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We have examined expression of the smg p25A (a ras p21-like GTP-binding protein) gene in neural crest-derived tumor cell lines and neuroblastoma tissues. The human neuroblastoma cell lines GOTO, IMR-32, NB-1, and SK-N-SH expressed the 1.6-kilobase smg-25A mRNA. SH-SY5Y and SH-IN, variant cell lines with a neuronal phenotype derived from SK-N-SH, expressed much more smg-25A mRNA than did SH-EP1, a variant line with an epithelium-like phenotype also derived from SK-N-SH. The primitive neuroectodermal tumor cell lines SK-N-MC and KU-SN and the Ewing's sarcoma cell lines RD-ES and SK-ES expressed the smg-25A mRNA to a much smaller extent than did neuroblastoma cell lines. Of 15 human neuroblastoma specimens tested, 13 expressed the smg-25A mRNA to various extents. When the relative ratio of the smg-25A mRNA level to the glyceraldehyde-3-phosphate dehydrogenase mRNA level was compared among neuroblastoma tumor tissues, the value was significantly higher in tumors histologically diagnosed as ganglioneuroblastoma. The smg-25A mRNA was not detected in the tissues of Hodgkin's lymphoma, Wilms' tumor, Ewing's sarcoma, or undifferentiated sarcoma of the liver. These results suggest that the smg-25A mRNA level is closely related to the neuronal differentiation state of tumors derived from the neural crest.

The authors reported 3 cases of dural arterio-venous malformation (AVM) in the posterior fossa and discussed mainly on surgical treatment. Case 1: 53-year-old man was admitted to our clinic with complaints of amnesia, visual impairment, dysarthria and gait disturbance. Neurological examination on admission disclosed slight disturbance of consciousness, bilateral papilledema, horizontal nystagmus, dysarthria and ataxic gait. Contrast CT showed a presence of vermiform irregular high density with enlarged ventricle, indicating phlebectasia in the brainstem and the cerebellum. Angiograms revealed a presence of dural AVM at the straight sinus fed by branches of external carotid artery and vertebrobasilar circulation with appearance of phlebectasia due to increase in straight sinus pressure on later phase. Dural sinus isolation for the affected sinus was performed under large occipital craniotomy which was initially reported by Hugosson and Bergström. Case 2: 55-year-old man was admitted to our hospital with complaint of gait disturbance. Neurological examination at the time of admission disclosed signs of raised intracranial pressure and caudal cranial nerves disturbance. Bruit synchronized with radial pulse was audible over the left occipital region. Angiograms showed a presence of dural AVM at the left transverse and sigmoid sinus with many feeding arteries and abnormal venous returns. Isolation of the involved sinuses was performed as same as in case 1. Case 3: 39-year-old woman was admitted to our clinic with complaints of protrusion of eyes and uncomfortable machinery noise over the right retromastoid region.(ABSTRACT TRUNCATED AT 250 WORDS)

A 7-year-old boy was admitted to Hokkaido University Hospital complaining of headache and vomiting. On admission he was slightly confused and presented Parinaud's sign. CT scan revealed abnormal high density mass with contrast enhancement effect at the pineal region and obstructive hydrocephalus. Laboratory studies showed the normal value of human chorionic gonadotropin and no trace of alpha-fetoprotein. Germinoma was most suspected based on the findings of CT scan and laboratory studies. The radiation therapy was carried out for a month and CT scan taken after the radiation therapy revealed marked reduction of the size of the tumor at the pineal region, and he was discharged. But he was re-admitted 3 months after the discharge complaining of headache and vomitting again. CT scan showed the recurrence of the tumor and laboratory studies showed abnormal high value of A.F.P. After the ventriculo-peritoneal shunt, the sub-occipital craniectomy was performed by the Stein's approach, and the tumor was removed. Pathologically the tumor was a typical yolk sac tumor. This case is a very interesting case because it suggests an alternation of the element of the germ cell tumor by the radiation therapy. At first admission, germinoma was the main element of the tumor judging from the effectiveness of the radiation therapy and laboratory studies. But the main element of the tumor seemed to have changed to yolk sac tumor after the radiation therapy. The relation between the tumor markers and the types of the germ cell tumor and histopathological characters of the intracranial germ cell tumor were discussed.

Vasospasm after clipping of an acute ruptured aneurysm plays an important role in its prognosis. An effective therapy for vasospasm has not been established. We had attempted to remove the subarachnoid clot, which probably caused vasospasm, by ventriculo-cisternal irrigation and had not so good results (A: a group without decompression). Therefore, we have performed a therapy combined ventriculo-cisternal irrigation with external decompression (B: a group with decompression). We wish to report the efficacy of external decompression for an acute ruptured aneurysm. Evaluation of the outcome is due to Table 2. 55% of A group and 80% of B group have a better grade than "fair". Furthermore, a significant difference lies between A and B group associated with symptomatic vasospasm (brain ischemia caused by vasospasm). Namely, A group has all poor or dead cases but B group has 80% of the cases better than "fair". We concluded that relieving ICP by external decompression could suppress the aggravation of the post operative symptomatic vasospasm.

