Juvenile migration of the exclusively pelagic cyprinid, Gnathopogon caerulescens (Honmoroko) in Lake Biwa, Central Japan.

Migration of wild and cultivated juvenile honmoroko Gnathopogon caerulescens of from the spawning and nursery areas in Lake Biwa were investigated, both in the Ibanaiko Lagoon and its outlet to Daido River, using beam-trawl surveys in 2013 and 2014. The study demonstrated migration of G. caerulescens from a nursery lagoon toward Lake Biwa after the juvenile stage. These findings appear to be the first direct evidence for migration of an exclusively pelagic cyprinid species from a littoral nursery to a pelagic adult habitat in a large deep lake.

Intraventricular hematoma secondary to a ventriculoperitoneal shunt.

A rare and serious complication of ventriculoperitoneal shunt is reported. A huge intraventricular hematoma was confirmed by computed tomography scanning and autopsy. This is the first report of such a complication in a newborn with hydrocephalus.

Cerebral arteriovenous malformations: factors influencing the surgical difficulty and outcome.

The outcomes of 151 patients with arteriovenous malformations (AVMs) treated either surgically or conservatively are presented. In terms of long-term survival rate and follow-up results, the patients who underwent total excision had more favorable results than did those treated conservatively. Patient age was the most important clinical factors, with the preoperative level of consciousness being the second most important. A grading system was formulated on the basis of the angiographical factors by using multiregression analysis; the size of the AVM influenced the surgical outcome twice as much as did the location and the pattern of arterial feeding. Thus, a large AVM (greater than or equal to 4 cm) was given 2 points; a small AVM (less than 4 cm) was given 0 points; a deep AVM was given 1 point; a superficial AVM was given 0 points; an AVM supplied by three of more artery systems was given 1 point; and an AVM supplied by one or two artery systems was given 0 points. AVMs were categorized into 5 grades from Grade 0 to 4 by the summation of these points. Predicted Karnofsky scale after surgery was calculated by this grading system and the following equation: predicted Karnofsky scale = 87.2 - 5.6 x Grade. Grade 0 and 1 AVMs showed high rates of total excision (Grade 0, 94%; Grade 1, 82%) and of satisfactory outcome (Grade 0, 90%; Grade 1, 82%) and were classified as "easy" lesions. Grade 2 AVMs are lesions classified as "moderate" and had a total excision rate of 76% and a satisfactory outcome rate of 71%.(ABSTRACT TRUNCATED AT 250 WORDS)

Synergistic effect of perfluorochemicals on BCNU chemotherapy. Experimental study in a 9L rat brain-tumor model.

In a study of the effect of adding perfluorochemicals to BCNU chemotherapy, 7 X 10(5) 9L tumor cells were implanted in the right cerebral hemisphere of Fischer 344 rats weighting 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), survival 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 less than 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.

Effect of perfluorochemicals on BCNU chemotherapy: preliminary study in a rat brain tumor model.

This preliminary study was undertaken to identify the combined efficacy of perfluorochemicals (Fluosol-43) and a chemotherapeutic agent (BCNU) in a rat brain tumor model. The brain tumor model was produced by the intracerebral transplantation of C6 rat glioma cells. Fluosol-43 plus BCNU in an oxygen environment produced a significant prolongation of mean survival time compared to that of BCNU treatment alone. Perfluorochemicals (Fluosol-43) seem to have some synergistic effect on BCNU chemotherapy for this brain tumor model.

Reversible congruous homonymous hemianopia as a symptom of shunt malfunction.

Congruous left homonymous hemianopia occurred as a symptom of ventriculoperitoneal shunt malfunction. The low attenuation along the ventricular catheter in the right occipital area that was seen on a computed tomography scan disappeared after revision of the shunt, and corresponded with improvement of this peculiar visual field symptom. In view of anatomic considerations and clinical course, this homonymous field defect might be caused by peritubular cerebrospinal fluid edema in the right occipital area. In evaluating the patients having shunts, precise neuroophthalmologic examination should be performed for possible visual field defects.

