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Two cases of peripheral anterior inferior cerebellar artery (AICA) aneurysms are reported. The first case was a 60-year-old man who showed frequent attacks of subarachnoid hemorrhage (SAH) and hearing disturbance. His aneurysm was obliterated by trapping the AICA and his neurologic status was unchanged compared with preoperatively. The second case had SAH without cranial nerve involvement; this aneurysm was obliterated by neck clipping. He was discharged without neurologic deficit. Peripheral AICA aneurysm has already been reported in 48 cases including arteriovenous malformation-associated cases. This aneurysm may show cranial nerve involvement (seventh and eighth) without SAH as in the case of internal carotid-posterior communicating artery aneurysms. We review the clinical signs of these cases and discuss them from the point of view of anatomic variations of the AICA and internal auditory artery.

Craniotomy sometimes causes pseudoankylosis of the mandible, i.e., limited mouth opening, leading to a difficult airway. We describe a case of difficult airway due to pseudoankylosis of the mandible after craniotomy, in which orotracheal intubation was successfully performed with an AirWay Scope (AWS). A 60-year-old woman was scheduled for clipping of an unruptured cerebral aneurysm. She had undergone emergency clipping of a ruptured cerebral aneurysm under frontotemporal craniotomy on the other side three weeks previously. In the previous anesthesia, she had presented normal mouth opening, and orotracheal intubation had been easily performed. Preoperative examination for the second surgery, however, revealed that she had a limited mouth opening with 1.8 cm of interincisor distance, resulting in a class 4 Mallampati view. A difficult airway was anticipated. In order to avoid the risk of hypertension caused by sedated-awake fiberoptic intubation, we planned orotracheal intubation under general anesthesia with AWS. After careful induction with fentanyl and propofol, the blade was inserted smoothly. Her glottic opening was easily visualized, and her trachea was intubated without any difficulty or any distinct hemodynamic disturbance. Careful assessment of the interincisor distance is essential in patients who have previously undergone craniotomy.

BACKGROUND Various carotid reconstructions have been used in Takayasu's arteritis (TA) to relieve brain ischemic insult. The indications and guidelines for surgical management, however, have remained poorly defined. The authors present a new reconstructive procedure using the sequential internal thoracic artery (ITA) as the donor for bypass surgery to supplement the cerebral blood flow. CASE DESCRIPTION A 38-year-old woman presented with three episodes of syncope. The patient was admitted to our hospital and was diagnosed with TA. Before the operation, the patient was designated to undergo aortocarotid bypass using saphenous veins. However, a dilated ascending aorta with an extremely thin wall made it impossible. Finally, we decided to use the ITA as the donor for bypass surgery. This patient is now free of cerebral ischemic insult 8 months after the operation. CONCLUSION Although the procedure is still at a preliminary stage, a successful case is briefly described.

Lipocalin-type prostaglandin D synthase (PGDS) is considered to be mainly produced in the leptomeninges and secreted into cerebrospinal fluid (CSF). We found PGDS levels in CSF of patients with normal pressure hydrocephalus (NPH) (8.99+/-2.59 microg/ml, mean+/-S.D., n=14) to be significantly lower than levels in a control (15.29+/-5.17, n=14, P

Japan is administratively divided into 47 prefectures. Since the 1995 Hyogoken Nanbu earthquake ( the Kobe earthquake ), each prefecture has conducted the task on the new assessment of earthquake hazard on its entire region. The overall framework of this assessment basically consists of the following, regardless of prefectures: (1) geology and seismicity; (2) prediction of physical phenomina due to earthquakes — (a) ground motions, (b) soil liquefaction, (c) landslides, (d) tsunami; (3) prediction of damage potential — (a) buildings, (b) lifeline, (6) transportation, (d) fires and spreads; (4) impact on population — (a) deaths, (b) injuries, (c) suffers; (5) countermeasures — (a) emergency response and recovery, (b) mitigation of earthquake risk. This paper presents the above content.

Extracranial-intracranial (EC-IC) bypass surgery had been widely performed for the treatment of internal carotid artery occlusion. However, it is presently difficult to predict how the bypass flow will contribute to intracranial circulation. We examined intracranial hemodynamics by transcranial color-coded duplex sonography (TCCD) after superficial temporal artery (STA)-middle cerebral artery (MCA) bypass and retrospectively studied the relationship between the postoperative contribution of the bypass flow and the preoperative collateral circulation and cerebrovascular perfusion status in 10 patients. Hemodynamics in the MCA detected by TCCD were classified into three patterns. In pattern A, perfusion of the whole MCA area is completely dependent on the bypass flow. In pattern B, perfusion of the M2 segment is dependent on the bypass flow, but perfusion of the M1 segment is independent of the bypass flow. In pattern C, perfusion of the whole MCA area is supplied by collateral flow and the bypass does not function efficiently. Preoperative absence of collateral flow via anterior communicating artery and cerebral perfusion status type 3 (reduced regional cerebral blood flow and regional cerebral vasoreactivity) seems to predict hemodynamic usefulness of the bypass flow after surgery. TCCD is an easy and noninvasive method for evaluating intracranial cerebral circulation after EC-IC bypass surgery.

A rare case of brain metastasis of thyroid papillary carcinoma is reported. The cerebral metastasis was surgically treated without irradiation despite the presence of a spinal metastasis. No recurrence was demonstrated by computed tomography 1 year postoperatively. We suggest that surgery is indicated for a brain metastasis of thyroid papillary carcinoma even if other metastatic lesions are present.

Six children with hydrocephalus diagnosed prenatally by ultrasound were presented. Since then, we have encountered 10 additional cases of fetal hydrocephalus and MRI were attempted in 4 of the cases to improve accurate diagnosis in the utero. MRI examination could be performed after 20 weeks gestational age and the authors think that MRI are more useful than ultrasound and/or whole body CT for evaluation of pathogenesis of fetal hydrocephalus.

The authors have encountered 10 cases with fetal hydrocephalus in the past. Six cases have already been reported and it was stressed that it was yet too early to do an intrauterine shunt procedure for fetal hydrocephalus.