Implantation of Xenogeneic Transgenic Neural Plate Tissues into Parkinsonian Rat Brain

Xenografting must be considered as a means of establishing neural transplantation therapy and of securing fetal neural tissues as donor material. The early stage (embryonic day 8.5, E8.5) embryonic mesencephalic neural plate (NP) from transgenic mice was examined for possible application in effective xenografting therapy. As recipients, Parkinsonian rats treated with 6-hydroxydopamine were used, and as donors, GT4-2 mice into which a β-galactosidase gene was introduced to allow brain tissue differentiation from the recipients by X-gal staining. Three microscopic pieces of E8.5 GT4-2 mice NP were injected into the striatum of the Parkinsonian rats. Some hosts were given immunosuppressants (cyclophosphamide and FK506) (IS group), others were not (non-IS group). Amphetamine-induced rotation was examined at days 11 and 21 after grafting (D11 and D21, respectively), and morphological investigations were performed using hematoxylin-eosin (H-E), X-gal, and thyrosine hydroxylase (TH) staining. The rotations were counted in 30 of the 38 transplanted rats before and after grafting. Histological data were obtained from 19 of these 30 rats. In 11 of them the grafts survived (survival group) and in the remaining 8, the grafts were unsuccessful (rejection group). In the survival group at D11, the mean number of rotations made by transplanted rats expressed as a percentage of the number before grafting (rotation percentage) decreased to 43.8% (n = 9), which, in comparison with the average of 125.9% (n = 6) in the rejection group, reveals significant behavioral recovery (p < 0.01). The rotation percentage at D21 was 23.8% in the survival group (n = 4) and 84.5% in the rejection group (n = 3). Behavioral recovery was thus seen to improve with time in the survival group. In the IS group (n = 19), the rotation percentages averaged 74.9% (D11, n = 15) and 51.1% (D21, n = 7), while the non-IS group averages were 136.7% (D11, n = 9) and 140.7% (D21, n = 9), indicating a tendency for better behavioral recovery in the IS group than in the non-IS group (p < 0.05). Fifteen IS group rats were studied histologically, 10 (sacrificed on D11, D21) from the survival group and 5 (sacrificed on D11, D21) from the rejection group. In the non-IS group (n = 4), there was a graft in only one rat sacrificed on D11. There were many X-gal positive and TH positive cells in the grafts, suggesting that mouse NP survived, and differentiated into TH positive neurons in the rat brain. Xenografted NP has the potential to cure central nervous system diseases.

Reversibility of energy metabolism and intracellular pH after cerebral ischaemia evaluated by 31P-MRS

We have previously developed a reproducible model of transient forebrain ischaemia in rats by bilateral carotid artery occlusion combined with temporary increase of ICP. With this model, reversibility of the energy metabolism and intracellular pH (pHi) was investigated by 31P-MRS during 120 min of recirculation in three groups of, respectively, 30, 60, and 120 min of ischaemia. With the induction of ischaemia, ATP and phosphocreatine (PCr) disappeared, and measurement of pHi showed severe acidosis in all rats. In the 30 min ischaemia group, both energy metabolism and pHi recovered almost completely. In the 60 min ischaemia group, ATP recovered to 74% of control values, but pHi showed full recovery. In the 120 min ischaemia group, ATP recovered to about 50% of control values, and recovery of pHi was variable. Showing logarithmical changes during recirculation in ATP and PCr, the rate of metabolic recovery was fast during 60 min of recirculation, but it decreased and reached plateau thereafter in all groups. Recovery of pHi was affected by ATP levels, and was precipitously accelerated as ATP levels exceeded 50% of pre-ischaemic values. These results suggest that prolongation of the duration of ischaemia limits the restoration of the energy state, and the quality of pHi recovery after cerebral ischaemia is affected by the degree of ATP recovery during 60 min of recirculation.

Effect of (6R)- and (6S)-tetrahydrobiopterin on L-3,4-dihydroxyphenylalanine (DOPA) formation in NRK fibroblasts transfected with human tyrosine hydroxylase type 2 cDNA

l-erythro-5,6,7,8-Tetrahydrobiopterin (BH(4)), which is the cofactor of aromatic amino acid hydroxylases, plays an important role in the biosyntheses of monoamine neurotransmitters. BH(4) exists as natural (6R)- and unnatural (6S)-isomers. In our previous reports, only (6R)-isomer significantly stimulated cofactor activity for tyrosine, tryptophan and phenylalanine hydroxylases (TH, TPH, PAH) in whole animals or in tissue slices. In this study we have compared the in situ cofactor activity on TH between natural (6R)- and unnatural (6S)-isomers in clonal cells. We have transfected human TH type 2 cDNA into the normal rat kidney (NRK) fibroblasts. These cells expressed TH protein, but had neither DOPA decarboxylase (DDC) nor BH(4). Thus, TH activity was observed only in the presence of exogenous BH(4). We compared the difference in in situ DOPA formation by TH activity in the presence of (6R)- or (6S)-BH(4) in the human TH-transfected cells. The effect of exogenous BH(4) was also compared between (6R)- and (6S)-isomers in rat pheochromocytoma PC12h cells, which contained approximately 100 ?M endogenous (6R)-BH(4). The rate of uptake of both BH(4) isomers into these cells increased in proportion to the pterin cofactor concentrations in the incubation medium up to 400 ?M but was nearly saturated at 1 mM BH(4). TH-transfected NRK fibroblasts formed DOPA only in the presence of exogenously added (6R)- or (6S)-BH(4) dose-dependently and released DOPA into the medium. At a saturating concentration of 1 mM, (6R)-BH(4) was approximately three times as active as (6S)-BH(4). In contrast, in PC12h cells which contained endogenous (6R)-BH(4) (approximately 100 ?M), exogenous (6R)-BH(4) activated DOPA formation maximally at 500 ?M about 10-fold, while (6S)-BH(4) activated it only slightly, about 2.5-fold. These results suggest that (6S)-isomer has lower cofactor activity with TH in the cells than (6R)-isomer. This TH transfected fibroblasts should be useful to assess cofactor activities of tetrahydropteridines in the cell.

