intraventricular hemorrhage developed 2 months after the operation, and an IC dorsal aneurysm was detected. Preoperative angiograms showed no aneurysm, so it was considered to be a traumatic aneurysm due to the surgical procedure. The aneurysm was clipped at once, but postoperative angiograms showed recurrence of the aneurysm. IC balloon occlusion was carried out as the Matas test was negative. In case 2, a small tear in the IC was inadvertently made during recurrent TSM removal, which was wrapped with muscle using fibrin glue. 2 weeks after the operation, frontal hemorrhage developed. Angiograms revealed a small aneurysm of the IC, which was considered to be a traumatic aneurysm. IC balloon occlusion was performed as the Matas test was negative. These 2 patients have had no episodes of rerupture after the IC balloon occlusion. Tumors and main arteries are frequently adhesive, so arteries are easily injured during removal of meningiomas. Muscle wrapping was not enough to prevent TA formation. Neck clipping was not appropriate for treatment of TA, but IC balloon occlusion was an effective and excellent therapy for TA of IC.

[A case of Turner's syndrome associated with moyamoya disease]

A case of Turner's syndrome associated with Moyamoya disease in a 10-year-old female is presented. This patient had experienced two periods of syncope and transient right hemiparesis in 2 years. She was short in stature. She had cubitus vargus and mental retardation. The serum LH and FSH values were high. By chromosomal examination Turner's syndrome (karyotype: 45, X/46, X, i(Xq)) was diagnosed. An MRI (SE 2000/20) revealed abnormal vessels on the basal ganglia. Cerebral angiography showed occlusion of bilateral internal carotid arteries at the distal portion, bilateral posterior cerebral arteries at the proximal portion. Basal moyamoya well developed. EDAS (encephalo-duro-arterio-synangiosis) was performed bilaterally. We consider that this may be the first case report of Turner's syndrome associated with Moyamoya disease, and that there may be no relationship between Turner's syndrome and Moyamoya disease in this case.

[Natural history for residual intracranial AVM: compared with that for conservatively treated AVM]

It is generally accepted that the most suitable treatment of AVM is surgical removal which does not cause neurological deficits. But in some cases, it is impossible to treat surgically because of size or location, so the patient is unfortunately discharged with some part of the nidus remaining. In this paper, we report the natural history of residual AVMs in which part of the nidus remained after initial therapy, and try to ascertain whether therapeutic reduction of the nidus is more effective in preventing intracranial hemorrhage than conservative treatment. Of 362 cases, residual AVMs were found in 35 cases, and were followed up for 9.2 years on average. Eighty cases treated with only conservative therapy were also followed up for 10.9 years on average. The annual risk of intracranial hemorrhage for residual AVMs was 2.9% and that for conservatively treated AVMs was 3.0%, not a significant difference. There was no difference between the two groups in mortality or ADL. We conclude that therapeutic reduction of the nidus was not effective in preventing intracranial hemorrhage.

Glycopeptide of P0 protein inhibits homophilic cell adhesion. Competition assay with transformants and peptides

Expression of major myelin glycoprotein P0 by P0 cDNA transfection into C6 glioma cells promoted homophilic cell adhesion of the cells. After the dissociated cells were incubated for various times, the number of particles at each time point was measured. The total number of particles decreased to 24% in 60 min for transformant (C6P0) cells, in contrast to only 68% for control (C6P0') cells. To confirm the homophilic mechanism of adhesion, mixed-cell aggregation experiments were performed. Among the four synthetic peptides corresponding to a part of the P0 sequence used, only peptide 3 (residues 90-96), which contained a carbohydrate attaching site, caused considerable inhibition of cell aggregation (approximately 50%). In addition, the glycopeptide (residues 91-95) obtained from bovine P0 markedly inhibited cell aggregation (by approximately 85%).

