[Diphenylhydantoin-induced pure red cell aplasia after neurological surgery: report of two cases].

Pure red cell aplasia (PRCA) is characterized by severe anemia, reticulocytopenia, marked selective hypoplasia of the erythroid precursor cells in the bone marrow and normal peripheral leukocyte and platelet counts. We reported two cases of diphenylhydantoin (DPH)-induced PRCA after neurological surgery. They recovered completely with discontinuance of DPH therapy. Neurosurgeons should be aware of this side effect because most reported cases of PRCA have occurred about a few months after neurological surgery under general anaesthesia and DPH therapy.

Pulmonary arteriovenous fistula manifesting as amaurosis fugax--case report.

Pulmonary arteriovenous fistula (PAVF) is a rare condition which occasionally causes neurological complications. A 43-year-old female with multiple PAVFs presented with several episodes of amaurosis fugax and transient right hemiparesis. She had no other vascular abnormality, and her human leukocyte antigen haplotype did not coincide with previous patients with hereditary hemorrhagic telangiectasia. She underwent PAVF embolization to prevent further neurological complications, and had an uneventful subsequent clinical course. Amaurosis fugax is a slight neurological symptom and may be an early important sign of PAVF. We stress that PAVFs should be considered in the differential diagnosis of patients with amaurosis fugax who complain of exertional dyspnea or demonstrate cyanosis.

Kainic acid-induced perirhinal cortical seizures in rats.

Seizures induced in rats by kainic acid microinjection into the perirhinal cortex were studied electrophysiologically and behaviorally and compared with known features of seizures following kainic acid injection into the amygdala. Unlike amygdalar seizures, perirhinal cortical seizures did not generalize to become limbic seizures but rather spread to sensorimotor cortex to become manifest as motor seizures. Perirhinal cortical seizures also required larger kainic acid doses for provocation and were briefer.

Fetal glioblastoma: rapid growth during the third trimester.

We present a case of fetal glioblastoma which appeared after 28 weeks' gestation. The first ultrasonographic finding was an enlarged fetal head with right shifted falx cerebri at 31 weeks' gestation. At 33 weeks, a large and high echogenic mass in the left hemisphere and right enlarged ventricle was identified. Magnetic resonance imaging showed that the tumor was localized in the left hemisphere and a margin of the tumor was defined. Because fetal well-being judging from biophysical parameters was good and we considered that the tumor was resectable, a male fetus weighing 2,670 g was delivered at 34 weeks' gestation by cesarean section. However, he was inoperable due to consumptive coagulopathy and rapid growth of the tumor, and died on the 41st day of life.

Preoperative localization of brain lesions by magnetic resonance imaging with a marking device. Technical note.

A new technique for preoperative localization of brain lesions using magnetic resonance imaging and a marking device is described. The projection of lesions, especially superficial brain tumors, is demonstrated on the scalp, with an acceptable tolerance for open procedures. This simple and inexpensive method, which was use in a group of 34 patients, can assist surgeons in planning an operative approach to intracranial lesions.

[A report of a transsphenoidal operation during pregnancy for a pituitary adenoma].

A 29-year old female, in her second pregnancy, complained of headache, nausea, vomiting and left blurred vision. In spite of improvement of these symptoms in the second postpartum, she complained of recurrent symptoms in her third pregnancy. CT and MRI showed a pituitary adenoma with hematoma. It was totally removed using the transsphenoidal approach during pregnancy at 8 months. The histological examination revealed that the tumor was an acidophilic adenoma with a hemorrhagic change. A healthy baby was born at the full term after the operation. Our transsphenoidal operation during pregnancy was only the second such attempt reported in our collected literature. The management of the pituitary tumor during pregnancy is discussed.

[A case of cerebral cysticercosis: cyst growth is confirmed by CT scan during 6 years of follow-up].