Hearing preservation by the extended and nonextended middle cranial fossa approach for acoustic neuroma

The results of 248 cases of acoustic neuroma surgery carried out mainly by the extended middle cranial fossa approach during a 16-year period from 1976 to 1991 are analyzed. Hearing preservation was attempted in 69 cases and successfully achieved in 35 (51%) cases. Hearing was preserved in 24 (57%) of 42 cases in which a tumor was 20 mm or smaller in diameter, pure-tone hearing level was 50 dB or lower, and speech discrimination score was 50% or higher. The hearing preservation rate (76%) in the cases with a tumor extending 3 mm or less from the internal auditory canal was much higher than in cases with a larger tumor. Hearing was preserved in three of seven cases with a tumor of 21 mm or larger and in two of four cases of neurofibromatosis type 2. The evaluation of postoperative hearing is also discussed.

Successful survival of grafted transgenic neural plate cells in adult central nervous system environment

1. Accumulating evidence indicates that damaged brain functions can be ameliorated in a variety of animal models by the grafting of fetal neuronal cell or tissue into damaged brain. Clinical trials are under way to determine whether human fetal mesencephalic tissue can ameliorate motor functions in patients with Parkinson's disease. 2. Autopsy findings of parkinsonian patient implanted with human fetal mesencephalic tissue clearly revealed that the fetal neuronal graft can survive for an extended period of time in the human brain and densely reinnervate the surrounding host striatal tissue. 3. It is, however, still important to obtain more practical, effective, and ethically justifiable donor material for the future clinical application of the procedures. Desirable properties for the donor cells include long-term survival in the brain, neuronal cell type for the reconstruction of damaged neural circuits, and susceptibility to genetic manipulation for the practical use. 4. With the development of molecular biology techniques, genetic modification and transplantation of the donor neuronal cells might be a feasible way to cure many kinds of central nervous system diseases toward a "graft-gene therapy."

Quality of hearing preservation in acoustic neuroma surgery

OBJECTIVE

This study aimed to investigate the factors affecting the quality of postoperative hearing in acoustic neuroma.

STUDY DESIGN

The study was designed as a retrospective case review.

SETTING

The study was performed at the Department of Otolaryngology, School of Medicine, Keio University, Tokyo, Japan.

PATIENTS

The subjects were 94 patients with unilateral acoustic neuroma.

INTERVENTION

Hearing preservation surgery was performed in the subjects via the extended cranial fossa approach or the middle cranial fossa approach.

MAIN OUTCOME MEASURES

The outcome measures included patient's age and gender, hearing level, speech discrimination score, tumor size, and surgical approach. The relationship between the qualities of preoperative and postoperative hearing and the long-term prognosis of preserved hearing also was investigated.

RESULTS

In 94 subjects, there were 47 patients whose hearing was preserved (HP group) and 47 patients whose hearing was not preserved (non-HP group). Overall, hearing preservation rate was 50%. There were no significant differences in age, gender, and tumor size between the two groups. The hearing preservation rate was significantly higher in patients with an intracanalicular tumor than that with a larger tumor. The better the preoperative quality of hearing was, the higher the postoperative one. Although the preserved hearing deteriorated after surgery in 4 patients, no significant hearing deterioration was observed in the other 43 patients.

CONCLUSIONS

The results of this study indicated that the diagnosis for acoustic neuroma in the early stage with serviceable hearing is the most important to improve the quality of postoperative hearing.

[Analysis of abnormal findings observed on brain MRI T 2 weighted image in a system for the detection of asymptomatic brain disease in 1,200 cases]

In this study we described the significance of asymptomatic cerebral infarction (ACI) and periventricular hyperintensity (PVH) observed on brain MRI in a system for detection of asymptomatic brain disease with 1,200 cases. The risk factors (RF), population in each age bracket of ACI and PVH, among groups with hypertension (HTG) and without RF (no-RFG), were investigated. The RF of ACI were hypertension (HT), diabetes mellitus (DM), and aging. Without DM, those are common RF of PVH. The population of PVH and ACI with PVH increased with aging in no -RFG. On the other hand, only the population of ACI with PVH increased with aging in HTG. The rate of these abnormal findings in HTG was significantly higher than that in no-RFG. In addition, HT accelerated the occurrence of these findings by 10-20 years. When patients were over 60 years old, ACI increased rapidly. Accordingly, we concluded that (1) PVH and ACI had a common background. (2) Long term follow up concerning the incidence of ACI in the group with only PVH was necessary. (3) It was desirable that treatment for RF should be effected before the age of sixty.

Plasma cell granuloma extending from the extracranial to the intracranial space associated with Epstein-Barr virus infection

A 70-year-old male presented with a plasma cell granuloma extending from the extracranial to the intracranial space. Findings of preoperative magnetic resonance imaging and intraoperative observation indicated that the lesion extended from the temporal muscle to the subarachnoid space, penetrating the frontal bone. The subarachnoid lesion was composed of neutrophils indicating the presence of acute or subacute inflammation. The final diagnosis of the resected tumor was plasma cell granuloma. High levels of antibodies against Epstein-Barr (EB) virus in the cerebrospinal fluid and the immunohistochemical demonstration of EB nuclear antigens in the plasma cell granuloma suggested that EB virus infection was associated with the development of plasma cell granuloma in this patient.

Prediction of consistency of meningiomas with preoperative magnetic resonance imaging

BACKGROUND

The consistency of a meningioma is one of the important factors in determining the surgical outcome. If the surgeon is aware of the consistency of a meningioma preoperatively, the surgical plans will be influenced. A few papers have described the correlation between consistency of meningiomas and their magnetic resonance imaging (MRI) findings. However, prediction of consistency with MRI is still difficult. We have tried to predict the consistency of meningiomas with MRI findings more precisely.

