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A case of meningioma with marked extracranial remote metastases is described. The patient was a 33-year-old female and was operated according to a diagnosis of parasagittal meningioma in both frontal lobes. Nine years later, however, she died of local recurrence and extracranial metastases in the lungs, liver, pancreas and vertebrae. Histologically, the tumor was diagnosed as angioblastic meningioma with high cellularity, some mitotic figures and abundant intersecting network of reticulin fibers frequently outlining vascular architectures.

The ganglioside concentrations and the ganglioside patterns were investigated in 18 meningiomas of different histological type and in the meninges. The ganglioside concentration in the meningiomas ranged from 0.16 to 1.63 mg ganglioside N-acetylneuraminic acid per gram dry weight (mean 0.68 mg/g). The gangliosides GM3, GD3 and GD1a were found to be the major ganglioside fractions of the meningiomas. In the endotheliomatous meningiomas, on teh average, the percentage of GM3 was higher, and the percentage of GD3 lower than in the endotheliomatous-fibromatous tumours. However, none of the individual ganglioside patterns observed seemed to be specific of a certain histological type.

The application of fine matrix computerized axial tomography (Emiscan) to the diagnosis of orbital space-occupying lesions is described. In this preliminary study 24 patients have been examined for a suspected orbital tumour with verification of the type of lesion present in 17. These comprised a wide variety of pathological states in the orbit, including examples of meningiomata, haemangioma, neuri-lemmoma, pseudotumour, melanoma and lacrimal gland tumours. A single example of an arterio-venous malformation, confirmed by arteriography, was included in the series. These patients were also examined by other techniques of orbital investigation, viz. orbital venography, axial hypocycloidal tomography and ultrasonography (B scan and holography). A comparison of these various investigations showed a diagnostic accuracy for Emiscan of 76·5 per cent, orbital venography 76·5 per cent, axial hypocycloidal tomography 75 per cent, and ultrasound 62·5 per cent. Preliminary results show that Emiscan is a very...

Radionuclide brain scanning is done routinely on patients with late-onset seizures referred to a hospital serving a population of 320,000. In a 12-month period 132 patients over the age of twenty developed seizures, and 26 were found to have abnormal brain scans, due to tumour, abscess, infarction, and trauma. Tumours were responsible for 11% of the seizures, and brain scanning accurately localised 19 out of 21 possibly remediable lesions, in many cases within days of the first seizure. The sites of tumours most likely to provoke seizures are those where brain scanning is most reliable, making the investigation very useful as a diagnostic test in patients with late-onset epilepsy.

Pathologic lesions of the orbit have eluded the most sophisticated radiographic methods in the past. By utilizing the EMI Scanner with appropriate settings, tumors of the orbit may be identified. The use of this new method also permits analysis of the optic nerve as well as an evaluation of the effects of the lesions on the posterior orbital wall. Several representative scans with accompanying diagrams are included.

Five human meningiomas were studied with techniques of thin section and freeze-fracture. Three specialized junctional complexes, desmonsomes, gap and tight junctions, were found between adjacent plasma membranes. Desmosomes were not shown in freezefracture replicas; they exhibited a charactersstic structure in thin sections. In thin sections the outer leaflets of adjacent plasma membranes of gap junctions appeared to fuse, obliterating the intercellular space. The gap junction in replicas was irregularly ovoid or polygonal in form, mostly 0.1–1.0 μ in diameter, and characterized by a hexagonal aggregation of particles in face A and associated pits in face B. The outer leaflets of adjacent plasma membranes in the tight junction fused at discrete points in thin sections. In replicas, the tight junction was characterized by short complexes of serpentine or ramifying ridges in face A and furrows in face B, and mostly discontinous in distribution. The histogenesis of meningioma cells was discussed from a standpoint of the characteristic features of the specialized intercellular junctions.

Review of clinical, roentgenographic, and histologic material of 75 purported meningiomas in patients younger than 20 years old revealed 48 cases that we considered clearly to represent meningiomas. The meningiomas were characterized by posterior fossa location (19 per cent), intraventricular location (17 per cent), roentgenographic evidence of tumor calcification (32 per cent), and frequent association with neurofibromatosis (23 per cent). These findings are contrasted with those of the adult population.

A patient with bilateral acoustic neurofibroma was repeatedly examined audiometrically during the progression of the disease. Postmortem, the temporal bone disease was studied to confirm severe progressive hearing dysfunction found in serial audiometric examinations. Results of the electronystagmographic examination showed bilateral absence of caloric nystagmus. Bilateral absence of the response was also shown by the galvanic body sway test.