Syrinx-fourth ventricle and lateral ventricle-peritoneal shunts for congenital hydrocephalus with syringobulbia and syringomyelia: case report.

A case of congenital hydrocephalus with syringobulbia and syringomyelia was reported. Although his neurological condition had deteriorated because of shunt malfunction, progressing syringobulbia, and syringomyelia, he recovered because of the direct communication from the syrinx in the medulla to the fourth ventricle, the shunt from the syrinx in the cervical spinal cord to the fourth ventricle, and the lateral ventriculoperitoneal shunt.

Intraarterial infusion of papaverine and change of cerebral hemodynamics in symptomatic cerebral vasospasm.

In 43 cases with symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage treated by intraarterial infusion of papaverine (IAP), we studied cerebral hemodynamics by measuring cerebral circulation time (CCT) using digital subtraction angiogram. CCT on the middle cerebral artery site was defined as CCT-LAV and on the anterior cerebral artery side as CCT-MAV. In the CCT-LAV, two phases were further defined; the arterial phase (CCT-A) and the capillary phase (CCT-CAP). Mean CCT-LAV before and after IAP was 6.35+/-1.69 sec, 4.91+/-1.56 sec, and mean CCT-MAV was 6.15+/-1.68 sec, 4.80+/-1.58 sec, each showing a significant shortening. Mean CCT-A before and after IAP was 0.274+/-0.105 sec, 0.226+/-0.066 sec and mean CCT-CAP was 6.00+/-1.62 sec and 4.60+/-1.55 sec. The shortening rate of CCT-A and CCT-CAP were 11.2+/-25.7% and 22.7+/-14.6% respectively. Our study confirmed that IAP shortened CCT and improved cerebral hemodynamics. Compared with CCT-A, CCT-CAP was shortened significantly, suggesting that IAP is working not only in the proximal vessels but also in the distal vessels, that is, effective for resolution of vasospasm in the view of cerebral microcirculation. Clinical outcome was not improved statistically, however, it is the fact that there are not a few cases improved neurologically and IAP is still useful for vasospasm as a means to directly dilate intracranial peripheral arteries.

Chronic subdural hematoma in elderly people: present status on Awaji Island and epidemiological prospect.

The epidemiological aspect of chronic subdural hematoma (CSH) in the elderly who are 65 years old or elder was evaluated on Awaji Island with about 170,000 inhabitants. The overall incidence of CSH was 13.1 per 100,000/year, 3.4 in people under 65 years old, and 58.1 in the elderly. The elderly were 17.7% of all inhabitants. If these incidences of CSH are extrapolated to all of Japan in the year 2020, the incidence will be 16.3 per 100,000/year. This suggests that CSH may become the most common neurosurgical condition.

Pseudoankylosis of the mandible as a result of methyl methacrylate-induced inflammatory cicatricial contracture of the temporal muscle after cranioplasty.

Pseudoankylosis of the mandible after intracranial surgical procedure has been widely reported, and is usually caused by fibrosis of the temporal muscle as a result of injury during the operation. We present an unusual case of mandibular pseudoankylosis as a result of methyl methacrylate-induced aseptic inflammatory cicatricial contracture of the temporal muscle after cranioplasty.

A patient whose cerebral aneurysm ruptured soon after an operation to remove a maxillary cyst.

A hypertensive woman complained of a headache soon after an operation to remove a maxillary cyst. A computed tomogram showed evidence of subarachnoid haemorrhage and on angiogram an aneurysm of an anterior cerebral artery. The aneurysm was treated by clipping and the patient recovered.

[Treatment and diagnosis of middle fossa arachnoid cyst: ventriculofiberscopy and cine-MRI].

