Immunohistochemical studies on mouse cerebral cortex grafted into the third ventricle of rats treated with cyclosporin A

Newborn mouse cerebral cortex was transplanted into the third ventricle of an adult rat brain. After the operation, the immunosuppressant cyclosporin A was administered daily for two weeks, and the grafted tissue was examined immunohistochemically at the 4th week. Neurons, astroglias and oligodendroglias were positively stained by antibodies against neurofilament, glial fibrillary acid protein and 2',3'-cyclic nucleotide 3'-phosphodiesterase (CNPase), respectively. The CNPase staining indicated that myelination had occurred in the grafted tissue. Thus both neuronal and glial elements in the grafted tissue could survive and mature in the third ventricle of the different species upon administration of cyclosporin A.

Cyclosporin A enhances the survivability of mouse cerebral cortex grafted into the third ventricle of rat brain

The effect of the immunosuppressant cyclosporin A on the survivability of newborn mouse cerebral cortex transplanted into the third ventricle of adult rats was investigated. Hematoxylin staining revealed that the transplanted mouse brain tissue was rejected by 4 weeks after the transplantation in the control group. In contrast, a large mass of grafted tissue was clearly detected in the third ventricle even 4 weeks after the transplantation in the cyclosporin A-treated group, and the grafted tissue was heavily stained with Thy-1.2 mouse monoclonal antibody. The results indicate that cyclosporin A is an effective immunosuppressant in neuronal transplantation as well as in transplantation of other organs.

[Blood-brain barrier opening microcirculation in human brain tumor]

The changes of the human tumor microcirculation after blood-brain barrier (BBB) opening was studied. BBB opening was performed by retrograde injection of hyperosmotic solution, such as mannitol or glycerol, from superficial temporal artery in the operation procedure. Serial fluorescein micro angiography of human tumor surface was taken by motor-driven camera equipped to surgical microscope. Two glioblastomas, two astrocytomas and one metastatic tumor were studied. In glioblastoma multiforme, after BBB opening, fluorescein sodium perfusion was increased with the enlargement of the venules and extravasation of fluorescein sodium was also observed from venules by the late venous phase of fluorescein microangiography. In low grade astrocytoma, after BBB opening, fluorescein sodium perfusion was relatively decreased in the vasculature which diameter was from 5 micron to 10 micron and no extravasation of fluorescein sodium was observed from the venules. In metastatic brain tumor, extravasation of fluorescein sodium was observed, ever before BBB opening, especially from arterial capillary or venous capillary. After BBB opening, extravasation of fluorescein sodium from those capillaries was increased and the tumor staining of fluorescein sodium was observed after BBB opening. But in low grade astrocytoma, BBB disruption was not observed. The effect of BBB disruption was more marked in malignant tumor, but little effect was observed in low grade astrocytoma and normal brain tissue. The degree of BBB disruption is depend on the volume and speed of hyperosmotic solution. Using our methods of volume and speed, we could observed the different BBB disruption according to the malignancy of the tumor. The difference of BBB reaction to hyperosmotic solution between low grade astrocytoma and malignant tumors is their stability of the BBB.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of concomitant posterior fossa and supratentorial hemangioblastomas]

The patient was a 31-year-old female who complained of headache and gait disturbance and admitted to our hospital on January 14, 1983. Familiar history revealed that her mother died of hemorrhage from hemangioblastoma in area postrema. Neurological examination revealed bilateral papilledema, right cerebellar sign and ataxia. Other neurological and clinical examinations were normal. CT-scan showed a right cystic cerebellar lesion and a right intraventricular lesion suggestive of hemangioblastomas. Right vertebral angiography demonstrated two vascular tumors lying in the right cerebellar hemisphere and right trigone of the lateral ventricle. Operation was performed on January 28, 1983. The histological diagnosis were hemangioblastomas.

Wilms' tumor with intracranial metastases presenting with intracranial hemorrhage

Intracranial metastasis of Wilms' tumor is very rare. Furthermore, intracerebral hemorrhage is an unusual presentation of metastases. We report the case of a 4-year-old girl who had multiple intracranial metastatic lesions, initially presenting as an intracranial hemorrhage. Removal of the tumors and hematoma was followed by radiation therapy and chemotherapy. Thereafter, complete remission occurred. It is thought that this malignant tumor with metastases may be curable through combined therapy.

Experimental study on changes of the spinal-evoked potential and circulatory dynamics following spinal cord compression and decompression

In an attempt to elucidate the pathogenesis of spinal cord injury, the authors investigated the changes in spinal-evoked potential (SEP) and serial fluorescein angiography during compression and after decompression of the thoracolumbar cord in dogs. The degree of compression was correlated well with the changes in SEP during compression and after decompression. The findings of serial fluorescein angiography immediately after decompression indicated hyperemia and extravasation of the fluorescein dye, especially in the group weighted with 36 and 60 g. Poor filling of the arteries and veins with fluorescein dye, and prolongation of the regional circulation time were observed at between 30 and 120 minutes after decompression in the group weighted with 36 and 60 g. These findings suggest that secondary circulatory disturbance plays an important role in the pathogenesis of spinal cord injury. The relation between changes of SEP and the circulation are also discussed.

