Early appearance of high grade glioma on magnetic resonance imaging.

The early appearance of high grade glioma on magnetic resonance (MR) imaging was retrospectively reviewed in the clinical records and MR images of 52 patients with intracerebral glioma treated in Osaka General Medical Center between 1997 and 2006. Three patients had no abnormal findings, and four patients had only hyperintense areas on T(2)-weighted imaging at initial MR examination. Five of the seven patients presented with generalized seizures. Six of the seven patients developed tumor progression within only 5 months. All patients underwent surgical tumor resection and the histological diagnoses were all high grade gliomas, glioblastomas in five, gliosarcoma in one, and anaplastic astrocytoma in one. Surveillance MR imaging should be performed at short intervals in adult patients presenting with seizures but with no or minimal abnormalities on initial MR imaging to identify progression of high grade glioma at the earliest opportunity.

[Massive epistaxis due to traumatic internal carotid artery pseudoaneurysm: a case report].

We present a case of traumatic pseudoaneurysm of the internal carotid artery (ICA) accompanied by skull base fracture, which was treated by endovascular trapping of the internal carotid artery. A 70-year-old woman met with a traffic accident and was admitted to our institution with epistaxis and accomapanied with shock. Angiography on day 2 showed carotidcavernous fistula. The patient had no eye symptom and was treated conservatively. A second angiography, two weeks aftrer the trauma, revealed development of a pseudoaneurysm on the C3-4 portion. We attempted balloon test occlusion (BTO) of the right internal carotid artery, and if torelated, the ICA may have been occluded. The day before BTO, she rebleed massively. Endovascular trapping of the ICA was performed. Although epistaxis was controlled completely, she suffered left hemiparesis due to an embolism during the procedure. Epistaxis from a traumatic aneurysm of the internal carotid artery may be fatal and emergency occlusion is proposed.

Basilar trunk aneurysms with associated fenestration treated by using Guglielmi detachable coils: two cases reports.

Basilar trunk saccular aneurysms associated with fenestration are infrequent. Surgical treatment of a basilar trunk aneurysm is difficult because of its anatomic environment and complicated surgical exposure. We experienced two cases of basilar fenestration aneurysm, and the patients were treated using Guglielmi detachable coils. The usefulness of 3-dimensional digital subtraction angiography and efficacy of endovascular treatment for basilar trunk aneurysms with associated fenestration is discussed in this article, and the relevant literature is reviewed.

Cervical extradural en-plaque meningioma.

A 22-year-old woman presented with a very rare extradural en-plaque spinal meningioma manifesting as right hemiparesis and gait disturbance. Magnetic resonance imaging revealed a well-enhanced lesion extending from the C-1 to C-5 vertebral levels, compressing the cord dorsally. Computed tomography revealed a slightly enhanced mass with calcification in the spinal canal, advancing in all directions except anteriorly. Surgery could not completely remove the part of the tumor that had progressed laterally. The histological diagnosis was cervical extradural en-plaque meningioma. Postoperatively, there was remarkable improvement in the patient's symptoms. Successful treatment of this type of tumor requires the development of a combined surgical and radiosurgical approach.

Intradural retroclival chordoma without bone involvement - case report.

A 63-year-old, previously healthy man presented with a rare large intradural retroclival chordoma without bone involvement. Computed tomography showed that the tumor was completely intradural and did not involve the bone, as confirmed at intraoperative inspection. The tumor was totally excised via the anterior transpetrosal approach. Surgery is the most effective first-line treatment for patients with chordoma despite the typical extradural extension and bone destruction. Complete resection is feasible for intradural extraosseous chordoma because of the sharply circumscribed margins and absence of bone involvement. Specialized skull base techniques should be used instead of conventional surgical approaches for intradural skull base chordoma.

Effect of gefitinib on brain metastases from non-small cell lung cancer.

Two patients with non-small cell lung cancer presented with multiple brain metastases. They received gefitinib orally for the treatment of the primary lung lesions. About one month later, the brain metastases unexpectedly disappeared or became smaller. The patients survived without recurrence of brain metastases and growth of lung lesions for 3-4 years. Gefitinib is a selective epidermal growth factor receptor tyrosine kinase inhibitor and is approved for use in the treatment of non-small cell lung cancer. Gefitinib may be very effective for multiple brain metastases in patients with non-small cell lung cancer.