A rare case of a 40-year-old woman with cerebral cysticercosis is reported. She has lived on the Island of Tokunoshima and has never travelled overseas. She was hospitalized in the hospital of Kagoshima University in 1980. A small cyst in the right temporal lobe, and a calcified area in the left parietal lobe was noticed on CT scan. When she was admitted to our hospital in December 1986, the cyst in the right temporal lobe was larger than it was 6 years before. An operation was performed for the cyst in the right temporal lobe. The cyst was pathologically confirmed as cysticercosis. Postoperatively, immunological reaction of cysticercosis was positive, but X-rays and CT scan of extremities showed no abnormal findings. Cerebral cysticercosis is a rare disease in Japan. CT scan is very useful in the diagnosis of this disease. Multiple cysts and calcified area in the parenchymal region are specific findings on CT scan.

[A case of clival chordoma without bone destruction].

A case of clival chordoma without bone destruction is reported. A 28-year-old man was admitted to Kagoshima University Hospital on April 8, 1983 with the complaints of headache, displopia and gait disturbance. Neurological examination revealed the right eighth, ninth, tenth nerve palsy and gait disturbance. Plain skull firms showed no abnormality and left vertebral arteriography revealed a displacement of basilar artery to the left side. The CT scanning showed a low density area at the retroclival region, and enhancement was acquired slightly. Metrizamide cisternography, CT cisternography showed retroclival round tumor and no destruction of the bone. The tumor which invaded intradurally was removed totally. Histological examination confilmed the chordoma. In this report, it will be stressed that when clival chordoma invades intradually, subtemporal approach will be most favorable, and metrizamide CT cisternography is one of the useful diagnostic procedures of retroclival mass.

An applicability study on a CT-guided stereotactic technique for functional neurosurgery.

When a CT-guided stereotactic technique for functional neurosurgery is adopted, extremely precise targeting is needed to obtain satisfactory surgical results. In this study the authors have investigated the accuracy of the target points determined by CT-guided techniques and compared with those of conventional roentgenographically controlled stereotactic procedures. Stereotactic surgery, employing the Brown-Roberts-Wells (BRW) system, was performed contemporarily 26 times in 23 patients, that is, 9 times in 8 patients for functional neurosurgery using with the roentgenographic method, and 17 times in 15 patients with the CT-guided method only for intracranial neoplasm biopsy. As a result, there were no problems of accuracy of determining the target points by CT-guided stereotactic surgery with the BRW system. When applying this technique for functional neurosurgery, it should be pointed out that there could be a discrepancy within 2 mm from the conventional target determination.

[Persistent primitive hypoglossal artery associated with intracranial aneurysm (author's transl)].

A case of the persistent left primitive hypoglossal artery associated with an intracranial aneurysm was reported. The thirty-year-old man was admitted to hospital in the diagnosis of subarachnoid hemorrhage at seven days after the onset. Bilateral carotid angiograms revealed a saccular aneurysm at the right internal carotid-posterior communicating artery junction and a persistent left hypoglossal artery arising from the left internal carotid artery at the level of the C-1 vertebra. Retrograde vertebral angiograms revealed right hypoplastic vertebral artery (2mm in diameter) and markedly hypoplastic left vertebral artery, vanishing at the level of the C-3 vertebra. The axial view of the left carotid angiogram demonstrated the hypoglossal artery entered into the cranial cavity through the hypoglossal canal. Linear tomogram in the modified reversed Stenvers projection demonstrated the enlarged left hypoglossal canal measuring 9 X 10 mm. The normal right canal measured 5 X 6 mm. The right frontotemporal craniotomy was performed and the aneurysm was successfully clipped at its neck under an operative microscope. The patient discharged without any neurological deficit. The persistent hypoglossal artery is one of the persistent carotidbasilar anastomoses. Ninety-six cases of the hypoglossal arteries have been reported in literature. Twenty cases of them were associated with intracranial aneurysms. The authors reviewed these twenty cases and discussed the genesis of the intracranial congenital aneurysm in relation to the persistent artery.