Characteristic findings of metrizamide CT cisternography in epidermoids

The characteristic findings of metrizamide CT cisternography in two cases of epidermoid are reported. The main finding was a "cauliflower-like" appearance and was thought to be caused by the irregular interstices of epidermoids. Metrizamide CT cisternography may be helpful in making a diagnosis of an epidermoid.

Experimental study on the circulatory dynamics of the spinal cord by serial fluorescein angiography

The circulatory dynamics on the dorsal surface of the spinal cord were observed by serial fluorescein angiography . Fluorescein dye appeared in the posterior spinal artery and pial arterial plexus, although the direction of blood flow might be opposite and the time taken for fluorescein dye to enter the arteries was different for each. Fluorescein dye appeared in the veins after various periods, and the directions of flow of the dye were also variable and complicated. Laminar flow often was observed in veins of less than 200 microns in diameter. The regional circulation time was calculated to be 2.1 +/- 0.4 seconds. There was no extravasation.

Intracerebellar hemorrhage due to rupture of angiomatous malformations in the cerebellum

Two infants were reported with intracerebellar hemorrhage due to rupture of angiomatous malformations in the cerebellum. There have been only a few reports on intracerebellar hemorrhage under 6 years of age, which was due to angiomatous malformation in all cases. The results of operations for intracerebellar hemorrhage in infants were more favorable than those in adults, so even if the infant patient shows severe neurological symptoms preoperatively, an operation should be performed.

[A case of primary malignant lymphoma of the brain which showed a remarkable response to prednisolone]

We have recently had a case of a patient with primary malignant lymphoma in whom the diagnosis was difficult and prednisolone was remarkably effective. The patient was a 59-year-old man. Mental signs developed rapidly over a period of approximately 1 month. On admission, he was confused; his orientation was disturbed and his impressibility and understanding were markedly decreased. CT scan on admission revealed a remarkable enhancement of a nodular high density area in front of the lateral ventricles, accompanied by a surrounding diffuse low density. Angiography failed to reveal a tumor stain. When prednisolone was administered to the patient, the high density area disappeared and neurological findings returned to normal. After that, left hemiparesis occurred twice and disappeared following the administration of prednisolone. After that, however, he was readmitted to our hospital because his left hemiparesis advanced rapidly. CT scan revealed a high density area in the right basal ganglia. It also decreased in several days after the administration of prednisolone. Malignant lymphoma was strongly suspected by operation. He was then readmitted to our department because of a gait disturbance, decrease in impressibility, and incontinence of urine about one year and a half after onset. CT scan revealed symmetrical ventricular dilatation. Although a shunt procedure was considered, gastrointestinal bleeding occurred, followed by rapid deterioration of his general condition and neurological signs. CT scan 2 days before death revealed a mass lesion in the left basal ganglia. Autopsy revealed that a gelatinous tumor, primarily in the left basal ganglia, was verified macroscopically, but that there was no specific tumor at any other site. Light microscopic examination revealed a diffuse infiltration of tumors cells around the blood vessels in the subependymal area of the lateral ventricle. Because tumor cells were not verified in any other organ, primary malignant lymphoma of the brain was considered. These results suggest that in the development of malignant lymphoma, once a mass lesion is formed, it is widely invasive especially along blood vessel walls. As far as we know, there have been no reports which describe a tumor decreasing or disappearing on CT scan following administration of steroid hormone alone.

Spontaneous carotid-cavernous fistula during pregnancy or in the postpartum stage. Report of two cases

The authors report two cases of spontaneous carotid-cavernous fistula that occurred during pregnancy. One patient was a 21-year-old woman whose symptoms improved and in whom disappearance of the carotid-cavernous fistula was confirmed by cerebral angiography after she aborted in the 12th week of pregnancy. The other patient was a 25-year-old woman in whom a carotid-cavernous fistula occurred at about the 28th week of pregnancy. The symptoms became aggravated 3 weeks after a normal delivery. Carotid-cavernous fistula was confirmed by cerebral angiography, and the clinical symptoms then improved. On the basis of cerebral angiographic findings, both patients were considered to have dural arteriovenous fistulas in the region of the cavernous sinus and both demonstrated spontaneous improvement.