The treatment of intracranial arachnoid cysts in controversial regarding its surgical indication and operative procedures. Conventional surgical approaches such as fenestration, membranectomy, and shunting operation are invasive. Also CT cisternography and/or RI cisternography are invasive, when it has been performed to evaluate the possible CSF communications between the arachnoid cyst and subarachnoid space. Between July 1994 and February 1997, 10 patients with intracranial middle fossa arachnoid cysts were treated with a newly developed ventriculofiberscope which is characterized by splendid mechanical flexibility and high resolution. The cine-MRI, which is a non-invasive diagnostic tool, is used to evaluate the CSF circulation around the cyst fenestration. The patients' ages ranged from 4 months to 10 years, with a mean of 4.46 years. The cyst locations were left middle fossa (9), and right (1). Eight patients presented with macrocrania, 4 with developmental delay, three with seizure, two with headache, and one with subdural hematoma. The patients were preoperatively evaluated by means of MRI and cine-MR images. In all patients ventriculofiberscopic procedures including cyst fenestration, membranous dissection, cyst puncture and shrivelling were successfully performed. Postoperative MR and cine-MR studies have shown reduction of the cyst size and appropriate CSF circulation. Neuroendoscopic procedures seem to be the choice for children with arachnoid cysts and the ventriculofiberscope proved to be very useful not only for cyst fenestration but also for cyst dissection. In addition, the non-invasive cine-MR studies are useful for long follow-up at OPD.

[Problems of the chemotherapy for malignant brain tumors--treatment with granulocyte transfusion for refractory infection due to agranulocytosis].

Recent progress of the chemotherapy for malignant brain tumors has made some prolongation of survival time of the patient. However, it is still far away from our satisfactions and still we are even irritable about the results of brain tumor therapies in neurosurgical practice. One of the major side effects of these chemotherapeutic agents is myelosupression which is dose-dependent. When applying the chemotherapy to the brain tumor patients aggressively, we experience that occasionally we are having a chance to see the so-called "chemotherapy death" caused by agranulocytosis and severe infections. In this report we introduced the granulocyte transfusion by the method of filtration leukapheresis in the neurosurgical field, especially its technical aspects, its advantages, and its indications. And we presented a case of pontine glioma who had been successfully treated with the granulocyte transfusion for the agranulocytosis with serious infection. The indication of granulocyte transfusion are as follows: (1) The count of granulocyte is under 500/mm3. (2) The patient has the infection that has no response to the intensive antibiotic therapy for about two days. The advantages of this method of granulocyte transfusion are as follows: (1) Low cost and simple process. (2) The contamination of lymphocyte is little. (3) A large number of granulocyte (1.93 X 10(10)) are obtained from one donor for about two hours. (4) Side effects to donor and patient are very few. We concluded hereafter that this method of granulocyte transfusion should be prepared broadly on the neurosurgical wards in cases of agranulocytosis during the chemotherapy for malignant brain tumors.

[Hemodynamic study of cerebral arteriovenous malformation by using 133Xe inhalation method].

We evaluated the hemodynamics of cerebral arteriovenous malformation (AVM) by measuring the regional cerebral blood flow (rCBF) with 133-Xe inhalation method in 20 cases. In addition, cerebrovascular CO2 reactivity were investigated in 12 cases among them by 5% CO2 inhalation (3 + 10 min). Twenty patients were 6 to 61 years of age (median 36.1 years) and 12 were male and 8 were female. Normal value of rCBF was obtained from 9 healthy volunteers. We measured rCBF using Novocerebrograph and evaluated by F1 & ISI value from 2 compartmental analysis. In order to evaluate CO2 reactivity, reactivity factor (RF) was calculated. (RF: CBF at 5% CO2-CBF at rest/PaCO2 at 5% CO2-PaCO2 at rest) AVM were divided into 3 types, namely superficial type in which the lesion was on the surface of the brain (5 cases), deep type in which the lesion was located deeply in the brain (13 cases) and dural AVM (2 cases). There were 2 types of feeding artery, that is, those via cortical branch or not, and we investigated the relationship between the angiographical findings and the types of AVM with reference to rCBF. In superficial type, all cases had feeding arteries via cortical branch. Two of them showed normal rCBF but 3 cases showed locally high and low value of rCBF on the lesion and low value around it. Angiograms showed hypovascular area coincident with this low value region. But a significant difference of mean CBF on both hemispheres was not detected in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diagnosis for dural arteriovenous fistulas based upon MR angiography].