METHODS AND RESULTS

Fifty patients diagnosed as having intracranial meningiomas were studied with 1.5 Tesla MRI. We compared the MRI findings with tumor consistency. The intensities of the tumors were categorized into three grades (low, iso, and high) compared to that of the gray matter. T1-weighted images had no specifics, but T2-weighted images and proton density images were useful for the prediction of tumor consistency. Hyperintensity on protein density (PD) and T2-weighted images was a sign of a soft tumor.

CONCLUSION

We presume that T2 and PD are useful for predicting consistency of meningiomas, and their water content is one of the main factors in their consistency. Histology may be one of the factors helpful in defining the consistency of a tumor. In this series, we found no relationship between histology and MRI findings, nor between histology and consistency. If the meningioma is believed to be hard, preoperative endovascular embolization is beneficial, which will induce necrosis of the meningioma and make it soft enough to be removed more easily and safety.

Implantation of xenogeneic transgenic neural plate tissues into parkinsonian rat brain

Xenografting must be considered as a means of establishing neural transplantation therapy and of securing fetal neural tissues as donor material. The early stage (embryonic day 8.5, E8.5) embryonic mesencephalic neural plate (NP) from transgenic mice was examined for possible application in effective xenografting therapy. As recipients, Parkinsonian rats treated with 6-hydroxydopamine were used, and as donors, GT4-2 mice into which a beta-galactosidase gene was introduced to allow brain tissue differentiation from the recipients by X-gal staining. Three microscopic pieces of E8.5 GT4-2 mice NP were injected into the striatum of the Parkinsonian rats. Some hosts were given immunosuppressants (cyclophosphamide and FK506) (IS group), others were not (non-IS group). Amphetamine-induced rotation was examined at days 11 and 21 after grafting (D11 and D21, respectively), and morphological investigations were performed using hematoxylin-eosin (H-E), X-gal, and thyrosine hydroxylase (TH) staining. The rotations were counted in 30 of the 38 transplanted rats before and after grafting. Histological data were obtained from 19 of these 30 rats. In 11 of them the grafts survived (survival group) and in the remaining 8, the grafts were unsuccessful (rejection group). In the survival group at D11, the mean number of rotations made by transplanted rats expressed as a percentage of the number before grafting (rotation percentage) decreased to 43.8% (n = 9), which, in comparison with the average of 125.9% (n = 6) in the rejection group, reveals significant behavioral recovery (p < 0.01). The rotation percentage at D21 was 23.8% in the survival group (n = 4) and 84.5% in the rejection group (n = 3). Behavioral recovery was thus seen to improve with time in the survival group. In the IS group (n = 19), the rotation percentages averaged 74.9% (D11, n = 15) and 51.1% (D21, n = 7), while the non-IS group averages were 136.7% (D11, n = 9) and 140.7% (D21, n = 9), indicating a tendency for better behavioral recovery in the IS group than in the non-IS group (p < 0.05). Fifteen IS group rats were studied histologically, 10 (sacrificed on D11, D21) from the survival group and 5 (sacrificed on D11, D21) from the rejection group, In the non-IS group (n = 4), there was a graft in only one rat sacrificed on D11. There were many X-gal positive and TH positive cells in the grafts, suggesting that mouse NP survived, and differentiated into TH positive neurons in the rat brain. Xenografted NP has the potential to cure central nervous system diseases.

[Cooperative multicentre study on posttraumatic epilepsy]

A multicentre cooperative prospective study have been conducted to investigate the factors influencing posttraumatic epilepsy (PTE) and to evaluate the prophylactic effect of anticonvulsants. Since April 1994, patients with head injury have been observed following our protocol as follows; anticonvulsants are administered only to the patients with brain parenchymal injury for one month just after head trauma and no anticonvulsants are administered after one month after trauma to any patients except those with posttraumatic epilepsy (PTE). Brain parenchymal injury included traumatic subarachnoid hemorrhage, acute subdural hematoma, contusion, intracerebral hematoma, and diffuse axonal injury. To April 1996, 635 patients with head injury have been registered and analyzed. During the follow-up period, 14 patients (2.2%) developed PTEs, which had only been observed in patients with brain parenchymal injury. Multiple regression analysis revealed that two factors, early epilepsy and brain parenchymal injury, could contribute to the prediction of PTE. The frequency of PTE in this study was compared with that in our previous retrospective study (Nakamura, 1995), in which anticonvulsants were administered to the patients with head injury. There was no significant difference in the percentage of patients having PTE between the group treated without anticonvulsants in this study and the untreated group in previous retrospective study. Anticonvulsants treatment after head injury was not likely to have a prophylactic effect against the development of PTE.

Neurotrophic activity in cytokine-activated astrocytes

Accumulating evidence indicates that various neurotrophic factors (NTFs) exist and function in the brain. In the mature mammalian brain, NTF expression is exclusively restricted to neurons. However, astrocytes activated by various cytokines, including fibroblast growth factor and interleukin-1 beta, produce a significant amount of nerve growth factor (NGF) in vitro. Furthermore, non-NGF type NTF expression in astrocytes is also activated by the cytokines. The cytokines also enhance both release of ciliary neurotrophic factor from and expression of high-molecular weight basic fibroblast growth factor (FGF) in astrocytes. In the early phase following brain injury, cytokine-activated astrocytes rescue the damaged neurons via NTFs and other biologically active molecules.