Usefulness of hemilaminectomy for microsurgical management of intraspinal lesions

Hemilaminectomy is a limited, unilateral approach to the spinal cord that provides excellent exposure of the dorsolateral and ventral portions of the spinal canal. This approach is most suitable for microsurgical management of the majority of extramedullary tumors. Contrary to conventional laminectomy, the posterior supporting structures of the spine are completely preserved on the contralateral side with this access route. The procedure has been applied in 3 patients who harbored a cervical neurilemmoma, a cervical lipoma, and a thoracic neurilemmoma, respectively. Optimal exposure of the lesion was achieved in each case, and each patient's symptoms improved or completely resolved postoperatively. There were no surgical complications. It is concluded that hemilaminectomy combined with microsurgical techniques should be given priority over standard laminectomy in the surgical management of extramedullary lesions arising in the spinal canal.

[Radiosensitive malignant meningioma presenting Garcin's syndrome: a case report]

A 58-year-old woman with Garcin's syndrome caused by malignant meningioma is reported. She first noticed left facial hypesthesia followed by left visual disturbance with exophthalmos. CT scan showed an enhanced mass extending from the left cavernous sinus to the left orbit. Cranial x-ray revealed bone deformity around the orbit. The tumor was subtotally resected and its histological type was shown to be anaplastic meningioma. After the initial surgery the patient was left with hyposmia, mild ptosis and incomplete 6th cranial nerve palsy on the left side. After one and half years, not only palsy of those cranial nerves but also that of other unilateral cranial nerves became progressively apparent due to tumor regrowth. In total, 11 nerves (2nd-12th) were affected by the tumor, without long tract signs or symptoms of increased intracranial pressure. Radiation therapy carried out after the 2nd surgery was extremely effective and resulted in the recovery of lower cranial nerve function. The tumor was founded to have disappeared completely on the 2-year follow-up CT.

Primary non-AIDS related brain lymphoma. Patterns of failure following radiotherapy

Thirteen patients with primary brain lymphoma (PBL) were treated with radiotherapy. Three patients also had ocular involvement with retinal masses at initial presentation. All but one patient received conventional whole brain irradiation and, in addition, spinal irradiation, intrathecal methotrexate or orbital irradiation were given in two, two and four patients respectively. The radiation doses for involved sites ranged from 40 to 65 Gy, and for prophylactic sites from 30 to 50 Gy. After radiotherapy, all patients had complete regression of the tumor on computed tomography. Nine patients relapsed, 5 of them with brain recurrence. Two patients had ocular recurrence exclusively as their first relapse. The remaining two relapsing patients had bone lesions. One patient died intercurrently. As a result, only three patients are alive and free of disease after 16 to 36 months and all three received some adjuvant treatment in addition to whole brain irradiation.

Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients

This report presents a new surgical method and the results in 10 patients with petroclival meningiomas extending into the parasellar region (sphenopetroclival meningiomas). Minimal but effective extradural resection of the anterior petrous bone via a middle fossa craniotomy offered a direct view of the clival area with preservation of the temporal bridging veins and cochlear organs. The dural incision was extended anteriorly to Meckel's cave, and in cases with invasion of the cavernous sinus, Parkinson's triangle was enlarged by mobilization of the trigeminal nerve. This approach offered an excellent view from the mid-clivus to the cavernous sinus. Extra-as well as intradural tumor masses and dural attachments could be cleared under direct view of the pontine surface. The risk of injury to the lower cranial nerve and of retraction damage to the temporal lobe and brain stem were kept minimal by this approach. Total tumor resection was achieved in 7 patients, with no resultant mortality. Eight patients had a satisfactory postsurgical course, extraocular paresis being their main complaint. The extent of tumor resection depended on the degree of tumor adhesion to the carotid artery, and operative morbidity on the degree of tumor invasion of the brain stem. Of the 3 patients in whom subtotal tumor removal was achieved, only one experienced regrowth of the tumor and underwent a second operation during the follow-up period (6 months-6 years).