Diagnosis of dural arteriovenous fistulas (DAVFs) has been traditionally based on cerebral angiography, which is still an invasive process. Recent advances of MR angiography have started to bring us into a new area of diagnosis for stroke patients. While using MRA at the out-patient clinic for screening patients with cerebrovascular disease, we have had a chance to diagnose DAVFs. We discussed MRA findings concerning DAVFs, comparing them with the findings of conventional angiography. We also stressed the need to set the slab so as to include the entire posterior fossa in order to disclose any vascular anomaly around the lateral and sigmoid sinus.

[Cerebral sinus thrombosis in a patient with protein S deficiency: a case report].

Cerebral sinus thrombosis associated with protein S deficiency is rare to the best of our knowledge. We report here a 22-year-old female who presented sudden onset of headache, vomiting and disturbance of consciousness. Neuroradiological studies including computed tomography scan, magnetic resonance imaging and cerebral angiography disclosed a huge cerebral sinus thrombosis in the territory of the superior sagittal sinus, torcular herophili, lateral sinus and straight sinus. Hematological studies confirmed the diagnosis of protein S deficiency. We summarize the reported cases of cerebral sinus thrombosis associated with protein S deficiency. For young patients presenting occlusive cerebrovascular disease, we stressed the importance of doing extensive hematological investigation to detect possible etiological factors, such as protein S deficiency, protein C deficiency, antithrombin III deficiency. Once we discover the etiology of a disease, we may be able to designate the precise treatment or regimen for each patient.

[The management of slit-like ventricle with the Medos programmable Hakim valve and the ventriculofiberscope].

A slit-like ventricle is one of the serious complications which can occur after a shunting operation. Low pressure valve systems are usually applied for hydrocephalus during infancy. As a result the shape of the ventricle often becomes slit-like after the operation. Many shunt dependent children with slit-like ventricles have to undergo shunt revisions repeatedly. From April 1995 to February 1997 the authors used the Medos programmable Hakim valve system for 20 hydrocephalic children with slit-like ventricles who had been suffering from multiple shunt problems. The patients ages at the operation were between 3-16 Male:Female was 12:8. Follow up periods were 10-20 months. In 12 of 20 patients the shunt revisions were performed at the time of shunt dysfunction and the valve pressure levels were able to be set at the highest levels without the appearance of any symptoms. In this group the size of all the ventricles had become slightly enlarged. In the other 8 patients the operations were performed for fear of other troubles arising if shunt revisions were neglected. In this group the valve pressure levels were set with reference to the intraoperative ICP. It took a relatively long period to elevate the valve levels. Shunt dysfunction due to obstruction of the ventricular catheter was seen in one case but the symptom was not so severe and the catheter which had firmly adhered to the choroid plexus was removed endoscopically. In 2 cases of this series the shunt systems were successfully eliminated. The authors report the method and efficacy of their series using the Medos programmable Hakim valve system and a newly developed ventriculofiberscope for the slit-like ventricle of children.

[A case of primary cerebral neuroblastoma surviving for eight years].