Acoustic neuroma surgery. Translabyrinthine-transtentorial approach via the middle cranial fossa

In our approach for acoustic tumors, the method of Morrison and King and that of Bochenek and Kukwa have been modified into one method. This modified method is basically a neuro-otological-neurosurgical team approach, extending the operative field by drilling the temporal bone and cutting the superior petrosal sinus, tentorium, and posterior fossa dura according to the size of the tumor. Therefore, for tumors slightly protruding into the posterior fossa from the prous of the internal auditory canal, only the bone adjacent to it is removed (Bochenek et al's method). For larger tumors, labyrinthectomy and mastoidectomy with the separation of the superior petrosal sinus and the tentorium and posterior fossa dura are also performed. In Morrison et al.'s method, the translabyrinthine approach is done first and the middle cranial fossa approach is performed thereafter. In contrast, in the modified method, drilling the bone from the middle cranial fossa to the tip of the mastoid--labyrinthectomy and mastoidectomy--is the first thing done after elevating the temporal lobe and revealing the middle cranial fossa, and the internal auditory canal is opened thereafter. Thirty-five cases of acoustic tumors and other cerebello-pontine angle tumors were operated on during the past 3.5 years through the middle cranial fossa. Among 30 cases of acoustic tumors, eight cases in which the tumors were confined to the internal auditory canal were operated on through the middle cranial fossa. In four cases, Bochenek et al's method was performed in which bones adjacent to the internal auditory canal and a part of the labyrinth are removed without cutting the superior petrosal sinus. In 23 cases including five cerebellopontine angle tumors, the modified translabyrinthine-transtentorial approach through the middle cranial fossa was done. This modification has the advantage that severe postoperative complications are less frequent. The surgical technique and the results are discussed.

Acute effect of the carbon dioxide laser on the epicerebral microcirculation. Experimental study by fluorescein angiography

The effect of laser radiation on the central nervous system has been studied in cases of clinical and experimental tumors. However, no report yet exists on the effects of laser radiation on the cerebral microcirculation in vivo. Cerebral fluorescein angiography permits observations of small vessels that are not possible by conventional angiography. In this study, disturbance in the epicerebral microcirculation after carbon dioxide laser radiation was localized. On fluorescein angiograms, a circular zone of nonfilling of fluorescein dye around the site of impact, 1 to 1.5 mm in diameter, was seen throughout from the arterial to later venous phase. Around the nonfilling area, thrombus formation in small vessles and extravasation of the dye were demonstrated. Such extravasation of the fluorescein remained after the dye had faded from the venules and veins. Microscopically, coagulation necrosis was observed to coincide with the area of nonfillin of fluorescein dye in the fluorescein angiograms. In areas surrounding this, edema, dilatation or rupture of the capillaries, and thrombus formation in the arterioles were observed. Such areas coincided with those of extravasation of the fluorescein dye.

Ultrastructure, immunohistochemistry and hormone release of pituitary adenomas in relation to prolactin production

Fifteen cases of pituitary adenoma, 14 of which were associated with hyperprolactinemia, were studied by observation and granule morphometry of electron micrographs, immunohistochemistry and sequential observation of in vitro release with regard to hormone production, storage and secretion. Adenoma cells of 6 cases with marked elevation of plasma prolactin were sparsely granulated, showed characteristic ultrastructures including the presence of small secretory granules, well developed Golgi and rough membranes, misplaced exocytosis, and positive or negative immunostaining for prolactin. These adenomas also showed vigorous release of the hormone into the circulation and/or culture medium. In vitro studies showed that negative immunostaining of adenoma cells did not preclude the production and secretion of the hormone. One densely granulated adenoma containing cells with numerous lactotroph type granules showed moderate release of prolactin into the circulation. In an acromegalic case associated with both high plasma growth hormone and prolactin, some cells were shown by immunohistochemistry to store both hormones There were 4 adenomas which could not be shown to produce, store and secrete prolactin by any method available.

Surgery of posterior communicating artery aneurysms that enlarge after common carotid ligation. Report of two cases

Two patients are reported who were originally treated by ligation of the common carotid artery for ruptured aneurysms of the posterior communicating artery. Long-term follow-up studies showed that the aneurysms had enlarged, and direct surgery of the aneurysms was undertaken.

Radioimmunoassay of alpha-fetoprotein in children with primary intracranial tumors

Serum alpha-fetoprotein (AFP) was measured in 10 cases of primary brain tumors in children (4 cases of medulloblastoma, 4 cases of germ cell tumor and 2 cases of astrocytoma). As a result, elevation in AFP was observed only in a case of embryonal carcinoma that showed partial mixture of germinoma. The absence of AFP elevation in 3 other cases of pure germinoma (atypical teratoma; pinealoma) agrees with reports which describe that, in the germ cell tumor of the gonads, a rise in AFP is not observed in pure seminoma but is found in embryonal carcinoma and endodermal sinus tumor (yolk sac tumor). The fluctuations in AFP in serum and cerebrospinal fluid are considered to be of significance in the diagnosis and treatment of primary intracranial malignant germ cell tumors.