Preservation of facial nerve function in acoustic neuroma surgery by the extended middle cranial fossa approach

The anatomical preservation rates of the facial nerve and postoperative facial nerve function were investigated in cases of initial operation for acoustic neuroma by the middle cranial fossa or extended middle cranial fossa approach. The cases were divided chronologically into three groups according to the date of surgery. The rate of anatomical preservation was 93% in the most recent period, compared to 82.4% for the entire series. This was attributable to higher preservation rates being achieved in cases with medium or large tumors with increased experience. Also regarding postoperative facial nerve function, the number of cases with no paralysis or only partial paralysis increased and the number of cases requiring sacrifice of the facial nerve decreased as experience was accumulated in the series. Even when the facial nerve was preserved anatomically, however, facial-hypoglossal anastomosis was carried out actively if facial nerve function did not recover satisfactorily one year after surgery. For this reason, as many as 33% of the patients underwent anastomosis. This high percentage, however, is attributable to anastomosis ultimately being carried out in 47.7% of the patients in the early period; 22.2% of the patients in the most recent period underwent anastomosis.

Hearing preservation in acoustic neuroma surgery by the extended middle cranial fossa method

The results of attempted hearing preservation were investigated in 160 cases of acoustic neuroma surgery carried out by a team of otologists and neurosurgeons at Keio University Hospital during a 14-year period from 1976 to 1989. Surgery was carried out by the middle cranial fossa (MCF) approach in the earlier cases and by the extended middle cranial fossa (EMCF) approach in the more recent cases. Measurable postoperative hearing was preserved in 20 of the 160 cases. Preoperatively, 22 cases had tumors of 20 mm or smaller in diameter, hearing levels (HL) of 50 dB or lower, and speech discrimination scores (SDS) of 50% or higher; 8 (36%) met these conditions postoperatively. Among those cases with hearing preserved postoperatively, hearing was unchanged from the preoperative level in 9 cases and changed in 11 cases. Total tumor removal was achieved in 19 cases. In one case, part of the tumor was left in order to preserve hearing, but MRI and CT have revealed no change in hearing or tumor enlargement to date, at 4 1/2 years after surgery. Hearing was preserved but progressively deteriorated postoperatively in one case in which the tumor was believed to have been totally removed but there was recurrence and in another case of total resection of neurofibromatosis II. Postoperatively, there were increased incidences of absence of the stapedius reflex, Type V by Békésy audiometry, and prolongation of the IT5, disappearance of Wave V, and no response in measurements of the ABR.

Classification of the extended middle cranial fossa approach

There are several possible operative approaches to acoustic neuroma surgery. Ideally, there should be no need to select among approaches according to tumor size or indications for hearing preservation. The ideal approach should also allow otologists and neurosurgeons to work as a team using the same operative field and achieve functional preservation (facial nerve function and hearing) in a high percentage of cases. In 1977, the authors first reported on the extended middle cranial fossa (EMCF) approach for AN surgery. Based on our 15-year experiences of this approach, we have classified it into 3 types and describe their indications and techniques in the present paper. In addition, we examine the advantages and disadvantages and emphasize its excellent applicability as a team approach for otologists and neurosurgeons.

Results of acoustic neuroma surgery by the extended middle cranial fossa approach

The results of surgery in 160 cases of AN are reported. Surgery was carried out by the extended middle cranial fossa (EMCF) approach in 138 cases and by the middle cranial fossa (MCF) approach in 22 cases. The tumor extended an average of 28.9 mm into the posterior cranial fossa; 42% of the tumors extended 31 mm or more. Mortality was 1.9%. Of the 3 cases of death, two had large tumors of 45 mm and 52 mm each, and one was a case of recurrence. Total tumor removal was achieved in an average of 78.8% of the cases. When the cases were classified by date of operation, the total tumor removal rate in the 60 most recent cases was 93.3%. The rate of facial nerve presentation was 82.4% on average and 93% in the recent cases. Hypoglossal-facial nerve anastomosis was performed in 33% of the cases in which facial nerve function failed to recover for an extended period of time. Among recent cases, however, anastomosis has been carried out in 22% of the cases. Hearing was preserved in 20 cases. Useful hearing was preserved in 8 (38%) of 22 cases. Recurrence was confirmed through surgery in 3 cases. Recurrence was suspected but was unconfirmed in 3 cases.