We report a case of a patient with primary cerebral neuroblastoma who has survived for 8 years. A 10-year-old boy was admitted to our hospital because of headache and nausea. CT scan on admission revealed a large cystic tumor on the right frontal lobe. Subtotal tumor resection was carried out. A second operation was performed for the residual tumors which were removed meticulously with confirmation of the absence of tumor cells on each frozen section. After tumor removal, YAG laser was applied at each local area. Histological diagnosis disclosed primary cerebral neuroblastoma. Because of postsurgical meningitis and parent's refusal, neither chemotherapy nor radiation therapy was performed. There have been no findings of the tumor recurrence during the last eight years, and now the patient is enjoying high school life to the full, without any neurological deficits. In reviewing the literature, outcomes of neuroblastoma cases are very poor. Our case seems to be one of the rare long-survival cases.

[Effect of perfluorochemicals on BCNU chemotherapy in a rat brain-tumor model].

Perfluorochemicals (Fluosol-43) is characterized with its small size and high propensity for carrying oxygen and carbon dioxide, and also have the function to improve the cerebral microcirculation. These characteristic features of Fluosol-43 may have a beneficial effect on brain-tumor chemotherapy in terms of the oxygenation of hypoxic cells, and/or the improvement of the pharmacokinetics of anticancer drugs. This study was undertaken to identify the combined effect of perfluorochemicals (Fluosol-43, 20 ml/kg) and chemotherapeutic agent (BCNU, LD10 dose; 13.3 mg/kg) in a rat brain-tumor model. Brain-tumor model was made by the intracerebral implantation of C6 rat glioma cells (1 X 10(5) cells/10 microliters). At 10 days after implantation, control animals had a macrotumor weighing about 100 mg with large part of central necrosis. The tumor-bearing rats for 10 days after implantation were randomly divided into 4 groups; a control group, a Fluosol-43 treatment group, a BCNU treatment group, and a Fluosol-43 plus BCNU treatment group. Control animals had mean survival time of 19.94 +/- 2.41 (S.D.) days, and mean survival time of Fluosol-43 treatment group was 19.47 +/- 1.36 days. BCNU treatment alone prolonged the mean survival time to 28.36 +/- 7.94 days (p less than 0.001). Fluosol-43 plus BCNU treatment group showed 36.00 +/- 10.15 days, which was significantly greater than that of BCNU treatment alone group (p less than 0.005). The long survivals lived over 50 days after implantation were 7 out of 27 rats in Fluosol-43 plus BCNU treatment group, in contrast to one out of 25 rats in BCNU treatment alone group. Perfluorochemicals (Fluosol-43) may have the synergistic effect on BCNU chemotherapy for brain tumors. It was speculated for the above results that following the oxygenation of hypoxic cells by Fluosol-43, hypoxic cells might be sensitized to BCNU, which might be much delivered into hypoxic area. And further studies should be done for the evaluation of the mechanism of perfluorochemicals on brain tumor experimentally before clinical application.

[Case of aseptic primary cavernous sinus thrombosis].

Cavernous sinus thrombosis (CST) is classified into aseptic and septic types on the basis of its pathognosis. Aspetic CST includes the primary and secondary types, in which the former is an unknown etiology. We have recently experienced a rare case of aseptic primary CST which showed initially the intraorbital congestive symptoms. This 64 years male admitted to our clinic with the complaints of non-pulsatile exophthalmosis and conjunctival congestion of left eye. On admission, he showed mild external ophthalmoplegia and clinical evidence of intraorbital congestion (choked disc, retinal vein thrombosis, retinal hemorrhage) on the left side. The blood examination, including the thyroid studies, revealed no abnormal findings except for mild anemia and increased ESR. In carotid angiography, there was occlusion of Sylvian vein and cavernous sinus in the affected side. Orbital venography and retrograde jugular venography demonstrated the occlusion of superior ophthalmic vein, cavernous sinus and inferior petreous sinus in left side. CT scan revealed parasellar enhanced area in the normal pattern. Enhanced orbital CT scan revealed the hypertrophy of left external occular muscles and optic nerve with a tomogram of the dilatated superior ophthalmic vein. Aseptic primary CST was diagnosed on the basis of clinical course, cavernous sinography and CT findings.