[Follow-up study of malignant astrocytomas showing complete response after initial treatment]

The prognosis for patients with malignant astrocytomas is still poor. The identification of groups of patients with good prognostic factors should be helpful in selecting the treatment strategies. In general, important prognostic factors are thought to be the extent of surgical resection required, age, performance status, duration of symptoms, location, and pathological tumor grade. The purpose of this present study is to evaluate the prognosis of patients with complete response (CR), that is, complete disappearance of the tumor mass in the contrast enhancement of computerized tomography (CT) scan after initial treatment. An additional purpose is to examine the effect of factors such as pathological tumor grade, location, age of patient, and the extent of surgical resection in achievement of CR. The subjects of the study were 81 patients with supratentorial malignant astrocytomas (45 males, 36 females) treated with surgical resection and radiochemotherapy in our division since 1980, and followed up for more than 5 years. There were 57 anaplastic astrocytomas (WHO grade III) and 24 glioblastomas (WHO grade IV). The extent of surgical resection and the response to the therapy were evaluated by CT scans. The Kaplan-Meier method was used in generating survival plots. Twenty-two cases (27%) showed CR at the end of the initial treatment, and the other 59 cases (73%) showed Non CR. Fifteen cases (26%) among 57 grade III patients and 7 cases (29%) among 24 grade IV patients showed CR. Tumor locations of CR cases were exclusively superficial with the exception of one case that involved deep structure. Average age of CR cases and Non CR cases were 34.4 and 49.7, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Multilobulated cystic formation in the brain stem with Benedikt's syndrome: case report

A 26-year-old man presented with an unusual multilobulated cystic formation in the brain stem with normal pressure hydrocephalus, followed by fluctuating cyst volume and Benedikt's syndrome. Ventriculoperitoneal shunting to relieve the hydrocephalus caused an increased cystic size, resulting in worsened neurological deficits. Cystectomy and an additional shunt resolved the symptoms. Immunohistochemical and electron microscopic examinations of the surgical specimen revealed no epithelial lining but numerous astrocytic processes on the luminal surface, probably resulting from expansion of the cyst. This case suggests that cystectomy before shunt emplacement is recommended in similar cases.

[A case of intracranial osteochondroma originating with psychomotor epilepsy]

A 28-year-old woman was admitted to our clinic due to psychomotor epilepsy. Craniogram, CT scan demonstrated a calcified lesion in the frontal, parasagittal region. MR proton images showed a mixed hyper-and hypodense lesion. The tumor originated from the frontal bone and was totally removed using airdrill safely. Histological findings revealed osteochondroma originating in the frontal bone is rare, and diagnostic procedures and surgical management of this tumor are discussed.

Gamma knife radiosurgery of a series of only minimally selected metastatic brain tumours

From December 1991 to October 1992, 77 lesions in 25 consecutive patients were treated with Gamma Knife radiosurgery. Thirteen patients (52%) had multiple metastases up to sixteen lesions and twelve patients had a single metastasis. The volume of the largest tumour treated was 12.5 cm3. Karnofsky performance status (KPS) of the patients was 20-90% (mean 70). Marginal tumour dose given was 18 to 35 Gy (mean 26.1 Gy) in 30 to 90% isodose line according to the tumour volume and site. All but two patients were followed by MRI or CT scan repeatedly for a minimum of 6 month or to death. All but one of the tumours were locally controlled. Seventeen patients died during follow up and in four death was due to remote CNS metastases. The median survival for this minimally selected group of patients was 8.5 months, and the median survival for the patients with a single metastasis was 10.5 months. In patients with multiple metastases the median survival reached only 2.5 months but in 11 patients out of 13 patients neurological symptoms and signs improved or stabilized shortly after radiosurgery.

