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We retrospectively analyzed the results of our 16 years of experience in the treatment of unruptured upper basilar artery aneurysms by surgery or coil embolization. This analysis involved 32 basilar tip aneurysms and 18 basilar superior cerebellar artery bifurcation aneurysms in 19 men and 31 women who ranged in age from 26 to 75 years (mean 57.0 years). Thirty-three aneurysms (66%) were small, 13 (26%) were large, and 4 (8%) were giant. Surgery were performed by 4 selected neurosurgeons and coil embolization was performed by 2 selected endovascular interventionalists. Treatment consisted of aneurysm neck clipping in 24, aneurysm coating in 5, and coil embolization in 21 patients. Surgery was mainly performed by the transsylvian approach. Immediate anatomic outcomes demonstrated complete or near-complete occlusion in 16 aneurysms (76.2%). Five aneurysms (23.8%) could not be embolized because of anatomic difficulties. In small aneurysms, 24 of the 26 (91.3%) patients treated with surgery remained neurologically intact or unchanged from their initial clinical status. Procedure-related morbidity and mortality were 7.7% and 0%, respectively. In small aneurysms, 8 of the 9 (88.9%) patients treated with coil embolization remained neurologically intact or unchanged from their initial clinical status. Procedure-related morbidity and mortality were 11.1% and 0%, respectively. In large aneurysms, the postoperative courses were uneventful in all 3 (100%) patients treated with surgery. There was no procedure-related morbidity or mortality. Eight of the 10 (80%) patients with large aneurysms treated with surgery remained neurologically intact or unchanged from their initial clinical status. Procedure-related morbidity and mortality were 10% and 10%, respectively. There were 3 poor results (75%) in patients with giant aneurysms, including 1 death caused by premature rupture. One severe disability patient treated with coil embolization died of rebleeding. Four of the 21 patients treated with coil embolization required additional coils because of coil compaction. Operative results of surgically accessible small aneurysms were satisfactory when patients were treated by selected surgeons. Therapeutic results of coil embolization for small and medium-sized aneurysms were also satisfactory. Aneurysmal neck clipping is superior to coil embolization in therapeutic radicality. Poor results cannot justify the therapeutic indication in every case with asymptomatic unruptured giant BA aneurysms.

A polyurethane elastomer actuator comprising a polyurethane elastomer 1 capable of deforming due to the orientation by an electric field, wherein the shrinkage displacement occurring at the time of the application of an electric field is transformed into other displacement. This polyurethane elastomer actuator does not require electrolyte and high voltage. Since it is not accompanied by chemical reactions and heat generation, its durability hardly deteriorates. This actuator deforms largely during driving.

Embolization of three surgically difficult cerebral aneurysms was performed using our newly developed non-adhesive embolic material, EVAL mixture (ethylene vinyl alcohol copolymer). Conventional embolic materials such as detachable balloons or microcoils were not used because of a large or irregular aneurysmal neck. After temporary occlusion of the parent artery with a superselective balloon catheter, the EVAL mixture was slowly injected through a microcatheter placed in the aneurysm or parent artery. The locations of the aneurysms were anterior communicating artery, basilar artery-posterior cerebral artery and basilar artery-anterior inferior cerebellar artery (BA-AICA). One aneurysmal occlusion and 2 parent artery occlusions were performed. Patients had no persistent deficits. The patient with the BA-AICA aneurysm associated with an arteriovenous malformation died of rupture of the residual AVM due to haemodynamic change 2 weeks after embolization. In selected and limited cases, embolization of surgically difficult cerebral aneurysms using EVAL mixture was more effective and safer than embolization using conventional embolic materials such as balloons and microcoils.

✓ Between April, 1989, and January, 1991, a total of 19 cases of giant aneurysm were treated by the endovascular approach. The patients included seven males and 12 females aged 15 to 72 years. Detachable balloons, occlusion coils, and ethylene vinyl alcohol copolymer liquid were used as embolic materials. In seven cases, thrombosis of the aneurysmal sac and/or base was achieved while sparing the parent arterial flow; complete obliteration of the aneurysm was achieved in four of these. Of these four patients, the thrombotic material was a detachable balloon in two, a combination of a detachable balloon and coils in one, and occlusion liquid in one. In the other three cases, complete occlusion was not achieved; one aneurysm was occluded with a detachable balloon and two with coils. In 11 patients, the parent artery was occluded either by trapping or by proximal arterial occlusion, and all patients showed complete occlusion of the aneurysms. In one patient, a combined bypass procedure and parent artery occlusion was performed. Among the 19 cases in this series there were four transient ischemic attacks, one reversible ischemic neurological deficit, and one death due to aneurysmal rupture during the procedure. Two patients died in the follow-up period, one from pneumonia 2 months postoperatively and the other from acute cardiac failure 2 weeks following surgery. Both deaths were unrelated to the endovascular procedure. It is concluded that the endovascular treatment of giant aneurysms remains difficult because of the large and irregular shape of the aneurysmal base and thrombus in the aneurysmal sac. The proper selection and combination of the available endovascular techniques is therefore of critical importance.