Electrophysiological investigation of hemifacial spasm after microvascular decompression: F waves of the facial muscles, blink reflexes, and abnormal muscle responses

In patients with hemifacial spasm, it has been said that the spasm is due to cross compression of the facial nerve by a blood vessel and that microvascular decompression (MVD) of the facial nerve is an effective treatment. The F waves, which result from backfiring of antidromically activated motor neurons of the facial motor nucleus, are indices of the excitability of the facial motor nucleus and are enhanced in patients with hemifacial spasm. Measuring blink reflexes and abnormal muscle responses (lateral spread), a characteristic sign of hemifacial spasm, has been used to investigate the mechanism of hemifacial spasm pathophysiologically. Thus the authors measured F waves of the facial muscle, blink reflexes, and abnormal muscle responses before and after MVD in patients suffering from hemifacial spasm to investigate the excitability of the facial motor nucleus and the course of the cure of hemifacial spasm after MVD. The authors obtained facial nerve-evoked electromyograms in 20 patients with hemifacial spasm before and after the MVD procedure. On the spasm side, the F waves and blink reflexes were enhanced preoperatively compared to those on the normal side and abnormal muscle responses were recorded in all patients. In 12 patients whose hemifacial spasm had not disappeared completely for 5.1 +/- 1.7 (mean +/- standard error) months following the MVD procedure, F waves were still enhanced significantly and abnormal muscle responses were still recordable, albeit at lower amplitude. Within 1 month after the hemifacial spasm had disappeared completely. F waves were still significantly enhanced in 17 patients and abnormal muscle responses were recorded in seven of 15 patients. Subsequently, the enhanced F waves and abnormal muscle responses disappeared completely. The authors' study supports the hypothesis that the cause of hemifacial spasm is hyperexcitability of the facial motor nucleus and suggests that additional surgery should not be performed for at least 2 years after MVD, because that period is necessary for the disappearance of the hyperexcitability of the facial motor nucleus.

[Practical localization of the central sulcus using a video display during surgery by cortical somatosensory evoked potentials and how to discern precentral P20 and central P25]

In patients with lesions around the central sulcus, cortical surface somatosensory evoked potentials (SEPs) have been applied for the purpose of localization of the central sulcus based on the polarity inversion of postcentral N20 to precentral P20 across the central sulcus. We have intraoperatively monitored SEPs to infer the location of the central sulcus in 16 cases since December 1988. Intraoperative localization of the central sulcus has been most useful in patients with frontal lobe gliomas in which the localization of the central sulcus enables the surgeon to extensively resect tumor without postoperative motor weakness. The localization of the central sulcus, however, might be misjudged by using the polarity inversion criterion alone, because central P25 following N20 and P20 complicates SEP waveforms. It is significant that P25, which is recorded also posterior to the central sulcus, is discerned from the precentral P20. In order to solve this matter, we regarded only the positivity in SEP waveforms having the identical peak latency to that of N20 as the precentral P20. Positive potentials having a later peak latency than that of N20 are the superposition of P20 and P25, and might also be recorded posterior to the central sulcus. For the observation of the polarity inversion of N20 to P20 across the central sulcus, a multi-channel SEP should be recorded using a sheet of silicone rubber embedded in a 16-electrode array consisting of a 4 by 4 grid. We projected the exposed cortical surface on the video display through the microscope apparatus and marked the locations of the recording electrodes on the video display. This enabled the location of the recording electrodes to correspond easily and precisely to the cortical surface. Our reliable and simple method of intraoperative localization of the central sulcus by cortical SEPs monitoring is presented in a practical case.

Bony foramina facilitate magnetic stimulation: an experimental cat sciatic nerve model

We have established an experimental bony foramen model in vivo using a cat sciatic nerve, a section of skull bone and a column made from methylmethacrylate. In each model, a foramen-like slit or fissure was created. Motor responses of the cat right gastrocnemius were elicited with a figure-of-8-shaped magnetic coil. Very high intensities of magnetic stimulation were necessary to evoke motor responses with the coil placed on the thigh. However, when the bone section or methylmethacrylate column was placed under the thigh muscle layer with the sciatic nerve fitted into the foramen-like slit or fissure, motor responses could be elicited with a smaller intensity of magnetic stimulation. Despite changes in stimulation intensity or shifts in the magnetic coil, the latency of the motor responses remained constant. By comparing the latency with the electrical recording, the site of excitation was predicted to be at the exit of the foramen. Our studies have confirmed that bony structures, especially bony foramina, facilitate excitation of the nerve by magnetic stimulation and that the exit of the foramen could be the preferential site for magnetic stimulation.

Effects of spinal cord ischemia on the refractory period of descending spinal cord evoked potential

The recovery cycle, following the conduction of action potentials along a nerve fiber, consists of the absolute refractory period (ARP), the relative refractory period (RRP) and the supernormal period (SNP). The recovery cycle of the descending conductive spinal cord evoked potential (SCEP) was shown during normal state, ischemia and after ischemia using paired stimuli in cats. During ischemia the refractory period revealed a trend towards increment. Five minutes after reperfusion the refractory period decreased transiently compared with the normal level and within 30 min the refractory period returned to the normal level. The recovery curve of the 2nd potential showed different pattern compared with that of the 1st potential. Moreover, during ischemia, firstly the 3rd potential and secondly the 2nd potential of the SCEP elicited by the 2nd stimulus were disturbed. These results demonstrated that there is increased excitability of the spinal cord to the second stimulus after a brief period of ischemia, and that the 2nd and 3rd potentials are evoked synaptically and easily disturbed during ischemia. Measuring the SCEP elicited by paired stimuli or constructing the recovery curve of the SCEP is useful for the electrophysiological assessment of spinal cord function.

Effect of repetitive stimulation on lateral spreads and F-waves in hemifacial spasm

The lateral spread (LS) response, which can be elicited in muscles innervated by other branches of the facial nerve, is electromyographycally specific for patients with hemifacial spasm (HFS), occurring about 10 ms after stimulus. The F-wave in facial muscles, which is a late response that antidromicaly propagates to the facial motonucleus and returns orthodromicaly down the same axon, revealed a trend toward enhancement in patients with HFS. The LSs were facilitated by repetitive stimulation during the microvascular decompression (MVD) operation, which has proved to be a successful treatment, and the F-waves were also facilitated by repetitive stimulation on the spasm side more than on the normal side. Greater facilitation of these responses was in direct proportion to higher stimulation rates and greater numbers of stimulations. The repetitive stimulation of the facial nerve may result in activation of the motoneuron pool and in the lowering of the threshold of somatic membranes. These results support the hypothesis that hemifacial spasm is caused by hyperexcitability of the facial motonucleus, which is increased by antidromic repetitive stimulation.