Thyroxine 5-deiodinase in human brain tumors

To determine whether human brains contain deiodinating pathways, we studied the activity of T4 5-monodeiodinase (5-D) in 20 human brain tumors obtained intraoperatively, including astrocytoma (10), meningioma (4), oligodendroglioma (2), glioblastoma (2), medulloblastoma (1), and malignant lymphoma (1). Mitochondrial-microsomal fractions prepared from these tumor tissues were used as the source of T4 5-D. Each sample was incubated with 32.2 nmol/L T4 and 30 mmol/L dithiothreitol at 37 C for 90 min. T4 5-D activity was measured by the production of rT3 from T4 with a RIA. T4 5-D activity was found in 6 of 10 astrocytomas, 2 oligodendrogliomas, 1 of 2 glioblastomas, and 1 malignant lymphoma. This activity depended on protein concentration, incubation time, incubation temperature, and pH of the incubation mixture. It was also heat labile. T4 5-D was not inhibited by 1 mmol/L propylthiouracil, but was inhibited by iopanoic acid and aurothioglucose in a dose-dependent manner. The apparent Km and maximum velocity for T4 5-D at 30 mmol/L dithiothreitol were 106.6 nmol/L and 22.7 pmol/mg protein.h, respectively. These data suggest that human gliomas (and probably malignant lymphomas) contain T4 5-D activity, which is similar to type III enzyme activity in the rat. T4 5-D may regulate the intracellular concentration of thyroid hormone in gliomas.

Huge multilobular cavernous angioma in an infant: case report

The authors encountered a rare case of multilobular cavernous angioma arising from the paraventricular region in an infant. Total resection of the angioma, which was 8 cm in diameter, was performed. The patient showed no neurological deficit. Although 22 cases in infants have previously been reported, this is the largest cavernous angioma and it is especially rare because of its multilobular configuration.

Neonatal medulloblastoma

A 9-day-old female presented with a large infra- and supratentorial medulloblastoma was treated by surgery, irradiation and chemotherapy. The infant suffered from vomit a few days after birth. She was hospitalized shortly thereafter, when head enlargement was noted. A CT scan taken on admission disclosed a large mass lesion in the cerebellum, extending to the pineal portion, and marked hydrocephalus. At the age of 14 days, the patient underwent ventriculoperitoneal shunting. When she was 67 days old, the tumor was radically resected. The histopathological diagnosis was medulloblastoma. Post operatively, she was irradiated with 30 Gy to the whole brain and 20 Gy to the tumor site. As chemotherapy, ACNU, 1-(4-amino-2-methyl-5-pyrimidinyl-3-(2-chloroethyl)-3-nitrosourea 1 mg/kg was administered twice per 6 weeks. On discharge at 7 months, her only neurological deficit was nystagmus. One week later, she could not move her legs and was readmitted. A CT scan showed no intracranial changes, but the spinal cord was swollen at Th12-L5 level. Myelography demonstrated a filling defect at the L3-5 level. Following irradiation of the spinal cord, the paraparesis gradually improved. However, her general status was deteriorating and a follow up CT scan revealed recurrence of the intracranial tumor. The patient died at the age of 9.3 months which is longer survival time than previous reported one. Neonatal brain tumors are rare, and there have been only 24 cases of neonatal medulloblastoma. The prognosis for these patients is extremely poor, regardless of treatment. Surgery, radiation and chemotherapy for neonatal medulloblastoma are discussed.

Overexpression and amplification of alpha-PDGF receptor gene lacking exons coding for a portion of the extracellular region in a malignant glioma

Overexpression of the alpha-Platelet Derived Growth Factor Receptor (alpha-PDGF) gene was detected in a case of malignant glioma. This overexpression was accompanied with amplification of rearranged alpha-PDGF receptor gene. We have isolated a cDNA for the transcript derived from the amplified receptor gene. Characterization of the cDNA revealed a deletion of 243 nucleotides coding for 81 amino acids in the extracellular region of the receptor. This in-frame deletion removed a part of the immunoglobulin-like domains in the extracellular region of the receptor. Analysis of the amplified alpha-PDGF receptor gene in the glioma indicated that exons coding for the 81 amino acids were lost by a gene deletion. The gene amplification was also detected in macroscopically normal cortex adjacent to the glioma from the same patient. However, the amplified gene in the macroscopically normal cortex had no major gene rearrangement. These data suggest that the overproduction of structurally altered alpha-PDGF receptor may take part in the onset and the development of malignant glioma.

Treatment results by uneven fractionated irradiation, low-dose rate telecobalt therapy as a boost, and intraoperative irradiation for malignant glioma

The prognosis of malignant glioma is extremely poor. We applied conventionally fractionated irradiation combined with 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea (ACNU), uneven fractionated irradiation with ACNU, low dose rate telecobalt therapy as a boost, and intraoperative irradiation against 110 malignant gliomas to investigate the efficacy of these methods as alternative treatments for malignant glioma. Although local tumor control by uneven fractionated irradiation was better than that by the other methods, no significant improvement was obtained in survival rates. As a result of multiple regression analysis, age and histology were major factors for survival rates, and the difference of treatment methods was not important. Both low-dose rate telecobalt therapy as a boost and intraoperative irradiation showed little advantage because of the high risk of brain necrosis associated with them.

