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Total removal of spheno-orbital fibrous dysplasia was achieved through intraoperative CT-assisted surgery via a burr hole. A 32-year-old man had persistent headache. Radiological studies demonstrated a small osteolytic lesion in the sphenoidal bone underneath the superior orbital fissure. Intraoperative serial CT scans showed the depth and width of the tumor within the complicated structure of the skull base. The lesion was successfully removed by CT-guided minimally invasive surgery.

We present frameless stereotactic radiosurgery using mobile CT, thermal plastic mask fixation, a vacuum-form body immobilizer and micro-multileaf collimators. A linear accelerator and a self-moving helical CT scanner gantry were installed in the same room. The isocenter of irradiation can be also aligned with the center of the CT gantry by rotating the couch. A thermal plastic mask and vacuum-form body immobilizer was used for registration and immobilization. The advantages of this system are as follows: 1) Accurate and painless frameless fractionated irradiation can be performed smoothly, as the patient's head is fixed without exchanging the couch from CT scanning to irradiation system. 2) This mask system can be applied to children, infants or adults with a previous craniotomy bone flap that must have a fixation pin placed into it. This system can be also used for fractionated radiotherapy without painful skull pin-fixed frame. 3) 1 mm micro-multileaf collimators enable irregular contour irradiation. 4) Image fusion (among CT, MRI, angiography, and PET) and 3D images can be used for irradiation planning. 5) This system can be used on any part of the body. 6) This system can be installed in any irradiation room without any extension or new construction.

The effects of antihypertensive drugs, such as nifedipine, chlorpromazine, reserpine and thiopental on mean arterial blood pressure (ABP), mean intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were studied in 43 patients with systemic hypertension and intracranial hypertension due to hemorrhagic cerebrovascular diseases and other causes. These drugs are commonly used in neurosurgical practice for the treatment of systemic hypertension. Nifedipine, chlorpromazine and reserpine reduced the mean ABP, raised the mean ICP and decreased the CPP. The effects of these drugs on mean ICP and CPP were more pronounced in patients with severely increased ICP (more than 40 mmHg) than in patients with moderately increased ICP (20-40 mmHg). Thiopental reduced both mean ABP and ICP, whereas the CPP was unchanged from the preadministration level. During thiopental administration, however, respiratory depression was observed, and hence, intubation and ventilation were required. We suggest that, in the treatment of systemic hypertension in patients with increased ICP, barbiturates are more desirable than agents with calcium channel or alpha-adrenergic blocking actions, despite the problem of respiratory control.

A case of pituitary adenoma associated with pancreatic islet cell tumor is presented. A 29-year-old man with symptoms of confusion and abnormal behaviour was admitted to the neurosurgical department. He was diagnosed as suffering from multiple endocrine adenomatosis (MEA) type 1. Screening of his family members revealed that his mother had high levels of gastrin, glucagon and parathormone and his father had a high level of gastrin. The pituitary adenoma and pancreatic tumor were removed satisfactorily. Family members as well as the patient should be checked periodically.

The prognosis of intraventricular hemorrhage (IVH) from rupture of intracranial aneurysms was studied in 43 patients admitted to our institution and to Kaga Central Hospital between April 1984 and December 1987. The total number of aneurysmal subarachnoid hemorrhage (SAH) patients admitted during this period was 156, so that 28% of SAH patients had IVH. In this study, the patients were analyzed with respect to IVH grading, volumes of intraventricular and intracerebral hematoma, consciousness level, intracranial pressure (ICP), ventricular dilatation and age. The IVH resulted from aneurysmal rupture of the anterior communicating artery (48%), anterior cerebral artery (distal portion of the anterior communicating artery) (11%), internal carotid artery (21%), middle cerebral artery (25%), and vertebro-basilar artery (14%). The mortality rate in patients with IVH was 33%, a poorer rate than that in patients without IVH (25%). As for morbidity, 44% of the patients with IVH had no or moderate disability, whereas the other 23% had severe disability or were in a persistent vegetative state. On the other hand, there was no or only moderate disability in 63%, and severe disability or a persistent vegetative state in 12% of the patients without IVH.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of calcified chronic subdural hematoma was presented. This patient was a 51-year-old man, who had a dizzy spell with headache and vomiting. He was examined by MR study as well as CT scan. The operation was performed and the calcified subdural hematoma was removed safely. MR study is very useful for the preoperative evaluation.

A rare case of intracranial lipoma of the cerebral peduncle was reported. Computerized tomography (CT) and magnetic resonance imaging (MRI) of this unusual tumor are described. The unique capability of direct sagittal imaging makes MRI the best procedure for evaluating the midline abnormalities. She did not have operation because she was asymptomatic. She will be checked periodically in the outpatient clinic.

A case is reported in which an aneurysm on the anterior communicating artery calcified during the time course of 17 years. A ring-like calcification was demonstrated in plain skull films as well as CT scans. Carotid angiograms showed that the aneurysm grew a little bit bigger for 17 years. The aneurysm was coated because of the calcified aneurysm.

The prognosis of intraventricular hemorrhage (IVH) due to hemorrhagic cerebrovascular disease has been regarded as unfavorable. The authors studied factors affecting the prognosis in 55 patients with IVH due to hypertensive thalamic and putaminal hemorrhages. The mortality rate in this study was 38%, a poorer rate than that in patients without IVH (18%). As for morbidity, 50% of the survivors (31% of all patients) with IVH had nor or moderate disability, but the other 50% had severe disability or were in a persistent vegetative state. On the other hand, there was no or moderate disability in 55%, and severe disability or a persistent vegetative state in 27% of the patients without IVH. Patients with intracerebral or intraventricular hematoma volumes greater than 25 ml, Glasgow Coma Scales of less than nine, intracranial pressures above 30 mm Hg, and ventriculocranial ratios over 0.22 had poor prognoses. These results suggest that greater volumes of intracerebral or intraventricular hematoma and the presence of acute hydrocephalus are of great significance when considering the outcomes of IVH cases.

Four infants with choroid plexus papillomas which were successfully treated with surgery are described. All patients showed the clinical signs of increased intracranial pressure and hydrocephalus within 8 weeks after birth. The tumors were in the lateral ventricles and histologically three of them were benign papillomas and other one was a malignant papilloma. Computerized tomography scan was useful for the diagnosis of both of the tumor and the hydrocephalus that was caused by the overproduction of cerebrospinal fluid and/or the obstruction of it's pathway. The tumor stain on the angiograms was noticed in two patients. Three patients have grown normally in both physical and mental functions after the surgical treatment, whereas one showed psychomotor retardation because of poorly controlled hydrocephalus.

Two cases are reported in which the abdominal catheters slipped into the scrotum through the unobliterated processus vaginalis.