Brain-blood partition coefficients for 133Xe were measured on 20 brain tumour specimens. Substantial variations were found from the values previously reported for normal brain, implying that the use of normal values for calculating tumour blood flow from 133Xe washout data can result in significant errors.

We have encountered four pathologically verified glioblastomas, all of which on angiography were associated with a prolonged tumor stain. In one case the neoplasm was mistaken for a meningioma by the neurosurgeon and in two others the surgeon's impression was that of a well demarcated lesion. Tissue from the fourth case removed en bloc permitted a satisfactory neuropathological examination which demonstrated good demarcation. — This observation of the association of demarcation and persistence of tumor stain, although by no means a pathognomonic sign, should alert one's attention to the possibility of more radical resection in glioblastoma surgery.

An in vitro microcytotoxicity assay has been used to study the humoral immune response to human astrocytomas. Sera of 17 of 26 patients with these tumors produced significant cytotoxicity when tested against allogeneic astrocytoma cells. The cytotoxic response was found to occur both preoperatively and postoperatively without obvious relationship to the histologic grade of the patient's tumor. Three of 46 sera from normal controls and 1 of 12 sera from patients with non-neoplastic nervous system diseases were also cytotoxic in this test. Sera from each of 3 patients with non-astrocytic neuroectodermal tumors were significantly cytotoxic, while none of 4 serums from meningioma patients was positive. These results indicate that a humoral immunologic response directed against antigens present on the astrocytoma cell surface occurs in most astrocytoma patients. The use of this microcytotoxicity assay may prove helpful in the preoperative diagnosis of this tumor. Cancer 33:1512–1519, 1974.

Two verified cases of combined nervous system tumors are presented, each with a meningioma and a glioma. Review of previous publications shows that this combination is unusual. The histogenesis cannot be stated with certainty. The cases presented appear to have occurred by coincidence. Correct angiographic diagnosis can be made. The same angiographic criteria apply to meningiomas and gliomas in combination as are used to identify either separately.

The results of orbital venography in 413 cases are reviewed. A percutaneous frontal approach was used in 398, with a success rate of 89%. Specific aspects of technique, anatomy, and interpretation are emphasized. Good clinical-radiological-surgical correlation was obtained in the localization of intraorbital space-occupying lesions. Possible pitfalls in diagnosis are discussed.

Summary Ninety-one patients with unilateral frontal or non-frontal lesions were given the WCST. Poor performance was shown to be multidimensional in nature. Patients with left frontal lesions did most poorly overall but this was not always due to a high perseverative error score. Patients with right frontal and non-frontal lesions were also impaired, but for apparently different reasons. Age and intelligence had little effect on performance although nature of lesion was important. Medial frontal lesions were found to be significantly associated with poor performance on some aspects of the task.

✓ A new isotopic method for the detection of cerebral tumors using labeled bleomycin is described. In a series of 104 patients, bleomycin was found superior to technetium-99m for the diagnosis of intracranial metastatic lesions; in 50% of the cases, bleomycin revealed metastases undetected by the Tc-99m, particularly in the posterior fossa. This method also provides valuable data for the differentiation of gliomas from metastases.

The angiographic findings of 17 brain stem tumors are reported in detail. The importance of the angiographic landmarks previously described is confirmed. Generally, the lateral view is found more informative than the Towne projection. The displacement of vessels is sometimes limited to those related to the upper or to the lower brain stem. This permits the recognition of small tumors and their position in the brain stem. The importance of the measurements of arterial and venous landmarks, described in the literature, is verified. The features of unusual paradoxical cases, simulating cerebellopontine angle lesions and posterior foramen magnum meningiomas, and of a false positive case, are discussed.

An automated method for the quantitative analysis of the polyamines putrescine, spermidine and spermine in cerebrospinal fluid (CSF) was used to analyze CSF samples from 37 patients with central nervous system (CNS) tumors and from 13 patients without tumors. The putrescine and spermidine concentrations in the CSF of most patients in tumors, particularly those with glioblastomas or medulloblastomas, were elevated when compared with those of non-tumor-bearing patients.

Gap junctions of five human meningiomas were studied by the freeze-fracture method. The gap junction was often irregularly ovoid or polygonal in shape, about 0.1–1.0 μ in diameter, and sometimes showed a single-file distribution or polygonal aggregation of several subunits. The globular particles in face A were about 70–80 A in diameter, and arranged mostly in a polygonal and sometimes in a hexagonal fashion. The pits in face B were more regularly oriented than the particles, often in a hexagonal array. The centre-to-centre distance of the particles or the pits was about 80A. A central, small white dot was evident on the tops of some particles, while a central bump was found in the depths of some pits. Both were about 20A in diameter and suggested the presence of an intercellular communicating pathway. A serrated edge at the transition from face A to face B of the gap junction suggested a complementary relationship of the particles and the pits as well as a close contact of the complementary subunits in the apposing plasma membranes.