Radioresponse and prognosis of malignant glioma

Radioresponse and prognosis of 91 malignant gliomas were studied to examine the efficacy of radiotherapy. There was no case of complete response. No statistically significant difference was observed among the prognoses of patients with various radiation methods. General survival rate was significantly higher than relapse-free survival rate both in astrocytoma grade III and in glioblastoma. This means that the retreatment after relapse is exceedingly important in any malignant glioma. In comparison with reported resection alone data, the efficiency of radiotherapy was evident in astrocytoma grade III and a part of glioblastoma; cases with minimal or no contrast enhanced area (CEA) in CT scans prior to irradiation. Poor radioresponders of glioblastoma with CEA should be reoperated.

Amplification of alpha-platelet-derived growth factor receptor gene lacking an exon coding for a portion of the extracellular region in a primary brain tumor of glial origin

In a primary brain tumor of glial origin, we found overexpression of the alpha-platelet-derived growth factor (alpha-PDGF) receptor mRNA. Southern blot analysis of the gene revealed amplification of the rearranged alpha-PDGF receptor gene in the glioma. A cDNA coding for an aberrant transcript from the amplified receptor gene was obtained and characterized. Partial nucleotide sequence analysis of the cDNA revealed a deletion of 243 nucleotides coding for 81 amino acids in a portion of the immunoglobulin-like domains of the extracellular region of the receptor. cDNA polymerase chain reaction (PCR) of the total cellular RNA in the glioma indicated that more than 80% of the transcripts have a deletion of 243 nucleotides. Analysis of a PCR-amplified DNA fragment derived from the amplified alpha-PDGF receptor gene in the glioma revealed that an exon coding for the 81 amino acids was removed by a 2.1 kb gene deletion. We also found amplification of the alpha-PDGF receptor gene in macroscopically normal cortex adjacent to the glioma from the same patient. The amplified gene in the macroscopically normal cortex has no major gene deletion, suggesting that gene amplification is not sufficient for the development of malignant gliomas.

Methylated cytosine level in human liver DNA does not decline in aging process

In order to ascertain a generality of the age-dependent decrease in DNA methylation level among different mammalian species, methylated cytosine contents in human liver and spleen DNA at different ages have been determined using high performance liquid chromatography (HPLC). Unexpectedly, the liver DNA revealed no appreciable decline with age while the spleen DNA showed a slight reduction. It indicates that a decrease of methylation level in genomic DNA is not a common denominator of age-related changes in mammals.

Brain tumors predominantly express the neurofibromatosis type 1 gene transcripts containing the 63 base insert in the region coding for GTPase activating protein-related domain

Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disorder. A part of the gene for NF1 was cloned and its deduced protein has a domain functionally related to mammalian ras GTP-ase-activating protein (GAP). Human tissues examined express two types of NF1 mRNAs: an originally identified species of NF1 mRNA (type I) and another one containing the 63 base insert in the region coding for GAP-related domain (type II). However relative levels of both mRNAs seem to change under certain conditions. Human brain expresses type I mRNA predominantly, while type II is preferentially expressed in most primary brain tumors (13/16 tumors analyzed). We suggest that higher levels of type II mRNA may be related to the genesis of brain tumors.

[Aneurysms of the distal posterior inferior cerebellar artery; the report of 10 cases]

Non mycotic and non traumatic distal posterior inferior cerebellar artery (PICA) aneurysms are rare, but eleven aneurysms in ten cases were reported. They all originated from subarachnoid hemorrhage due to rupture of these aneurysms. The patients in these cases were all admitted within 5 days after the onset. The neurological state of four cases on admission was grade 4 or 5 in Hunt and Kosnik's grading system. Two patients of grade 5 died within 24 hours after the onset. The CT scan on admission revealed heavy subarachnoid hemorrhage mainly in the posterior fossa. In severe cases, ventricle hematoma, cerebellar hematoma and/or subdural hematoma were evident in the posterior fossa. The locations of these eleven aneurysms were as follows: On the bifurcation of the Telovelotonsillar segment in six cases. In the cortical segment in three cases. In the anterior medullary and tonsillomedullary segment in one case. Six saccular aneurysms were situated on bifurcations of parent arteries but three saccular aneurysms did not arise from bifurcations. Two of them were not from turning points of the arteries. One fusiform aneurysm situated on the bifurcation of telovelotonsillar segment was excised, and histologically shown to be a dissecting aneurysm with hypoplasia of elastic lamina and tunica media in the parent artery. Three cases were associated with small AVM located on the superior surface of the cerebellar vermis and fed mainly by the superior cerebellar artery (SCA) in two cases, and by SCA and PICA in one case. In these cases the hemodynamic stress on PICA did not seem to increase so remarkably.(ABSTRACT TRUNCATED AT 250 WORDS)

