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Summary After introducing of Helical scanning CT (HCT) and 3D-CTA (three-dimensional CT angiography), various improvements to these methods have been made every year to achieve better imaging quality. The current resolution permits visualisation of the internal structure of tumors, although as yet insufficiently clearly. We suggest that these improvements can be more efficient than conventional cerebral aneurysms angiography. In this study, we compared HCT and 3D-CTA with conventional cerebral angiography in patients with cerebral aneurysms at our facility. We also examined whether 3D-CTA has the possibility of independent clinical application and can surpass conventional DSA in diagnostic efficacy. In this paper, we found this information insufficient in clipping operations using 3D-CTA only when 1) It was difficult to distinguish a crooked infundibular dilation from an aneurysm, 2) Imaging threshold influenced the measured value of the vascular diameter and 3) It was also difficult to confirm whether the peripheral vessels adhere to the aneurysm. In conclusion, from the result of the comparison between 3D-CTA and DSA in this study, it was concluded that 3D-CTA is a reliable alternative method to conventional angiography in the diagnosis of anterior circulation and most aneurysms of regular size. In such cases it may be possible to obtain the same quality of preoperative information, but it is less invasive. [ABSTRACT FROM AUTHOR]

The content of norepinephrine (NE) in the ventricular, basal cisternal and lumbar cerebrospinal fluid (CSF) was determined in 19 patients with ruptured cerebral aneurysms. The cisternal CSF in patients with vasospasm contained a significantly higher level of NE (0.246 ± 0.049 ng/ml) compared with those without vasospasm (0.075 ± 0.001 ng/ml) (p < 0.001). However, this increase is not considered to be high enough to constrict cerebral arteries, unless there is an increased NE-sensitivity in subarachnoid haemorrhage. Vascular responses to NE in vivo were then studied after reversing blood-induced prolonged vasospasm of the rabbit's basilar artery through a transclival approach as well as a newly developed basal cisternal irrigation model. However, NE in molar concentrations between 1 × 10 and 10 failed to produce further contraction of the artery. In conclusion, the increase in NE with vasospasm might be only a secondary phenomenon, and not a causative factor of vasospasm. Early removal of subarachnoid blood clots seemed to prevent the development of vasospasm. [ABSTRACT FROM AUTHOR]

A case of anterior sacral meningocele which was clearly visualized on whole body computerized tomography is presented. Posterior surgical approach with ligation of the narrow communication between the sacral dural sac and the meningocele alleviated the subjective complaints of a feeling of abdominal distention and of dysuria. For the purpose of postoperative follow-up study, examination by whole body computerized tomography proved to be the best method of evaluating the size of the meningocele and also the state of neighbouring structures. [ABSTRACT FROM AUTHOR]

The essential feature of tumour therapy rests upon host-tumour interaction. To achieve therapeutic effects, a prerequisite to immunotherapy is the reduction of tumour cells in the host's body. Such measures should not be immunosuppressive. Cytotoxic chemotherapy is not appropriate in this regard. Supraradical surgery and non-specific radiotherapy are not desirable for preservation of nervous function, if their immunosuppression is not as severe as cytotoxic substances. Boron-neutron capture therapy is a highly specific and least immunosuppressive means of reducing tumour cells of the central nervous system. A brief introductory review of basic research is presented. The interim clinical results are: (i) Treatment of recurrent glioblastoma: Survival extension obtained by neutron capture therapy is 21.9±7.2 mos in contrast to that obtained by conventional treatments of 6.7±0.6 mos (p<0.001), ( Total survival 26.3±6.7 mos); and (ii) only three patients including two glioblastoma cases were treated with neutron by the same surgeon who, by performing the first tumour operation, had the advantage in topographic knowledge for determining the radiation field. They survived 4, 5, and 6 years in almost fully active conditions. The new Musashi Institute of Technology Reactor Thermal Neutron Therapy Facility and the increased domestic production of boron-10 isotope have enlarged the therapeutic capacity to two dozen patients a year. [ABSTRACT FROM AUTHOR]

The authors survey 443 cases of intracranial aneurysms treated in the past seven years. 403 cases were operated upon with microsurgical techniques. The operative mortality was 5.4 per cent, and 82.4 per cent of surgically treated cases are well and working, leading useful social lives. It was found that cases submitted to surgery in the first three days after subarachnoid haemorrhage (SAH) (the day of SAH being counted as the first day) showed good results, little appearance of postoperative vasospasm, and no mortality due to vasospasm. Cases operated upon after one week from the insult of SAH also showed good results, whereas fatal postoperative vasospasm was seen in cases operated upon on the 4th-7th day after SAH. Cisternal, ventricular, and epidural drainage are recommended after the clipping of aneurysms in the acute stage of SAH. There were 68 cases with preoperative vasospasm. There was no case in which vasospasm was identified during the first four days after SAH, while 66 per cent of the cases exhibited vasospasm between the sixth and ninth days after SAH. These 68 cases can be classified into four groups: 1. 8 cases died from vasospasm before surgery; 2. 8 cases had renewed bleeding mainly when vasospasm began to subside; 3. 22 cases underwent surgery after vasospasm had subsided, the duration of vasospasm ranging from 8 to 24 days, on an average 14 days; 4. 30 cases underwent surgery while vasospasm was still present; of this group, (4E) 15 cases submitted to surgery, on an average 4.5 days after the onset of vasospasm, manifested deterioration of clinical states because of aggravation or new appearance of vasospasm; (4L) 15 cases which underwent surgery, on an average 7.4 days after the onset of vasospasm, showed no such deterioration. In the follow-up, well and working cases were seen in 45.5 per cent (3.), 60 per cent (4E), and 80 per cent (4L), respectively. The authors classified vasospasm into three types: Type 1, extensive diffuse, Type 2, multi-segmental, and Type 3, local. Type 1 was prognostically worst, Type 3 good, and Type 2 was located between these two types. [ABSTRACT FROM AUTHOR]

In a series of 3.072 cases of intracranial neoplasms up to the end of 1973 there were 82 tumours in the pineal region (2.7%), excluding meningiomas of the falx and tentorium. More than half (forty seven) were pinealomas (two cell pattern type tumours, and pineoblastomas), twelve were teratomas, eight were ependymomas, three were epidermoids, and the remainder were gliomas. In addition to ventriculography, millipore filter-cell culture of cerebrospinal fluid, and fibre ventriculoscopy were found useful for diagnosis. Most of the patients were treated by surgery followed by radiotherapy. Results with the pinealomas were fairly good, the one year, five year, and ten year survival rates being 87.5%, 71.4%, and 33.3% in those below the age of 15 years, and 80.0%, 46.2%, and 12.5% in those above that age. The radiosensitivity of pinealomas and the beneficial effect of reduction of tumour bulk by direct surgery may both be important factors in the achievement of good results. [ABSTRACT FROM AUTHOR]

Of the transsellar transsphenoidal meningoencephaloceles (TTSMEs), the true type presents with the hernial sac extending from the intracranium to the epipharynx through the sellar floor. The true type is the most serious and difficult to manage, especially when the hernial sac contains vital structures, such as the anterior cerebral artery, pituitary gland, optic nerve, hypothalamus, and third ventricle. Surgical outcome for true type TTSME is reported to be poor. We describe a successful case of endoscopic repair for a 36-year-old man with true type TTSME. Our success with endoscopic repair for true type TTSME in an adult is the first reported case. We believe that the endoscopic transsphenoidal approach allows less invasive surgery and provides an acceptable operative outcome in comparison with other microsurgical approaches.