A detailed analysis of normal cerebrovascular anatomy on axial transverse computed tomographic (CT) images is presented. Fresh cadavers were injected with gelatinous iodine solution for clear visualization of cerebral blood vessels. A detailed knowledge of the normal cerebrovascular anatomy on the axial transverse CT image in relation to other intracranial structures is a prerequisite for the interpretation of cerebral computed angiotomograms.
The authors describe two cases of traumatic aneurysm of peripheral cerebral arteries. Surgical treatment as soon as possible after the diagnosis has been made is advised to avoid the high risk of delayed hemorrhage.
We have carried out basic investigations of an intravenous minimum dose bolus (MinDB) injection method for cerebral computed angiotomography by comparing blood iodine concentrations with high resolution computed tomography (CT) images of cerebral blood vessels. With the GECT/T 8800 scanner, a MinDB injection of 1 ml/kg of 60% Conray at a rate of 2 ml/s made it possible to increase the blood iodine concentration in the carotid artery to more than 15 mg/ml for about 20 s. Computed tomography performed during this period enabled us to obtain clear images of the circle of Willis, including other main cerebral arteries, deep veins, and cortical and lenticulostriate arteries. Cerebral computed angiotomography using this method should be useful for noninvasive screening or detection of cerebrovascular lesions themselves, such as cerebral aneurysms, cerebrovascular obstructions, arteriovenous malformations, and moyamoya disease, and should also be useful for determining the anatomical relationship between the cerebral blood vessels and other parenchymal or space occupying lesions.
A case of craniopharyngioma confined in the third ventricle is reported. A 53-year old man was admitted because of headache, nausea, vomiting and general malaise lasting for one year and a half before admission. Neurological examinations showed no significant abnormalities except for a slight degree of papilledema. Lumbar cerebrospinal fluid contained 200 mg/dl of protein and other laboratory tests were normal. Plain skull films were normal. A static technetium 99m brain scan showed no increased uptake. Angiography demonstrated only symmetrical dilatation of the lateral ventricle. Conray ventriculography outlined an irregular mass almost completely filling the anterior third ventricle. Pneumoencephalography showed no abnormality in the suprasellar cistern. Biplane CT scans showed a homogeneously highly enhanced tumor located precisely above the sella turcica and in the third ventricle. A right frontal craniotomy was performed and the transcallosal approach to the lateral ventricle was made. A part of the tumor protruded through the left dilated foramen of Monro into the lateral ventricle. The tumor was reddish, solid, soft and densely adherent to the right wall of the third ventricle. The tumor was subtotally removed under an operating microscope. Histopathological examination of this tumor revealed squamous cell type craniopharyngioma. The patient made an uneventful postoperative recovery, but 2 months after the first operation. a V-P shunt was performed because of gradually developing normal pressure hydrocephalus. Although he recovered after the shunt operation, he died of pneumonia 2 months after the shunt operation. No autopsy was performed. Craniopharyngioma located entirely in the third ventricle has, to our knowledge, been reported in only six cases previously. These reports were reviewed and the condition is discussed in terms of etiology, diagnosis, clinical course and treatment.
Three cases of blow-out fractures of the orbit were evaluated by Towne and semisagittal computed tomography (CT). The Towne CT well delincated the inferior rectus muscle, the orbital floor, and the entrapped orbital contents, including a bony fragment in the maxillary sinus. The semisagittal CT plane was optimal for lateral delineation of the orbit, although their is need for improvement in the head positioning and gantry width. Postoperative recovery of impaired eye movements was related to CT findings.
The left middle cerebral artery (MCA) was occluded at its origin via a subtemporal approach under operating microscopic control in 24 dogs.In 8 of these 24 dogs, end-to-side anastomosis between the maxillary artery (MA) and a branch of the left middle cerebral artery (MA·MCA anastomosis) was completed 4 hours after MCA occlusion (prompt bypass). In 5 dogs, MA·MCA anastomosis was performed 3 weeks after MCA occlusion (delayed bypass). These MA·MCA anastomoses were carried out with microsurgical technique as well. Remaining 11 dogs without MA·MCA anastomosis were used for control animals.Each animal was observed clinically every day until sacrifice.In control animals, common carotid angiography was performed just prior to sacrifice between 2nd and 5th postoperative weeks. Treated animals were studied with selective external carotid angiography 2 weeks after MA·MCA anastomosis.After sacrifice, transcarotid perfusion with 10% formalin solution was carried out, the brains were removed carefully, and they were additionally fixed in 10% formalin for 2 weeks. Each brain was sectioned, stained and examined histologically.1. MA·MCA anastomosis was devised as a new experimental model for extracranial-intracranial bypass graft in the dog. In prompt bypass of 8 dogs, 7 cases showed patency of anastomosis (88%), and in delayed bypass of 5 dogs, angiogram revealed 4 patent anastomosis (80%). In successful cases, angiogram demonstrated excellent filling of the entire territory of MCA through the new shunts.Anatomical and spatial advantage of the MA seemed to have brought good results in our series of anastomosis than that of other previous experimental extracranial-intracranial bypass graft in the dog. This is the first report on successful patent bypass graft after long-term occlusion of the MCA in animals. It seems that this new experimental model brings the progress in the field of studies of extracranial-intracranial bypass graft for cerebral infarction.2. Clinical evaluation of all control animals showed mild to severe neurological deficits, mainly contralateral hemiparesis, or death. On the other hand, animals with patent prompt bypass demonstrated no neurological deficits.Gross and histological evaluation of the brains showed that permanent occlusion of the MCA produced medium or large-sized infarct located in its territory in control animals, and patent prompt bypass usualy caused no or only microscopical infarct. In patent delayed bypass, the size of infarct seems to be smaller than that of non-treated animals.No hemorrhagic infarct caused by revascularization was found in treated animals with both prompt and delayed bypass grafts.There was fairly good relation between the neurological deficits and the pathological features in the brains.In general, it seemed that animals with patent bypass grafts fared better than untreated animals both clinically and pathologically.This experimental data suggest that reestablishment of blood flow by extracranial-intracranial bypass graft, especially in prompt bypass, might lead to significant restoration of neurological function without pathological damage of the brain.
