The treatment of large cerebral arteriovenous malformations (AVMs) is still difficult and challenging. Reported here is a case of complete cure of a large right parietal AVM treated by multi-staged embolization and gamma knife surgery (GKS). A 31-year-old woman was referred to our hospital with intraventricular hemorrhage caused by a large AVM in the right parietal lobe. The nidus size was 68×69×37 mm. The main feeders were the right anterior cerebral arteries (ACA), right middle cerebral arteries (MCA) and right posterior cerebral arteries (PCA), and drained by the cortical veins. We embolized feeders of the PCA, ACA and MCA with coils and polyvinyl acetate (PVAc) four times. Thereafter, nidus size was reduced to less than 30 mm and she underwent the first GKS. An angiogram showed the nidus size had been reduced to 6×4×4 mm two years after the first GKS, and a further angiogram one year later showed the nidus size had been reduced to 3×2×2 mm. The patient underwent GKS again four years after the first GKS as the size of the nidus remained unchanged from the last angiogram. An angiogram two years after the second GKS showed the nidus had disappeared. The second GKS was successfully achieved in this patient without neurological deterioration. Repeated GKS treatment minimizes endovascular complications and maximizes the treatment effect when multimodality therapy is used for large AVMs, illustrating the effectiveness of this approach.
A 7-year-old boy presented with a longitudinal clival fracture following a traffic accident. The boy presented only with temporary unconsciousness despite suffering a fracture of the clivus. Fractures of the clivus are often caused by severe head trauma, and the mortality rate is high due to coexisting injury of the adjacent vessels, brain stem, and lower cranial nerves. Review of the radiological and clinical findings of longitudinal clival fractures found that all reported pediatric patients with longitudinal clival fracture, including the present case, suffered an occipital impact, whereas the majority of longitudinal clival fractures in adults occur following frontal or axial impact.
Intracerebral metastasis in osteosarcoma is extremely rare. A 14-year-old girl who had previously been operated upon for osteosarcoma of the femur presented with seizures and left hemiparesis. A right parietal lesion with calcification and brain oedema was found. After resection of the mass, pathology revealed an osteosarcoma metastasis.
The fibrinolytic activity of cerebrospinal fluid has been studied in 60 cases with subarachnoid hemorrhage by Astrup's biochemical method. In 26 cases of them the fibrinolytic activity of CSF has been measured repeatedly during early stage of subarachnoid hemorrhage. It increased especially in the first one week after subarachnoid hemorrhage in all cases, and decreased gradually when the rebleeding of reptured aneurysm did not take place. On the other hand, increased fibrinolytic activity of CSF was detected repeatedly or gradually when rebleeding occured afterward. These results suggested the relationship between rebleeding of ruptured aneurysm and increased fibrinolytic activity of CSF. The authers forcasted the rebleeding of subarachnoid hemorrhage and determined the best time of operation by monitoring of fibrinolytic activity in CSF. Compared with alteration of fibrinolytic activity of CSF, the fibrinolytic activity of serum was normal continuously after subarachnoid hemorrhage. It has been suggested that local fibrinolysis would cause rebleeding of ruptured aneurysm. Fibrin-fibrinogen degradation products (FDP) was increased in CSF with subarachnoid hemorrhage. FDP, D fraction was detected in bloody CSF, but FDP, X, Y, and E fractions were not detected in CSF with subarachnoid hemorrhage immunologically. This result also suggested increased local fibrinolysis. Localization of fibrinolytic activity in tissue has been studied in 9 aneurysms and 5 arterio-venous malformation by Todd's fibrin slide technique and immunofluorence study. Increased activity was seen in adventitia and endothelium of ruptured aneurysm, arachnoid menbrane, area of brain softening and wall of vessels of arterio-venous malformation. Increased fibrinolytic activity in CSF with subarachnoid hemorrhage must be released from these structures. The authors emphasized the important role of local fibrinolytic activity on rebleeding of ruptured aneurysm.