[Skull base metastasis from renal cell carcinoma presenting as abducens nerve paresis: report of two cases]

We report two cases of skull base metastasis from renal cell carcinoma. Case 1: A 55-year-old female presented with a skull base tumor located on the clivus. Partial removal of the tumor was performed via the transsphenoidal approach. Case 2: A 44-year-old male presented with a skull base tumor occupying the orbital, nasal, and paranasal cavities. The first operation, partial removal of the tumor, was performed via the transsphenoidal approach. Thereafter, the tumor regrowth and the patient's symptoms were progressive, so a second operation was performed via Le-Forte I craniotomy to prevent cranial nerve dysfunction and air way obstruction. The initial symptom of these two cases was abducens nerve paresis, which is caused by the tumor extending from the clivus to the cavernous sinus. The neuroradiological features were the destruction of skull base bone and angiographic tumor stain. Histopathological examination of the surgically resected specimens revealed clear cell carcinoma, and thereafter they were diagnosed as skull base metastasis from renal cell carcinoma. We emphasize the necessity of a thorough medical workup to enable speedy diagnosis of renal cell carcinoma in such cases.

Cholesterol granuloma of the petrous apex: establishment of a drainage route into the superior tympanic cavity--technical note

A 40-year-old male presented with a cholesterol granuloma of the petrous apex manifesting as progressive hearing loss and tinnitus. The lesion was treated via an extradural middle cranial fossa approach employing a new procedure to establish a drainage pathway into the superior tympanic cavity which preserved his hearing. The pathway was formed by a groove 5 mm wide and deep in the anterolateral aspect of the petrous bone, crossing the major petrosal nerve and carotid artery, running around the cochlea, crossing the tensor tympanic muscle, and entering the superior tympanic cavity above the orifice of the eustachian tube. This procedure is easy to perform without special techniques.

Expression of CD44H in the cells of neural crest origin in peripheral nervous system

We investigated the expression of the adhesion molecule CD44 in rat peripheral nervous system (PNS) at the protein and mRNA levels. Most migrating neural crest cells strongly expressed CD44, in contrast to the lack of expression in the neural tube. In dorsal root ganglion (DRG) and sciatic nerve, the distribution of CD44, neurofilament (NF) and S100 suggested the localization of CD44 on the membrane of Schwann cell and neurones and in extracellular matrix (ECM). The expression of CD44 was also confirmed on the membrane of cultured neurones and Schwann cells from DRG. mRNA coding for the haematopoietic form of CD44, CD44H, was detected in neural crest cells, DRG neurones and Schwann cells. These results show that CD44 may play some role in migration of neural crest cells and myelination in terms of adhesion between Schwann cells, axons and ECM.

Cytokine-induced selective increase of high-molecular-weight bFGF isoforms and their subcellular kinetics in cultured rat hippocampal astrocytes

Cytokines such as interleukin-1 beta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha) and epidermal growth factor (EGF) are probable factors responsible for up-regulation of basic fibroblast growth factor (bFGF) expression in reactive astrocytes following brain damage, however the effect of these cytokines on the expression of each bFGF-isoform has not been elucidated. Western blot analysis revealed the expression of 18, 22 and 24-kD bFGF isoforms in cultured rat hippocampal astrocytes, and the expression of high molecular weight (HMW)-isoforms (22 and 24-kD isoforms) but not of 18-kD isoform was selectively increased by cytokines. Immunofluorescent analysis demonstrated that bFGF content in the cytoplasm of astrocytes is initially increased by cytokines followed by nuclear targeting and localization in agreement with the previous evidence that HMW-isoforms possess a nuclear targeting signal. The present results suggest the important role of HMW-bFGF isoforms in the response of nervous tissue to injury.

Grafting of genetically manipulated cells into adult brain: toward graft-gene therapy

Accumulating evidence has shown that functional recoveries in various kinds of animal models of neurodegenerative diseases can be achieved by grafting fetal neurons into the brain. On the basis of these successful results, clinical trials are under way to determine whether human fetal mesencephalic tissue can ameliorate motor functions in patients with Parkinson's disease. Recent autopsy findings of parkinsonian patient implanted with human fetal mesencephalic tissue clearly revealed that the fetal neuronal graft can survive for extended period of time in the human brain and densely reinnervate the surrounding host striatal tissue. It is, however, still important to obtain more practical, effective and ethically justifiable donor material for the future clinical application of the procedures. Desirable properties for the donor cells include long-term survival in the host brain, neuronal cell type for the reconstruction of damaged neural circuits, and susceptibility to genetic manipulation for the practical use. With the development of molecular biology techniques, genetic modification and transplantation of the donor neuronal cells might be a feasible way to cure many kinds of central nervous system diseases toward a "graft-gene therapy".

Accidentally detected brain tumors: clinical analysis of a series of 110 patients

The clinical records of 1,155 patients with 1,159 brain tumors who drained on Keio University Hospital between 1983 and 1994 were reviewed. Apparently asymptomatic patients and those whose complaints or neurological deficits were not caused by the brain tumors were defined as accidental cases. For example, patients with a headache which was considered to be unrelated to the presence of a tumor were included in this series. One hundred and ten (9.5%) of the 1,155 cases were found to be accidental. Since three accidental cases had multiple meningiomas, there were 113 accidental brain tumors which involved 63 meningiomas, 22 pituitary adenomas, 9 gliomas, 7 metastatic carcinomas. 5 acoustic neurinomas and 7 miscellaneous. Meningiomas occurred significantly more frequent than other types of accidentally identified tumors. Convexity meningiomas and falx meningiomas accounted for 53.9% of the accidental meningiomas, whereas parasagittal meningiomas were less frequent. It is of note that three out of four cases with multiple meningiomas were accidental. Comparison between the present results and the previously reported incidence of asymptomatic brain tumors in postmortem studies suggest that a substantial number of pituitary adenomas, acoustic neurinomas and small parasagittal meningiomas without suggestive symptoms are likely to be missed by routine neuroradiological examinations.