The diagnostic value of computerised tomography (C.T.) with the EMI scanner has been assessed in a prospective study of 106 patients thought to have an intracranial tumour on clinical grounds alone. 92 patients were undergoing investigation for the first time and 14 were suspected of having a recurrence of a previously excised tumour. A tumour was ultimately confirmed in 75 of the 92 patients in the first group. The C.T. scan permitted diagnosis of a neoplasm in 65 and was abnormal in a further 6 patients finally shown to have a tumour. In addition, 5 patients were finally diagnosed as having cerebral atrophy and 4 cerebral infarction; the C.T scan recognised abnormalities in all these patients. In the second group a tumour recurrence was confirmed in 10 patients, and all were recognised by the C.T. scan. C.T. scanning has been compared with the conventional neuroradiological investigations in these patients, and it emerges with a diagnostic potential similar to angiography and pneumoencephalography.

A graphical system to report EMI scan findings is described. This includes schematic anatomical cross sections corresponding to the middle plane of the standard scans. The findings are graphically ind

In a series of 50 consecutive tumours involving the frontal lobes, seven cases (14%) were found who exhibited the syndrome, first described by Andrew and Nathan in 1964, of frequency of micturition, urgency, and incontinence causing distress to the patient. This suggests that this syndrome may occur rather more commonly than those authors had indicated. In 100 consecutive intracranial tumours, no instances were found with non-frontal tumours, indicating that the syndrome may be of localizing value.

Serial direct magnification angiography enhances detailed orbital vasculature apart from the surrounding vessels and aids in the diagnosis of orbital neoplasms. Selective techniques show branches of the internal and external carotid arteries supplying the orbit and their important anastomotic channels. The dual blood supply to the orbit is structured on embryological origins.

A new and fundamentally different X-ray method is described. The cranium is scanned in successive layers by a narrow beam of X rays, in such a way that the transmission of the X-ray photons across a particular layer can be measured, and by means of a computer, used to construct a picture of the internal structure. Employing a suitably designed scanning gantry, a continuously operating X-ray tube, and a narrow collimated X-ray beam, the transmissions of X-ray photons across a slice of tissue may be measured by a system of crystal detectors in such a way that 28,800 readings are obtained. These form the basis of 28,000 simultaneous equations which are solved by a computer. The solutions are transformed into absorption coefficients and by means of a suitable algorithm related to their correct cells in a matrix of chosen size. The results are stored, computed, and then made available from a magnetic disc to construct a picture on a CRT. The numerical results are available from a print-out. The examin...

Es wurde uber 6 Falle von Hamangioperizytomen der Meningen berichtet und versucht, Besonderheiten im angiographischen Verhalten dieser Geschwulste zu finden. Wegen der geringen Zahl von Publikationen uber das angiographische Verhalten dieser Geschwulste ist die Beschreibung weiterer Angiogramme wunschenswert. Die Prognose der Hamangioperizytome ist, bezogen auf den gesamten Lebenszeitraum eines Patienten, als ungunstig anzusehen. Six cases of haemangiopericytoma of the meninges are described. The angiographic appearances differ in some respects from meningiomas. Because of the poorer prognosis of haemangiopericytomas, pre-operative differentiation should be attempted. Further angiographic studies of this tumour are needed.

Thirty-eight spontaneous tumours of the central nervous system of rats are described. They originated from a population of approximately 35 000 rats aged more than one year. In a second study in 10 255 rats, no tumours of the central nervous system were diagnosed at less than 1 year old; one tumour was seen in animals between 1 and 1 1 2 years; and 5 between 1 1 2 and 2 years. Tumours described include meningiomas, reticulo-sarcomas, astrocytomas, oligodendrogliomas, glioblastomas and poorly differentiated glial tumours.

Internal carotid artery (ICA) blood flow, mean arterial blood pressure (MABP), intracranial epidural pressure (EDP), and arterial blood gases were measured during spontaneous, generalized epileptic se

Two cases of meningioma of the free margin of the tentorium developing subtentorially into the quadrigemino-pineal region are described. In the first patient, who was gravely ill only a full angiographic investigation was done whereas in the second, pneumoencephalography was also performed. The radiological pattern of these tumors is analysed and the problem of differentiation from tumors of the pineal region and lamina quadrigemina is discussed.

✓ The authors report two cases of intracranial meningiomas that metastasized to organs outside the nervous system, and review 54 comparable cases from the literature. Apparently neither previous surgery nor pulmonary involvement is a prerequisite for metastasis.