We evaluated regional blood flow and oxygen metabolism in the cerebral and cerebellar cortices of 15 patients with unilateral major cerebral artery occlusive disorders with PET. These patients showed a cortical blood flow asymmetry in middle cerebral artery distribution. Only subcortical abnormalities were detected on computed tomography. Nine patients showed crossed cerebellar hypoperfusion, a reduction in contralateral cerebellar blood flow, while six did not. No difference in the degree of cerebral blood flow asymmetry existed between the two patient groups. However, oxygen metabolism asymmetry was more pronounced and was more closely matched to blood flow asymmetry in patients with crossed cerebellar hypoperfusion. These findings suggest that a major cause of cerebral cortical blood flow reduction is reduced metabolic demand in patients with crossed cerebellar hypoperfusion. Crossed cerebellar hypoperfusion may have clinical significance as a reflection of the cerebral metabolic state on blood flow images.

To achieve prolonged breath-holding, oxygen was administered just before dynamic CT and high resolution lung CT. Oxygen administration has proved to be a supportive means to improve the quality of CT studies.

A case of bronchiolitis obliterans was studied by high resolution CT. The morphologic changes of the lesions are described.

A 39-year-old man with aleukemic monocytic leukemia cutis was treated with total skin electron therapy. The patient was irradiated twice a week for five weeks using three overlapping beams (SSD 145 cm) in a four-field technique with 4 MeV electrons. After delivery of 20 Gy, the nodular lesions disappeared. The patient tolerated the treatment well and showed no serious side effects.

In June 1987, a 20-year-old man was diagnosed as T-cell acute lymphoblastic leukemia. In August, at a nadir period of the remission induction chemotherapy, he complained of high fever and dry cough. A chest roentgenogram also showed a nodular area of increased density in the left upper lobe. Since his clinical state deteriorated progressively despite the administration of broad-spectrum antibiotics, amphotericin B was administered intravenously (with an initial dose of 5 mg/day, increased up to 25 mg/day). Concomitant with bone marrow recovery and continued antifungal therapy, he became soon afebrile and improved over the next 2 months. The infiltrates also began to resolve. Then he abruptly coughed up about 800 ml of blood and suffered from acute respiratory failure. Bronchial arteriographic studies demonstrated active extravasation of contrast medium in the region of the cavity. After therapeutic embolization with Gelfoam, the extravasation was no longer observed. Active bleeding abruptly ceased and had not recurred until the left upper lobectomy which was performed 10 days after the embolization. This case typically demonstrates the value of bronchial arterial embolization in treating massive hemoptysis.

A case of Moyamoya disease with ruptured aneurysm is reported. This is a rare case in that episodes of intraventricular bleedings were repeated. The size of the aneurysm was markedly increased after the second bleeding, and the ruptured aneurysm was histologically certified after operative resection to be a pseudo-aneurysm.

A case of right periureteric venous ring, associated with retrocaval ureter, is presented with illustrative CT images.

Ten patients with hepatoma who had received radiotherapy for their metastatic sites have been reviewed. In 13 lesions of bone metastasis in 7 patients complete pain relief from 5 lesions (38%) was achieved, while partial relief (54%) was obtained in other lesions. Of 3 patients with a brain metastasis, one attained complete symptomatic improvement with a 65% tumor reduction, and one of the remaining two gained a symptomatic palliation. In a patient with two pulmonary metastases, intraarterial chemotherapy showed a more remarkable effect when treatment was combined with radiotherapy than intraarterial chemotherapy alone. It may be concluded that radiation therapy is effected modality for palliating metastatic lesions of hepatoma.

Spinal epidural cavernous hemangiomas are very rare; only 18 cases have been reported in the literature. The authors describe the case of a 38-year-old male whose first symptom was numbness of the foot, which, after 2 years, spread to the abdomen. On admission, he had no weakness but exhibited hyper-reflex of the lower limbs and hypalgesia below the 7th thoracic dermatome. Magnetic resonance imaging (MRI) revealed an extradural tumor at the level of the 7th thoracic vertebra, with erosion of the 7th vertebral body. T1-weighted images were obtained by inversion recovery with a repetition time (TR) of 2100 msec, an inversion time of 600 msec, and an echo time (TE) of 40 msec. T2-weighted images were obtained by a spin echo pulse sequence with a TR of 2000 msec and a TE of 120 msec. Compared with the spinal cord, the tumor showed low intensity on T1-weighted images and high intensity on T2-weighted images. The tumor was removed through a laminectomy. The histological diagnosis was cavernous hemangioma. After surgery, the patient's symptoms and signs improved. This is the first report of a spinal epidural cavernous hemangioma that includes MRI findings. It appears difficult to differentiate cavernous angiomas from neurinomas by MRI.