Strength-duration curve of conductive spinal cord evoked potentials in cats

Strength-duration curves of the ascending and descending conductive spinal cord potentials (SCEPs) in cats were obtained using constant current stimuli. For the formulation of numeric indices of excitability, the rheobase is defined as the minimal current strength below which response cannot occur even if the current continues, and the chronaxie is defined as the minimal duration of a current required to evoke the potential at twice the rheobase strength. The chronaxies and rheobases were calculated from the constructed strength-duration curves. The purpose of this study is to produce strength-duration curves and to evaluate the utility of chronaxies and rheobases for SCEPs. This study showed the following results: (1) there was a hyperbolic relationship between stimulus strength and stimulus duration at threshold values, similar to that seen in peripheral nerves; (2) the ascending and descending tracts of SCEP were mediated through the same pathway (based on the similar chronaxies and rheobases); (3) following spinal cord compression the chronaxie and rheobase increased significantly (P < 0.05), which is similar to peripheral nerve disturbance. However, the rheobase decreased significantly following slight spinal cord compression (P < 0.05) and systemic cooling (P < 0.01), and the strength-duration curve shifted showing a tendency towards decrease of the galvanic threshold, therefore, amplitude augmentation with slight compression and with decrease in temperature seems to contribute to the reduction of the threshold. The strength-duration curve, the chronaxie and the rheobase may be useful in assessing spinal cord function.

Abnormal muscle response (lateral spread) and F-wave in patients with hemifacial spasm

In patients with hemifacial spasm (HFS) the spasm is due to cross compression of the facial nerve by a blood vessel and microvascular decompression (MVD) has proved to be a successful treatment. Abnormal muscle response (AMR), which can be elicited by one facial nerve branch stimulation in muscles innervated by other branches of the facial nerve, is specific for patients with HFS, and the AMR consists of a constant response occurring about 10 ms after stimulus and an afterdischarge with long duration (variable response, autoexcitation). The F-wave in facial muscles is a small recurrent discharge that antidromically propagates to the facial motonucleus and returns orthodromically down the same axon. We measured the AMRs and F-waves of facial muscles in HFS patients in order to investigate the relationship of both potentials and the origin of the AMRs. We obtained facial nerve evoked electromyograms from 10 HFS patients. The afterdischarges of the AMRs and the enhanced F-waves were always elicited at the same time by marginal mandibular branch stimulation of the facial nerve. There was a linear correlation between the duration of these two potentials in each case. Between the duration of the afterdischarge of the AMRs elicited in the mentalis muscles by the zygomatic branch stimulation of the facial nerve and that of the F-waves in the mentalis muscles, there was also a linear correlation in 10 cases. These results suggest that the F-wave and the afterdischarge have the same origin and that the AMR is an exaggerated F-wave.

Surgical approaches for vertebro-basilar trunk aneurysms located in the midline

Fourteen cases of midline vertebro-basilar trunk aneurysms were operated on by four routes of surgical approach: middle fossa anterior transpetrosal approach (ATP), presigmoid transpetrosal approach (PTP), conventional lateral suboccipital approach (LSO) or suboccipital transcondylar approach (STC). There was no mortality, but the morbidity was different depending on the surgical approach. In basilar trunk aneurysms located higher than the internal auditory canal, excellent results were obtainable by ATP, especially in the case of posteriorly projecting aneurysms. For midline vertebral aneurysms located lower than the internal auditory canal, STC resulted in less surgical complications than LSO. Extradural resection of the jugular tubercle was necessary for aneurysms located on the distal vertebral artery at or close to the vertebro-basilar junction. For vertebro-basilar junction aneurysms located at the level of the internal auditory canal, hearing was preserved by STC, but not by ATP or PTP. However, choice of the surgical approach may depend on the direction of the aneurysm and the technical accessibility of the skull base. All these skull base approaches reduced surgical complications of retraction damage to the cranial nerves and the brain stem. This holds true for all aneurysms arising from the midline vertebro-basilar trunk.

Primary spinal leptomeningeal gliomatosis presenting visual disturbance as the initial symptom: case report

We report a case of diffuse leptomeningeal gliomatosis which spread from the cervical to the sacral spine. A 60-year-old man was admitted with visual disturbance due to papilledema. Magnetic resonance imaging revealed holocord leptomeningeal gliomatosis without a definite intraparenchymal lesion, and the patient's neurological examination was unremarkable except for papilledema. Intracranial hypertension secondary to spinal tumor is well known but unusual, and the mechanism is still unclear. In our case, an elevated protein concentration of cerebrospinal fluid is suggested as the cause of intracranial hypertension.

The neural origin generating early cortical components of SEP: topographical analysis using temporal-second-order-differentiation of cortical SEPs

In order to identify dipole generators of the N20/P20 and P25, we employed second-order-differentiation in the temporal dimension (temporal-second-order-differentiation; TSOD) with delta t = 2 msec. The rate of variation in the voltage of cortical SEPs calculated by TSOD identified responses of each dipole, reflecting the density of neuronal firing. On topographic analysis, the distributions of N20/P20 and P25 conformed to the shape of gyrus better in the TSOD maps than in the isovoltage maps. The TSOD maps indicated that N20 and P25 were post-central components and that P20 was a pre-central one. Therefore, we concluded that the two dipoles generating N20/P20 and P25 were located in the posterior wall of the central sulcus (area 3b) and the crown (areas 1 and 2) of the post-central gyrus, respectively.