In 1975, the Brain Tumor Registry of Japan (BTRJ) was founded to investigate the statistical characteristics of brain tumors in Japan.The Committee of the BTRJ (Ex-Chairpersons: Keiji Sano, Kintomo Takakura, and Kazuhiro Nomura) has published 12 reports.The 12 th report of the BTRJ, which includes 82,844 primary and metastatic brain tumor cases from 1984 to 2000, was issued in 2009.Here, we publish the 13 th edition of the BTRJ.This edition contains the statistical data of 16,338 patients in Japan with primary and metastatic brain tumors from 2001 to 2004.These data were collected via the Internet Data and Information Center for Medical Research in the University Hospital Medical Information (UMIN) system, instead of via a paper registration form.We hope that these data will be more reliable, given the use of computerized systems.This edition includes the frequency, anatomical distribution, patient age and sex, and survival data for all brain tumor cases, according to the World Health Organization (WHO) 2007 brain tumor classification.We hope that this edition will provide internationally valuable information to the fields of neurosurgery and neuro-oncology and contribute to the development of successful treatments for patients with brain tumors.
We studied the significance of lipids Lip to confirm the e#ectiveness of proton magnetic resonance spectroscopy 1 1 H-MRS, although there are problems such as a change of pattern due to settings and precision, it is a useful and valid test to determine the diagnosis and evaluate the grade of malignancy from a metabolic state. Furthermore, in this study, the developmental stage and growth rate of a tumor can be determined by knowing its biological behavior. This study may also be of help in predicting its prognosis and determining its therapeutic e#ects.
The aim of this study was to evaluate the clinical manifestations and prognostic factors of progressive brain injury following trauma. We reviewed the records of 779 patients with head injury who had an admission Glasgow Coma Scale of 9 or more; 70 (7.0%) developed progressive brain injury as evidenced on serial CT scans. Of these 70 patients, 19 (27.1%) had a subdural hematoma, 19 (27.1%) an epidural hematoma, 16 (22.9%) a cerebral contusion, 13 (18.6%) an intracerebral hematoma, and 3 (4.3%) a diffuse brain swelling. Three months after injury, 36 (51.4%) patients died, 2 (2.9%) were left in a vegetative state and 23 (32.9%) had a favorable outcome. The appearance of progressive brain injury was associated with patient age, admission Glasgow Coma Scale, injury mechanisms, skull fracture and hemorrhagic lesions on the initial CT scan. Patients with the extracerebral lesions deteriorated 4 hours after injury, whereas those with intracerebral lesions deteriorated 8 hours after injury. The outcome based on Glasgow Outcome Scale was significantly associated with age, type of intracranial lesion, Glasgow Coma Scale following deterioration, the mechanism of injury and surgical treatment. It is concluded that early repeated CT scan is indicated in patients with risk factors of developing progressive brain injury.
Spontaneous resolution of the encapsulated chronic subdural hematoma has been observed not rarely in clinical practise. The authors had investigated eight such cases in detail in 1967, and the tentative criteria for the resolving hematoma had been proposed. Further eight cases were presented in this paper which accounted to seven percent of 121 cases of chronic subdural hematoma encountered between 1968 and 1978. Two cases of bilateral hematomas, two cases of apoplectic type and two cases of biconvex hematomas on CAG were included in the eight. These observations meant that the resolving subdural hematoma was not a different clinical entity from conventional chronic ones. The resolving hematoma appeared as preservation of low density area or area of decreasing density from mixed to low in successive CT scans in a course of resolution. It was proposed that in case of the resolving type increased fibrinolytic activity of the hematoma capsule and of the fluid became prematurely diminished due to unknown initiation and that spontaneous resolution took place without surgery. The previous criteria were commented based on discussion on the natural history of chronic subdural hematoma, outline of which was graphically illustrated.