[Dissecting aneurysm of distal posterior inferior cerebellar artery--case report and review of the literature]

A rare case of dissecting aneurysm of distal posterior inferior cerebellar artery (PICA) is reported. A 51-year-old woman was admitted to our hospital complaining of severe headache and nausea. CT scan revealed subarachnoid hemorrhage which was thicker in the posterior fossa. The vertebral angiography demonstrated an aneurysm on the telovelotonsillar segment (Lister's classification) of the left PICA. On the third day, the left suboccipital craniotomy was performed and the fusiform aneurysm was resected. The postoperative course was uneventful. Histological examination of the resected aneurysm showed a dissection between the ruptured elastic lamina and the tunica media. Dissecting aneurysm of distal PICA is still belong to a rare entity. In all three cases found in the literature, the dissecting aneurysms are sited in the anterior medullary segment of PICA. Probably, this is the first report described a dissecting aneurysm on the more distal part-telovelotonsillar segment of PICA. The clinical features, pathogenesis and treatment of intracranial dissecting aneurysms are briefly discussed with reviewing the literature.

Early CT features of ruptured cerebral aneurysms of the posterior cranial fossa

This report describes our retrospective evaluation of CT features of the acute phase in 34 cases of ruptured cerebral aneurysms of the posterior cranial fossa. The results are as follows. 1. Examination of cisternal haematoma distribution revealed that SAH had extended to the supra- and infratentorial cisterns in 28 cases (82%). There were only 6 cases (18%) in which SAH was confined to the posterior cranial fossa only but even when there was subarachnoid haematoma in both the supra- and infratentorial cisterns, thick haematomas were seen at the periphery of the brain stem. In cases of vertebral artery-posterior inferior cerebellar artery aneurysms (VA-PICA AN), haematomas in the ambient cistern were thicker on the aneurysm side. In addition, in cases of basilar artery-bifurcation (BA-Bifurcation AN) and basilar artery-superior cerebelli artery aneurysms (BA-SCA AN), there were many thick, high-density haematomas in the interpeduncular cistern. 2. The rate of intracerebral haemorrhage was extremely low (1 patient). 3. The rate of intraventricular haemorrhage was high, and these haemorrhages demonstrated a reflux pattern. 4. The rate of hydrocephalus was high (76.5%) in comparison with that noted in association with SAH due to the rupture of anterior circulation aneurysms.

Intratumoral oxygen pressure in malignant brain tumor

Oxygen pressure (pO2) in brain tumors, pO2 in brain cortex surrounding the tumors, and PaO2 were measured simultaneously during total resection in 16 patients with previously untreated brain tumors in order to detect hypoxic regions within the tumors. When the inhaled O2:N2O ratio was 1:3 under enflurane anesthesia, mean PaO2 was 109.2 +/- 5.8 mm Hg, a rather high value when compared with that obtained when air is inhaled under atmospheric pressure. The simultaneously measured intratumoral pO2 and pO2 in brain cortex surrounding the tumor were 15.3 +/- 2.3 and 59.8 +/- 6.5 mm Hg, respectively. Each intratumoral pO2 value was significantly lower than that of pO2 in brain cortex surrounding the tumor (mean less than 30 mm Hg, Wilcoxon signed rank test, p less than 0.005) and influenced the oxygen effects on radiation. These results appear to confirm that there are hypoxic regions within human brain tumors. A comparison between intratumoral pO2 and either the angiographic or contrast-enhanced computerized tomography scans of the tumor vasculature disclosed no correlation.

