[Tethered cord syndrome--our three cases and the review of the literature (author's transl)]

Three cases of tethered cord syndrome are presented with reference of reported literatures. This syndrome is usually associated with spina bifida occulta and cutaneous manifestation such as subcutaneous tumor, skin dimple, hairy patch, and neavus. Presented symptoms are various progressive neurological deficits involving weakness and/or sensory disturbance of lower limbs, bowel and/or bladder dysfunction, leg and/or low back pain, and orthopedic pathological conditions such as scoliosis and/or foot deformities. Properly performed myelography is the only method of preoperative confirmation of this syndrome. As the surgical release of the tethered spinal cord is effective for these various symptoms except for foot deformity, early investigation and early surgery are recommended.

Moyamoya disease associated with aneurysm

Five cases of moyamoya disease associated with aneurysm are reported. In three cases, the aneurysms were located at the peripheral portion of the posterior choroidal artery, and in two at the basilar artery. Based on these cases, the symptoms and mechanisms of formation of aneurysms in moyamoya disease are discussed.

Brain tumor in newborn babies

5 cases of brain tumor in newborn babies under 2 months are presented. 4 of them were supratentorial teratoma and originated from the midline, and 1 was a glioma at the cerebelloponitine angle. 2 cases died before surgery and 2 cases after surgery. In our 5th case a benign teratoma of 150 g was removed from the third ventricle. He was discharged and enjoyed rather good health for 2 years and 1 month before dying of recurrence of tumor. Internal hydrocephalus associated with the huge tumor was responsible for the sudden deterioration of general condition. Therefore, shunting procedures should be performed as the first aid. However, in our experiences, the conditions at admission were the critical and/or too late to be beneficial. Thus early diagnosis is absolutely necessary for surgical treatment. A summary and discussion of the data of 103 previously reported cases are included.

[Electroencephalography of Moyamoya disease]

Attempts were made to evaluate the EEG findings in 16 children and 12 adults with Moyamoya disease. (1) The children revealed specific findings such as hemispheric posterior slow (HP slow), centrotemporal slow (CT slow) and re-build-up after the end of hyperventilation. (2) HP slow was mainly observed in EEG examined within one year after the initial onset. In children in whom EEG was performed more than three years after the onset, chronic suppressive findings were found on EEG. (3) Buildup after the end of hyperventilation was revealed in almost all the children, which we called "Re-build-up". (4) No specific findings were verified on EEG in adult Moyamoya, beside slight abnormalities.

[Cerebrovascular moyamoya disease associated with basilar aneurysm (author's transl)]

Two adult cases of cerebrovascular Moyamoya disease, associated with basilar aneurysm are reported. At the follow-up study of angiogram performed 14 months later in one case, the aneurysmal shadow was slightly larger than before. In the other case, craniotomy was performed and two aneurysms were confirmed to be the saccular aneurysms arising from the basilar head and superior cerebellar artery junction, respectively. From these facts, it is suggested that these aneurysms were not pseudo-aneurysms but sacuular aneurysms. As for the pseudo-aneurysm associated with cerebrovascular Moyamoya disease, we discussed in our previous report. It has been generally through that the mechanism of the occurence of symptoms in adult patient with cerebrovascular Moyamoya disease is due to rupture of abnormal vessels in the subarachnoid space. But from our experiences, it is suggested that there should be another mechanicsm, which begins with rupture of these basilar aneurysms. In addition to that, the growing mechanisms of basilar aneurysm associated with cerebrovascular Moyamoya disease is discussed.

[Cerebrovascular moyamoya disease associated with aneurysm at the peripheral portion of the posterior chorioidal artery (author's transl)]

Three adult cases of cerebrovascular Moyamoya disease associated with aneurysmal shadow at the peripheral portion of the posterior choriodial artery are reported. According to the follow-up study of carotid angiograms, this aneurysmal shadow is considered to be a pseudo-aneurysm, which indicates a bleeding point in the brain tissue. It has generally been thought that the mechanism of the occurrence of the symptom in adult patient with cerebrovascular Moyamoya disease is due to rupture of vessels in the subarachnoid space on the brain surface. But from our experience, it is suggested that there should be another mechanism, beginning with rupture of vessels in the brain tissue.

Persistent hypoglossal artery associated with aneurysms. Report of two cases

Two cases of persistent hypoglossal artery associated with aneurysm are presented. In one case the aneurysm arose from the anterior communicating artery and in the other from the persistent hypoglossal artery itself. Both aneurysms were treated successfully with direct surgery.

[Homonymous hemianopsia due to chiasmal compression by intracranial aneurysm (author's transl)]

Eight cases of homonymous hemianopsia due to chiasmal compression by intracranial aneurysms have been reported in the literatures. Two similar cases were experienced in our clinic and reported. Of the total 10 cases, 8 were giant aneurysms--over 2 cm in diameter--and 9 cases were aneurysm developing medially from the internal carotid artery. Visual disturbances in all the 10 cases were incongruous homonymous hemianopsia without macula sparing. It should be noted that the existence of aneurysm is possible, in patients with homonymous hemianopsia, even when there is no other clinical evidence of mass lesion.

An attempt to treat cerebrovascular 'Moyamoya' disease in children

Moyamoya formations at the base of the brain are not congenital vascular malformations but represent collateral pathways associated with chronic progressive stenosis of the carotid fork. The authors have studied 44 personal cases, 18 children under 15 years of age, and 26 adults. In children the Moyamoya vessels change through six stages: (1) carotid fork stenosis; (2) progressive carotid stenosis with initial Moyamoya collaterals and dilatations of cerebral arteries; (3) dilatation of Moyamoya collaterals and disappearance of anterior and middle cerebral arteries; (4) thinning of Moyamoya; (5) contraction of Moyamoya and disappearance of posterior cerebral arteries; (6) intracerebral vessels perfused from the external carotid and/or vertebrae. These six stages are not observed in adults. Bilateral cervical perivascular sympathectomy (PVS) was performed in 9 children and superior cervical ganglionectomy (SCG) was added unilaterally in 4 and bilaterally in 3 cases. Angiographic follow-up studies were carried out 1-7 years following surgery. Improvement was observed in most of the cases examined within the first 2 months after surgery. This was not the case in arteriograms performed more than 6 months postoperatively. It would seem that PVS and SCG can improve the progress of Moyamoya vessels but only for a short period of time. Clinical symptoms, however, seem to continue improving over a long period of time. Cerebral blood flow improved 5 weeks following surgery in a 13-year-old boy.