Ceruminoma with intracranial invasion--case report

Ceruminous gland tumors (ceruminomas), which usually involve the external auditory canal, are rare. A case of ceruminoma invading the temporal bone and histologically proven to be papillary adenoma is presented. The tumor recurred and invaded intracranially after subtotal removal and was finally diagnosed as adenocarcinoma. The importance of early diagnosis and radical treatment is stressed.

Mixed pituitary adenoma and gangliocytoma associated with acromegaly--case report

A gangliocytoma in the sellar region is very rare. We report a case of an intrasellar gangliocytoma complicated by pituitary adenoma presenting with acromegaly. A 52-year-old female was admitted to our hospital with headache, mild acromegaly, and bitemporal hemianopsia, and endocrinological study found a high serum level of growth hormone (GH). A computed tomographic scan revealed a tumor in the sellar region, which was almost totally removed by trans-sphenoidal surgery. Histological examination of the resected specimen showed diffuse, chromophobe-type pituitary adenoma, partially containing cholesterin clefts. Areas of clusters of dysmorphic neurons, adjacent to or mixed with pituitary adenoma, were diagnosed as gangliocytoma. The immunohistochemical examination showed GH-releasing hormone (GRH)-positive dysmorphic neurons and GH-positive pituitary adenoma. We consider that the trophic effect of GRH secreted by the neurons of GRH-producing intrasellar gangliocytoma probably caused the GH-producing pituitary adenoma.

Tetrahydrobiopterin-dependent production of L-dopa in NRK fibroblasts transfected with tyrosine hydroxylase cDNA: future use for intracerebral grafting

In the present study, tyrosine hydroxylase (TH; EC 1.14.16.2) cDNA was transfected into cultured fibroblasts and the production of L-3,4-dihydroxyphenylalanine (L-DOPA) was determined. Type 2 TH cDNA was transfected into fibroblasts (NRK-49F) derived from the normal rat kidney, and the expression of the TH minigene was screened by immunocytochemical staining and immunoblotting analysis with TH antiserum. Several clones of the NRK transfectants that produce TH molecules were obtained. The expressed TH molecules showed high enzyme activity in a complete assay system in vitro. However, L-DOPA was not detected in the cultured cells due to the possible absence of de novo synthesis of (6R)-L-erythro-tetrahydrobiopterin (BH4) in these cells. When BH4 was added to the medium, a large amount of L-DOPA was detected not only in the cells but also in the medium. These findings may aid in regulating the amount of L-DOPA secretion from cells after they are transplanted into the brain.

Xenogeneic neural transplantation: role of vasculature and MHC antigen in immunological rejection

The reconstruction of blood vessels in a graft is one of the important events inducing immunological rejection. First, we investigated the reconstruction of blood vessels in a graft by using a monoclonal antibody against mouse endothelial surface antigen 1. Secondly, the lymphocyte proliferative response to Ia antigen were examined in mixed lymphocyte cultures by using monoclonal antibodies against Ia antigen. The results show that the blood vessels originating in the host tissue inoculate with those originating in the donor graft tissue and that the expression of Ia antigen on the vascular endothelial cells plays an important role in the immunological rejection through sensitization of peripheral lymphocytes.

Mosaic reconstruction of blood vessels in mouse neocortical tissue transplanted into the third ventricle of rat brain

Newborn mouse neocortical tissue was transplanted into the third ventricle of rat brain and the reconstruction and the origin of the blood vessels were investigated by using a monoclonal antibody against mouse endothelial surface antigen-1 (MESA-1). It was clearly demonstrated that some of the blood vessels in the graft originated in the donor mouse neocortical tissue. An India ink perfusion experiment revealed that the blood was supplied to the MESA-1-positive blood vessels. Furthermore, electron microscopic immunohistochemical studies demonstrated the existence of a mosaic reconstruction of blood vessels which consisted of mouse- and rat-derived vascular endothelial cells. It was concluded that the blood vessels originating in the donor tissue and those originating in the host tissue inoculate with each other in the grafted tissue.