[Encapsulated chronic intracerebral hematoma caused by venous angioma of the basal ganglia: a case report]

A case is reported of venous angioma at the right basal ganglia simulating the encapsulated chronic intracerebral hematoma. A 29-year-old man was admitted to our hospital on July 14, 1988 with a two-month history of headache. Neurological examination revealed left homonymous lower quadrantic anopsia. CT scans showed a mosaic high density lesion at the right basal ganglia with extensive adjacent edema. MRI revealed that the high density lesion on CT scans was the combination of a reticulated core of mixed signal intensity with a surrounding rim of decreased signal intensity. The lesion was accompanied with extensive edema. Followed up CT scans showed the transformation of the lesion and ring-shaped enhancement. A right frontotemporal craniotomy was performed on August 9, 1988. After thorough dissection of the sylvian fissure and small corticotomy to the insula, a tough capsule was seen. There was blood in various stages of organization in the capsule. A histological examination gave a diagnosis of venous angioma in the membrane similar to the outer membrane of chronic subdural hematomas. Postoperatively, the patient showed slight left motor weakness, but it gradually improved and he was discharged on foot, on October 19, 1988. There have been a lot of reports about angiographically occult intracranial vascular malformation (AOIVM). But AOIVM at the basal ganglia is rare, and to our knowledge, only 8 cases have been reported. In our case, the presence of adjacent extensive edema, and ring-shaped enhancement on CT scans confused the preoperative diagnosis. Those findings might have been caused by encapsulation. By using CT scans and MRI, a complete and accurate diagnosis was impossible.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical analysis of etiology of spontaneous subarachnoid hemorrhage diagnosed by computed tomography]

In 575 cases with subarachnoid hemorrhage (SAH) diagnosed by computed tomography (CT) scan, four vessel cerebral angiography was performed several times at more than two-week intervals to investigate a source of the hemorrhage. The first four-vessel study on admission revealed 530 cases (92.2%) of ruptured cerebral aneurysms, four (0.7%) of ruptured arteriovenous malformation, 25 (4.3%) of unknown etiology. Repeated four vessel study showed eight (32.0%) aneurysms among 25 cases whose first studies were negative. Six of the eight cases had aneurysms in the vertebro-basilar system. In 11 cases, repeated four-vessel study failed to detect the hemorrhagic source; and no generalized diseases were noted. One of them had recurrence of SAH 19 months after the onset of the initial one. The patient was underwent operation, which showed thrombosed ruptured aneurysm. Our present investigation demonstrated that ruptured aneurysm was responsible for 94.8% of all 575 cases of SAH detected by CT scans and 10 cases (1.7%) were diagnosed as cases of SAH of unknown etiology.

[Homocystinuria accompanied with cerebral deep venous thrombosis--a case report]

Homocystinuria is an inborn error of methionine metabolism, of which cause is mainly deficiency of cystathionine synthetase. The major clinical manifestations of homocystinuria are mental retardation, seizures, ectopia lentis, skeletal deformities and occlusive vascular disease. A case of homocystinuria accompanied with deep cerebral venous thrombosis was reported. A 29-year-old woman was admitted to our hospital with unconsciousness and tetraparesis on December 7, 1984. She was diagnosed as homocystinuria due to cystathionine synthetase deficiency at 13-year-old. Amino acid analysis of serum revealed homocystinaemia (1.37 mg/dl, normal 0), hypermethioninaemia (1.27 mg/dl, normal 0.2-0.48) and low cystathionine content. CT scan revealed intraventricular hemorrhage and diffuse low density in basal ganglia and white matter. Cerebral angiograms showed that deep cerebral veins and superior sagittal sinus can not be recognized clearly in any phase, and Sylvian veins are opacified markedly. It is suggested that intraventricular hemorrhage, and low density area in basal ganglia and white matter is due to hemorrhagic infarction by venous thrombosis of internal cerebral vein. The major clinical manifestations of homocystinuria result from the elevated plasma homocysteine level. The excitotoxic effect of homocysteic acid accounts for mental retardation and seizures.(ABSTRACT TRUNCATED AT 250 WORDS)

[Influence of superior cervical ganglion on cerebral hemodynamics--measurements of cerebral blood flow and metabolism during superior cervical ganglionectomy in patients with moyamoya disease]

The effect of superior cervical ganglionectomy (SCG) on cerebral blood flow and metabolism was investigated in moyamoya disease. Measurement of cerebral blood flow and metabolism was performed in 12 cases (15 operations) of moyamoya disease during SCG. Mean age was 65.2 years (from 3 to 38). 4 were male and eight were female. Ischemic cases were 8 and hemorrhagic cases were 4. At encephalo-duro-anterio-synangiosis, a Laser Doppler flow meter and probes for measuring cortical tissue oxygen and carbon dioxide were set out to allow measurement from identical sites on the surface of the brain over the cortex. Moreover, an electromagnetic flow meter was placed on the common carotid artery. And the mean arterial blood pressure was also measured from femoral artery. After the electrode had been stabilized, continuous recordings were made of cerebral blood flow and metabolism during SCG. The mean arterial blood pressure fell slightly post operatively, but the changes in blood pressure were considered not to be significant enough to affect blood flow. Cortical CBF did not change immediately after SCG. However it increased gradually to 118.8% of preoperation level 30 minutes later respectively, and the difference was observed significant. The carotid blood flow and the tissue oxygen developed a tendency to increase after 30 minutes, but the tissue carbon dioxide did not changed. The present study indicates that superior cervical ganglionectomy is the useful procedure to increase in cerebral blood flow immediately after the operation on patients with moyamoya disease.