-A successful case of hypertrophic cranial pachymeningitis treated by optic nerve decompression

A successful direct operation in a case of hypertrophic cranial pachymeningitis (HCP) is described. A 51-year-old male was admitted with right visual disturbance. CT scanning revealed a mass lesion in the right middle cranial fossa extending into the right orbita. From MRI it was ascertained that this mass lesion consisted of thickening of the skull base dura. The effect of steroids was transient and his visual disturbance was rapidly increasing. A direct operation was performed consisting of partial dissection of the thickening dura and decompression of the right optic nerve. Histological diagnosis showed HCP. After surgery his symptoms dramatically improved. The etiology, natural course and treatment of HCP are well reported in the literature. in the present case the etiology was not clear, but there was a possible relationship with intraorbital pseudotumor or multifocal fibrosclerosis. The reported occasional transitory effect of steroids on HCP and a poor prognosis for visual acuity are common traits in these patients. The authors thus feel that a direct operation should be immediately carried out when the effect of steroids on visual disturbances associated with HCP is judged transient.

Stabilization of adhesion plaques by the expression of drebrin A in fibroblasts

The expression of drebrin A was induced in mouse fibroblasts (L cells) after transformation of cells with a vector that carried cDNA for rat drebrin A (developmentally regulated brain protein A) under the control of the promoter of the gene for metallothionein-I. When drebrin was expressed in the transformed cells (MTI-5 cells), the organization of actin filaments changed such that stress fibers were converted to a mesh-like structure. After subsequent treatment with 5 micrograms/ml cytochalasin D (a reagent that depolymerizes actin filaments), MTI-5 cells maintained their shape, while cells of a drebrin-negative cell line, MTI-11, formed retraction processes. Simultaneously, actin filaments changed into patchy dot-like aggregates in the cytoplasm of both MTI-5 and MTI-11 cells. These aggregates are known as cytoplasmic pools. In MTI-5 cells, adhesion plaques that were resistant to treatment with cytochalasin D appeared upon expression of drebrin. These adhesion plaques were immunostained with vinculin-specific antibodies, while those in MTI-11 cells were hardly immunostained. The amount of vinculin in MTI-5 cells increased in parallel with increase in the level of drebrin. These results suggest that expression of drebrin A induces changes in the assembly of actin filaments and adhesion plaques, with resultant modulation of cellular adhesion to the substratum.

Lipomas of the frontal lobe

An extremely rare case of lipomas on the cerebral surface in a 65-year-old female is reported. The tumors were located both in an unusual fissure of the right frontal convexity and under the right frontal lobe associated with and surrounded by areas of focal cortical dysplasia. Angiograms revealed dilated branches of the right anterior cerebral artery associated with angiomatous tumor blushes. The etiology of the combination of the lipomas and the anomalies, and the angiographic features, are briefly discussed.

F-wave in patients with hemifacial spasm: observations during microvascular decompression operations

In patients with hemifacial spasm (HFS), the spasm is due to cross compression of the facial nerve by a blood vessel. There are currently two hypotheses how the cross compression can cause HFS: 1. the spasm is caused by ephaptic transmission and hyperexcitability at the site of compression; and 2. the spasm is caused by hyperexcitability in the facial motonucleus. In peripheral nerves, F-waves, which result from the backfiring of antidromically activated anterior horn cells, have been proposed as indices of anterior horn cell excitability. Enhancement of the F-waves in facial muscles also indicates increased excitability of the facial motonucleus. On the other hand, abnormal muscle response (AMR), which can be elicited by stimulating one branch of the facial nerve and recording electromyographically from muscles innervated by other branches of the facial nerve, is specific for patients with HFS. We have therefore measured the AMRs and the F-waves in the facial muscle of HFS patients under anesthesia in order to investigate the excitability of the facial motonucleus. We obtained facial nerve evoked electromyograms from 14 HFS patients during microvascular decompression (MVD) operation. The F-waves, obtained with surface electrodes from the mentalis muscle, were defined as the second response after the M-wave. The F-waves in facial muscles cannot usually be elicited during surgical anesthesia using inhalation anesthetics. However, the F-waves were elicited on the spasm side in 10 out of 14 patients with HFS and the F-waves disappeared after MVD under anesthesia, as the early responses (R1) of the blink reflex were elicited on the spasm side before MVD under anesthesia. The F-waves elicited during anesthesia were suppressed significantly, compared with those before MVD. These results suggest that excitability in facial motonucleus increased on the spasm side.

Electrophysiological investigation of hemifacial spasm: F-waves of the facial muscles

In patients with hemifacial spasm (HFS), the spasm is due to cross-compression of the facial nerve by a blood vessel. There are currently two hypotheses for the mechanism of HFS: 1) the spasm is caused by ephaptic transmission and an increase in excitability at the site of compression; and 2) the spasm is caused by hyperexcitability in the facial nerve nucleus. In peripheral nerves, F-waves, which result from the backfiring of antidromically activated anterior horn cells, have been proposed as indices of proximal motoneuron conduction and anterior horn cell excitability. Enhancement of the F-waves indicates increased anterior horn cell excitability. We have therefore measured F-waves in the facial muscle of HFS patients in order to investigate the excitability of the facial nerve nucleus. The authors obtained facial nerve evoked responses from 20 HFS patients before microvascular decompression (MVD), 10 HFS patients after MVD and 10 healthy controls. The F-waves, obtained with surface electrodes from the mentalis muscle, were the second response after the M-wave. On the patient's spasm side, the F-wave duration, F/M amplitude ratio and frequency of F-wave appearance significantly increased compared with those of the normal side or healthy controls; minimum latency and chronodispersion did not significantly differ between these groups. In patients whose spasm disappeared completely following MVD, the abnormal muscle response (lateral spread), which is a characteristic sign of HFS, and the enhancement of the F-wave eventually also disappeared. Because of the correlation between HFS and F-waves, the authors' study supports the hypothesis that the cause of HFS is hyperexcitability of the facial motonucleus.

