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Anthony J. Raimondi, Satoshi Matsumoto and Robert A. Miller

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Anthony J. Raimondi and Satoshi Matsumoto

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Chisato Araki and Satoshi Matsumoto

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Veins draining the pineal body

An anatomical and neuroradiological study of “pineal veins”

Norihiko Tamaki, Kiyoshi Fujiwara, Satoshi Matsumoto and Hajime Takeda

✓ The authors present a detailed anatomical and neuroradiological study of the veins draining the pineal body proper, which they designate “pineal veins.” They describe three variations of the pineal veins. Since each has a characteristic angiographic relationship to the pineal body, the results of the study may permit early diagnosis of a pinealoma and distinguish the nature of the tumors of the posterior third ventricle.

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Kunihiko Osaka and Satoshi Matsumoto

✓ The clinical, angiographic, and pneumoencephalographic features of seven cases with holoprosencephaly are reported. Three of the alobar type in this series revealed the facial dysmorphia characteristic of the anomaly. In the other four cases (one alobar, one semilobar, and two lobar), such facial anomaly was absent, and the diagnosis was achieved only after contrast studies.

An azygous anterior cerebral artery running over the cerebral surface due to a defective interhemispheric fissure is pathognomonic for alobar and semilobar holoprosencephaly. Dysgenesis of the deep venous system was found in alobar, semilobar, and lobar holoprosencephaly, a finding helpful in diagnosis, especially of the lobar type. Air study and computerized tomography scan revealed incomplete separation of the ventricular system. The basic nature of holoprosencephalization and its differentiation from non-holoprosencephalic malformation are discussed. Six of the seven patients reported had hydrocephalus.

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Kunihiko Osaka, Takashi Tanimura, Akihiko Hirayama and Satoshi Matsumoto

✓ The authors report a study of 92 human embryos and four fetuses with myeloschisis. The characteristics of embryonic myeloschisis compared with spina bifida cystica in infants are: 1) the lesion is often more diffuse, involving the whole spinal cord (12 embryos); 2) the cervical cord is more frequently affected (23 of the remaining 80 embryos); 3) holoprosencephaly is frequently associated (18 embryos); 4) meningocele is not found; and 5) hydrocephalus and Arnold-Chiari malformation are not yet developed. Hydrocephalus and Arnold-Chiari malformation are found in myeloschistic fetuses. Almost all embryos with diffuse and cervical myeloschisis or with holoprosencephaly are extruded before birth by spontaneous abortion. Absence of meningocele in the embryonic period implies that its appearance is deferred to the fetal period. The development of hydrocephalus and Arnold-Chiari malformation also seems to be delayed until the fetal period. Our observation implies that myelomeningocele is induced by non-closure of the neural tube, not by rupture once it was closed. “Neural overgrowth” and disturbed “recanalization process” are discussed in relation to the pathogenesis of myelomeningocele.

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Kazuyoshi Korosue, Norihiko Tamaki, Satoshi Matsumoto and Yoshiyuki Ohi

✓ The authors report a rare case of intracranial granuloma as a complication of subdural-peritoneal shunting for the treatment of subdural effusion. The necessity of the removal of the entire shunt system as soon as the subdural effusion has cleared is emphasized.

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Synergistic effect of perfluorochemicals on BCNU chemotherapy

Experimental study in a 9L rat brain-tumor model

Keiichi Kuwamura, Takashi Kokunai, Norihiko Tamaki and Satoshi Matsumoto

✓ In a study of the effect of adding perfluorochemicals to BCNU chemotherapy, 7 × 105 9L tumor cells were implanted in the right cerebral hemisphere of Fischer 344 rats weighing about 100 gm each. On the 7th day after implantation, rats were given BCNU or Fluosol-43 (perfluorochemical artificial blood substitute), or a combination of the two, and the therapeutic effects of these treatments were studied. Mean survival time of control animals was 15.23 days ± 2.84 days (standard deviation); in the group treated with Fluosol-43 and kept in an oxygen chamber (95% O2, 5% CO2), survivial time was 15.30 ± 2.11 days. The BCNU treatment alone and BCNU in rats kept in an oxygen chamber prolonged the mean survival time to 20.90 ± 3.80 days and 21.10 ± 2.14 days, respectively. Survival times in rats receiving BCNU plus Fluosol and breathing normal air, BCNU plus dextran-40 and breathing normal air, and BCNU plus dextran-40 in an oxygen chamber were 21.20 ± 2.63 days, 22.90 ± 1.52 days, and 22.20 ± 1.79 days, respectively. On the other hand, treatment with BCNU plus Fluosol-43 in rats kept in an oxygen chamber resulted in a significant increase of mean survival time of 32.27 ± 4.80 days (p < 0.005). From these results, it seems likely that Fluosol-43 with oxygen might have a synergistic effect for BCNU chemotherapy in malignant brain tumors.

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Polycystic kidney disease and intracranial aneurysms

Early angiographic diagnosis and early operation for the unruptured aneurysm

Toshimitsu Wakabayashi, Shigekiyo Fujita, Yoshiro Ohbora, Tohru Suyama, Norihiko Tamaki and Satoshi Matsumoto

✓ From August, 1981, to August, 1982, the authors performed four-vessel angiography in 17 patients with polycystic kidney disease (PKD) who had no neurological deficit and no history of subarachnoid hemorrhage. Seven cases of unruptured aneurysms were found among these 17 patients (an incidence of 41.2%). Five of the unruptured aneurysms were operated on prophylactically, with no mortality or morbidity. Nine of the 17 patients had hypertension and, of these, two (22.2%) had aneurysms. Of the eight patients without hypertension, five (62.5%) had aneurysms. This study suggests that the coexistence of PKD and intracranial aneurysms might not be due to the hypertension that occurs concomitant with PKD, but instead may be attributable to congenital factors. The authors stress the necessity of early diagnosis and early operation for unruptured aneurysms in patients with PKD.

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Cerebral hemodynamics in normal-pressure hydrocephalus

Evaluation by 133Xe inhalation method and dynamic CT study

Norihiko Tamaki, Tadaki Kusunoki, Toshimitsu Wakabayashi and Satoshi Matsumoto

✓ Cerebral hemodynamics in 31 patients with suspected normal-pressure hydrocephalus were studied by means of the xenon-133 (133Xe) inhalation method and on dynamic computerized tomography (CT) scanning. Cerebral blood flow (CBF) is reduced in all patients with dementia. Hypoperfusion was noted in a frontal distribution in these patients compared with normal individuals. There was no difference in CBF patterns between patients with good and those with poor outcome. The CBF was increased following cerebrospinal fluid (CSF) shunting in patients who responded to that procedure: increase in flow correlated with clinical improvement, frontal and temporal lobe CBF was most markedly increased, and the CBF pattern became normal. In contrast, CBF was decreased after shunt placement in patients who were considered to have suffered from degenerative dementia, as evidenced by non-response to shunting.

Dynamic computerized tomography studies demonstrated that patients with a good outcome showed a postoperative reduction in mean transit time of contrast material, most prominent in the frontal and temporal gray matter, and slight in the deep frontal structures, but not in the major cerebral vessels. Patients with poor outcome after shunting, however, had an increase in transit time in all regions. This corresponded well with the results as determined by the 133Xe inhalation method.