[Trigeminal neurinoma with massive extracranial extension, report of a case (author's transl)]

It appears that more than a hundred cases of trigeminal neurinomas have hitherto been reported, but massive extracranial extension of a benign neurinoma into the sphenoid sinus and soft part tissue of the neck is unusual. A 36-year-old woman was admitted to our clinic with complaints of left blindness, vertigo and left nasal stuffiness. Neuroradiological examinations, including plain craniography, angiography and CT, showed a huge mass which destroyed the left middle fossa and extended into the left sphenoid sinus and soft part tissue of the neck. On December 14, 1978, left fronto-temporal craniotomy was carried out, and intracranial portion of the tumor was removed, leaving its extracranial portion intact. Pathological examination revealed benign neurinoma. The postoperative course was uneventful except temporary left total ophthalmoplegia. It was emphasized that, to obtain cure for trigeminal neurinoma, early diagnosis is extremely important, and, for this purpose, CT, including coronal one, was considered to be one of the most useful examinations.

[Intracerebral germinoma developing in the right basal ganglia--report of a case followed up by CTscan and review of the literature (author's transl)]

Recently, a case of intracranial germinoma in the right basal ganglia was experienced in our department. He was a 14-years old boy with left motor hemiparesis. On repeated CT studies (7 times), developmental process of the tumor was observed for about 2 years. The tumor developed from the right putamen and invaded toward it's neighboring area (right basal ganglia, thalamus and hypothalamus). As the tumor grew larger, multiple cysts were formed in the tumor tissue and dislocation of ventricles occurred. On 21 December 1978, right temporal craniotomy was performed and a piece of the tumor was removed. It's tissue was diagnosed as germinoma by pathohistological examination. As the effect of postoperative 60Co irradiation and chemotherapy (Vicristine, CCNU), tumor stain (high density area) on CT scann disappeared and remained only as a well margined low density area. On CT scan in September 1979, recurrence sign was not noted. Clinical features of the germinoma located in the basal ganglia has not been well known, because of it's rarity. As a result of the survey of 7 cases reported in the Japanese literature and our case, it has been made clear that most of them are characterized by motor hemiparesis in the early stage, not accompanied by intracranial hypertension.

Organ of Corti in the human fetus: scanning and transmission electronmicroscope studies

The organ of Corti in the five-month human fetus was studied by transmission and scanning electronmicroscopy. Differentiation of the surface organization of the organ of Corti into a single row of inner and three to four rows of outer hair cells was complete at this stage except at the apical end. The morphological aspects of the hair bundles changed with maturation of the sensory cells; the inner hair cells preceded the outer hair cells in cytodifferentiation at a given location.

[Intracranial mycotic aneurysm--report of a case (author's transl)]

A case of intracranial mycotic aneurysm has been reported. The case was a 26-year-old female and was admitted to our hospital on November 11, 1975. She was semicomatous and showed right hemiplegia. On auscultation systolic murmur radiating from the mitral area to the left axilla was found. Left carotid angiogram showed a saccular aneurysm 5 mm in diameter, arising from peripheral portion of the percentral cerebral artery and accompanied by intracerebral hematoma. Emergency craniotomy was performed. A thin subdural hematoma, coated with pus, was found and microabcesses were seen to be scattered in the nearby subarachnoid space. After aneurysmectomy and removal of intracranial hematoma, the patient improved without complications. On histological examination of the aneurysmal wall, moderate degree of neutrophilic infiltration was found. It was especially marked around the vasa vasorum. Heretofore only eight cases of intracranial mycotic aneurysm have been reported in the domestic literature.

Spontaneous rupture of the esophagus. Report of two cases successfully treated by intravenous high caloric nutrition and review of 59 cases collected from Japanese literature

For the period from 1951 through 1975, 4 cases of spontaneous rupture of the esophagus have been successfully treated at the IInd Department of Surgery, Tohoku University Hospital, Sendai, Japan. Two cases of them conservatively treated with intravenous high caloric nutrition were reported. Fifty-nine Japanese cases of spontaneous rupture of the esophagus were reviewed. Symptoms, diagnosis, treatment and prognosis of the disease were discussed.