Developmental patterns and characteristic symptoms of petroclival meningiomas

Thirty-six cases of petroclival meningiomas with clearly defined anatomical features were selected to analyze the site of tumor attachment and the displacement of the trigeminal nerve. The tumors were classified into four categories according to the origin and extension of the tumor: clival origin medial to the trigeminal nerve (upper clivus type), clival origin with dumbbell extension to the cavernous sinus (cavernous sinus type), tentorial origin over the trigeminal nerve (tentorium type), and petrous apex origin lateral to the trigeminal nerve (petrous apex type). Patients with tumors in each category had characteristic neurological symptoms. Patients with the upper clivus type had oculomotor nerve paresis as a single symptom, if suprasellar tumor extension was present. Patients with the cavernous sinus type commonly presented with abducens nerve paresis caused by epidural tumor invasion around Dorello's canal. Dumbbell tumor extension along the venous drainage of the cavernous sinus was a significant problem for surgical removal in this type. Half of the patients with the tentorium type had a characteristic symptom of trigeminal neuralgia caused by retrograde tumor invasion into Meckel's cave from its orifice, but the cavernous sinus was not involved. The main complaint of patients with the petrous apex type was hearing disturbance, but no epidural or parasellar extension was present. Clinical symptoms and magnetic resonance imaging provide important information about the origin and extension patterns of these tumors, especially the presence or absence of tumor extension into the cavernous sinus. Abducens nerve paresis or trigeminal neuralgia suggests tumor invasion into the cavernous sinus or Meckel's cave, respectively.

Proximal ligation of large distal posterior inferior cerebellar artery aneurysm

A 41-year-old male presented with vertigo, nausea, and vomiting suggesting a space-occupying lesion of the posterior fossa. Computed tomography (CT) and left vertebral angiography revealed a large distal posterior inferior cerebellar artery (PICA) aneurysm. Operation revealed the fusiform aneurysm was partially embedded in the medulla, preventing neck clipping or trapping of the aneurysm. Therefore, proximal ligation of the PICA was performed. The symptoms caused by the mass effect improved, and the aneurysm was not visualized by CT or angiography. Ligation of the PICA proximal to the choroidal point is not necessarily safe. In our case, ligation was distal to the tonsillomedullary segment from which the perforating arteries mainly arose, so the postoperative course was good without new neurological deficits. Proximal ligation is an effective treatment for distal PICA aneurysms manifesting as mass effect if other interventions are not possible.

Interleukin-1β and tumor necrosis factor-α co-operatively enhance a novel trophic activity of astrocytes for pontine cholinergic neurons in vitro

Insulin and insulin-like growth factors (IGFs) are the only known trophic factors for pontine cholinergic neurons. The present study revealed that astrocyte-extract pretreated with IL-1β and TNF-α significantly enhanced choline acetyltransferase (ChAT) activity of the pontine neurons in the presence of a supramaximal dose of insulin, while various trophic factors including IGFs failed to increase the ChAT activity under the same culture conditions, suggesting that IL-1β and TNF-α co-operatively enhanced the expression of a novel trophic factor for pontine cholinergic neurons in astrocytes.

Spontaneous disappearance of a cerebral arteriovenous malformation

A 63-year-old male presented with a cerebral arteriovenous malformation in the dominant motor area which subsequently disappeared spontaneously. He had suffered from epileptic attacks in his right extremities for 2 years before he first presented aged 53 years. He was treated with anticonvulsants and was followed up. Bleeding from the cerebral arteriovenous malformation occurred when he was 61 years old. Two years later, angiography revealed the complete disappearance of the cerebral arteriovenous malformation. Such spontaneous disappearance is rare, and the patient should be followed up as the nidus may reappear later.

[Cooperative multicentric study on posttraumatic epilepsy]

A multicenter cooperative study was conducted to investigate factors influencing posttraumatic epilepsy (PTE) and to evaluate the prophylactic effect of anticonvulsants. A retrospective study of 102 PTE patients revealed the following typical clinical features: occurrence in young males, traffic accidents, contusion and/or cerebral hematoma. The latent period after the injury was longer in children. The percentage of EEG paroxysmal activity gradually increased as the generalized abnormality diminished. A retrospective-prospective study of 1998 patients who suffered a head injury between 1984 and 1988 was conducted till 1994. During the follow-up period, 62 patients (3.1%) developed PTE. The drop-out cases were excluded, and the 154 cases followed at least two years were analyzed. Statistical analysis of differences between patients with and without PTE suggested following factors: young, immediate early epilepsy (within 24 hours after injury; IMEE) and early epilepsy (within one week after injury). The risk with the highest relative risk rate was early epilepsy. Multiple regression analysis revealed that three factors, IMEE, early epilepsy and young age, contributed to the prediction of PTE. There was no significant difference in the percentage of patients having PTE in the group treated with anticonvulsants and the untreated group. Anticonvulsant treatment after head injury was unlikely to have a prophylactic effect on the development of PTE.

Distribution of PASII/PMP22 and connexin 32 proteins in the peripheral nervous system

Various mutations of PO, PASII/PMP22 and connexin 32 genes were recently reported in hereditary neuropathies, such as Charcot-Marie-Tooth disease (CMT) and Dejerine Sottas disease (DS). However, physiological roles of the proteins in PNS are not well understood. To address the functions of the proteins, we examined their localization in PNS comparatively by immunohistochemical methods. In Western blotting, a polyclonal antibody against the carboxyl terminal peptide of PASII/PMP22 reacted to 20-24 kD bands of PASII/PMP22 in mammalian PNS myelin, but produced no reaction in either mammalian or carp CNS myelin proteins. Monoclonal anti-connexin 32 antibody recognised connexin 32 of a dimer or monomer form in rat and human PNS myelin. By histological examination, PASII/PMP22 expressed dominantly in rat PNS compact myelins, while connexin 32 localized exclusively in the nodes of Ranvier, but not in compact myelins. In cell culture, axonal contact induced a remarkable increase of PASII/PMP22 in the Schwann cell in contrast to faint staining in immature Schwann cells. While localization of connexin 32 is quite different from that of PASII/PMP22, the mutations of the two proteins often induce similar phenotypes of hereditary neuropathies.