[A case of recurrence of a metastatic brain tumor which disappeared due to chemotherapy only]

A rare case of recurrence of a metastatic brain tumor which disappeared due to chemotherapy only is reported. A 52-year-old male was noticed to have an abnormal shadow in his chest X-P at a routine medical examination, so a close examination was made. He was diagnosed as having right renal cell carcinoma which had metastasized to the lung. He was treated by intra-arterial infusion of anti-cancer drugs and embolization of the right renal artery. No renal symptom was seen, growth of the primary tumor stopped, and the abnormal shadow in his chest diminished. However, weakness in the left hand appeared 19 months after the first examination and he was admitted to our clinic. He was alert, but slight left hand weakness was observed. CT scan revealed a diffusely enhanced mass in the right parietal lobe. Total removal of the brain tumor was performed and the histology was metastasis of renal cell carcinoma. He was discharged and was able to walk but he had slight left hemiparesis. UFT 6 capsules a day were administrated in our out-patient clinic. However, CT scan revealed recurrence of the tumor 2 weeks after discharge, we followed up with conservative treatment, and no growth of the tumor was seen. It disappeared 5 months after discharge after being treated with UFT only. We regard UFT as having been effective in this case.

[Analysis of PO2 in brain tumor and effectiveness of PFC (perfluorochemicals) to increase intratumoral PO2, blood flow and its clinical use]

The presence of hypoxic Zone in clinical brain tumor is verified. The value of intratumoral PO2 is about 16 mmHg under the condition with physiological PaO2. Perfluorocarbon, which can transport rich O2, was used to increase intratumoral PO2. Intratumoral PO2 increased to about 36 mmHg by using Perfluorocarbon with inhalation of O2. I conducted new Protocol, namely, irradiation method should be selected altered dose fractionation when hypoxic cell of the tumor change to normoxic cell. Perfluorocarbon was administered on the day when irradiation dose is high. Clinical result showed much better than previous our result, especially in the group of glioblastoma, the mean survival duration prolonged 8 months to 2 years.

Regional cerebral blood flow with age: changes in rCBF in childhood

Changes in cerebral blood flow (CBF) and regional cerebral blood flow (rCBF) throughout the entire age range including childhood were reported. The CBF in grey matter of children was markedly higher than that found in adults and showed a negative correlation with age. In contrast, the blood flow in white matter did not show a notable decrease with age. The regional distribution of CBF in children did not exhibit the frontal lobe dominance typical of adults. The rCBF pattern began to approach that of adults with growth and by 10 yr the rCBF pattern of children was similar to that of adults.

[A case of neonatal medulloblastoma]

A nine-day-old female with cerebellar medulloblastoma treated by surgical and radiation therapy is reported. She suffered from vomiting within a few days after birth. Subsequently, her head became enlarged and she was admitted to our hospital. CT scan on admission showed a large mass lesion at the cerebellum expanding to the pineal portion, and marked hydrocephalus. At the age of 14 days, a ventriculo-peritoneal shunt was carried out, and at the age of 67 days, radical resection of the tumor was performed. The histopathological diagnosis was medulloblastoma. Postoperatively, radiation therapy of the brain was carried out. Irradiated dose was 30 Gy on the whole brain and 20 Gy at the location of the lesion. She was discharged at the age of seven months. She remained in good condition with no neurological deficit except for nystagmus. One week later, it was found that she was unable to move her legs and she was readmitted to our hospital. CT scan showed no remarkable change in the intracranial region, but spinal cord swelling was revealed at the Th12-L5 level. Myelography showed a filling defect at the L3-5 level. Radiation therapy of the spinal cord was performed, and the paraparesis gradually improved. However, her general condition was getting worse, and the following CT scan showed intracranial recurrence of the tumor. She deteriorated day by day and at the age of 9.3 months she expired. Brain tumors during the neonatal period are very rare, especially neonatal medulloblastoma. Only 24 cases can be found in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)