Ultrastructural changes of the nerve elements following disruption of the organ of Corti. I. Nerve elements in the organ of Corti

3-137 days after disruption of the guinea pig organ of Corti by perilymphatic perfusion with 20% streptomycin (SM), ultrastructural changes of the nerve fibers in the organ were observed. Most of nerve fibers began to degenerate after a latent period of 4 days. On the other hand, a number of fibers survived reactively enlarged and later developed into myelinated and unmyelinated fibers by becoming enclosed in Schwann cells which entered the organ of Corti through the habenula perforata. Regeneration and sprouting of the surviving nerve fibers also occurred. The fibers became mature, but atrophied after 60 days and then gradually disappeared. The regenerating fibers were mainly of the myelinated and unmyelinated efferent type. Retrograde degeneration occurred in both afferent and efferent fibers. In the less damaged organ of Corti perfused with 2% SM or Ringer's solution, Schwann cell invasion was not found.

[Calcified epidural hematoma-report of a case incidentally found 16 years after head injury (author's transl)]

A calcified epidural hydroma, or old hematoma, was incidentally found in the left parietal region of a 55-year-old man presenting status epilepticus due to uremia after a lapse of 16 years following head injury. The hydroma (10x7x1.2 cm) was extirpated operatirelly. There was an extensive calcificantion in the wall, and the outer wall showed bone-like metaplasia and hemosiderin deposit. No skull fracture was discernible. The dura and the brain surface neighboring the hydroma were gloslsly normal. The patient eventually died of uremia.

[Peripheral arterial aneurysm of the brain occurring after brain abscess extirpation and healing spontaneously-report of a case and review of the literature (author's transl)]

In 33 year-old man an aneurysm of a pheripheral branch of the right middle cerebral artery was disclosed by angiography 8 days after extirpation of a parietotemporal brain abscess. The aneurysm was absent in the preoperative angiogram. Since the site of the aneutysm coincided with the operative field, it is sure that the etiology of the aneurysm was related to operative trauma and/or arteritis. Although inflammatory or mycotic factor could not be excluded from its etiology, it seems reasonable that traumatic factor was major one. The aneurysm was found to have disappeared eventually in the angiogram made on 372th postoperative day. Traumatic aneurysms arising from peripheral branches of the intracranial arteries are very rare. The first case was reported by Krauland in 1949. We collected 32 such cases from the literature. Of the 33 cases including the present one, 5 are iatrogenic. In more than half of the 33 cases, aneurysms were formed within 14 days following head injury. Posttraumatic delayed hemorrhage was found in 15 cases, the hemorrhage occurring within one month following injury in 12 cases. Of 31 cases with known prognosis, 11 died, 6 of them dying of delayed hemorrhage. Aneurysm operation was performed in 21 cases and 15 of them survived. In the present case, aneurysm luckily healed spontaneously. There are two cases including the present one, of spontaneous healing in the 33 cases. We believe surgical treatment is one of choice whenever possible.

[Spinal cord tumor of children--a cured case of infantile spinal cord tumor and review of domestic literature (author's transl)]

Spinal cord tumor of children is a rare occurrence and infancy it is extremely rare. Experience with a 3-month-old female case of intraspinal extradural neurinoma was reported. This is the youngest reported case in the domestic literature. The tumor, which was solid and extended from the level of 11th thoracic vertebra to the /th lumbar vertebra, was successfully removed. Preoperative symptoms, such as sensory and motor disturbances of bilateral lower extremities and urinary and fecal incontinences, disappeared postoperatively. The patient is quite healthy 7 years after the operation. The domestic literature consisting of 73 cases of spinal cord tumor of children was reviewed and statistically observed. Histopathologically, teratoma and teratoid tumors were the major constituents. Neurinoma, which is a major entity in adult cases was observed only in 12 cases (16.4%). In infancy early diagnosis is often difficult due to absence of subjective complaints and, in about half of the reported cases, motor disturbance was the first noticed clinical sign. In the present case, the parents noticed crying of the baby on lifting up the limbs to change diaper and the presence of some sort of sensory disturbance was suggested. Thus in suspicious cases, diagnostic procedures such as myelography should be done in early stage and early operation should be undertaken.

Extraneural metastasis of pineal tumor

The case of an eight-year old male with a pineal tumor is reported, in which metastases occurred to extraneural organs. The pineal tumor consisted of portions of benign teratoma, malignant ependymoma and embryonal carcinoma. Only the embryonal carcinoma metastasized. The intracanial and spinal subarachnoid space alos was invaded by disseminated embryonal carcinoma. There have been seven other similar cases reported. All patients were males from five to 34 years of age.