To elucidate the connection between blood flow and the localized genesis and development of atherosclerosis and thrombosis at the bifurcation and curving portion of the human cerebral artery, detailed studies of the flow patterns were carried out by directly observing and photographing the behavior of tracer particles flowing through the isolated transparent segment of the middle cerebral artery, prepared from a human subject post-mortem. It was found that a standing recirculation zone consisting of a pair of complex spiral secondary flow, located on both sides of the common median plane of the bifurcation, was formed in the lateral side of the daughter vessels over wide ranges of inflow Reynolds numbers, Re0, and flow rate ratios, Q1/Q0, The formation and the size of the recirculation zone were largely dependent on Q1/Q0, as well as on Re0. Also a eddy formation was observed in the inner side at the curving portion as well as at the bifurcation of the middle cerebral artery. The results suggest that, under physiological conditions, a standing recirculation zone exists in the bifurcation and bending portion of the middle cerebral artery, thereby affecting local mass transfer and interactions of blood cells with the vessel wall, which may lead to the incidence of atherosclerosis and thrombosis in these region.

Not a little difficulties lie in extraction of useful information by visual inspection alone from massive amount of data contained in multichannel polygraphic recordings of electroencephalography (EEG). Therefore, an effort to summarize conventional EEG and to demonstrate it semi-quantitatively has been made by many investigators and recently topographic mapping of EEG (TME), which is able to display equipotential maps of square roots of power spectra over each frequency band on computer-driven color video screen, has been designed. This system was clinically applied to the 16 patients who developed cerebrovascular disease with supratentorial lesions. (1) Slow wave focus was more obviously visualized on delta and/or theta bands of TME compared to visual inspection of conventional EEG in 8 cases out of 16. Also, suppression of alpha wave was beautifully demonstrated in 12 cases out of 16. The fact indicates that TME is useful as a sensitive detector of suppressed neuronal function. (2) Improvement of both TME and clinical signs after oxygenation at high pressure (case 3), carotid endarterectomy (case 1) and bypass surgery (case 6) were well correlated. The fact indicates that TME is one of the acceptable objective parameters for assessment of efficacy of various therapies. (3) TME was employed as a test evaluating effectiveness of bypass operation. This test was performed by compressing anastomosed superficial temporal artery (STA) for 10 minutes and change of TME after compression of STA was observed. In case 2 and 15, suppression of alpha activity was obviously noted in the occipital area ipsilateral to the STA compression following compression of STA, which suggested that these 2 cases depend hemodynamically on the anastomosed STA.(ABSTRACT TRUNCATED AT 250 WORDS)

We reported two cases of germinoma originating in the basal ganglia among the 50 cases of intracranial germinoma which were experienced at the Department of Neurosurgery, Hokkaido University Hospital. (Case 1) A 8-year-old boy was admitted to our hospital in October 1977, because of precocious puberty and left hemiparesis. Plain CT showed an irregularly-defined high density lesion in the right basal ganglia, which had several low density spots and was moderately enhanced on contrast CT. Endocrinological examination by radioimmunoassay revealed abnormally high level of serum luteinizing hormone and scanty level of serum follicle stimulating hormone. Beta-subunit of human chorionic gonadotropin (HCG) showed 46.4 ng/ml. Following radiation, the lesion on CT disappeared and beta-subunit turned to be in the normal range. It was concluded that the precocious puberty was due to hypersecretion of HCG by the tumor. About 2 years after the first admission, the tumors were disseminated to the spinal cord, followed several months later by the intracranial recurrence. The neurosurgical exploration was performed to both intracranial and spinal tumor lesions, which were proved to be germinoma by histological examination. Postoperative course was uneventful without recurrent signs. (Case 2) A 10-year-old boy was admitted to our hospital with 6-month history of right hemiparesis in February, 1979. CT at the first admission disclosed a slight high density lesion in the left basal ganglia, which had low density area suggesting cyst formation and was moderately enhanced on contrast CT. CT after one year showed multiple cysts in the tumor and displacement of neighboring structures. In February, 1980, a piece of the tumor was removed under bifrontal craniotomy and histologically diagnosed to be germinoma. Following radiation, the tumor disappeared on CT and his clinical features improved. In August, 1981, no recurrent signs were noted. From our 2 cases and review of the literature, it can be concluded that germinoma originating in the basal ganglia is rare and have high radiosensitivity as well as germinoma arising in the other sites, and common symptoms and signs are hemiparesis in all cases, not accompanied by intracranial hypertension in the early stage.

There have been only a few reports of asymptomatic aneurysm clinically treated up to the present. The authors incidentally found eight cases of intracranial aneurysm: five cases with brain tumor, one with brain abscess and the remaining three with head injury. It may be considered that the careful observation of angiograms could reveal more asymptomatic aneurysms. The ideal treatment of aneurysm should be direct operation before rupture. But it is difficult to find out them before the onset of signs and symptoms of subarachnoid hemorrhage or cranial nerve involvement. The only chance of finding asymptomatic aneurysm is brought about by paying special attention to aneurysm even in angiography for other intracranial diseases such as tumors, head injuries, vascular diseases and so on. It was thus concluded that incidentally-discovered aneurysm should be directly treated if the prognosis of the original disease is thought to be good. The authors operated on four aneurysms of three patients and operative result was excellent.