[Show abstract][Hide abstract] ABSTRACT: Glioma stem cells (GSCs) have the capacity to repopulate tumors and mediate resistance to radiotherapy and chemotherapy. The Notch signaling pathway is important in proliferation, stem cell maintenance, cell differentiation, and tumorigenesis in GSCs. In this study, we compared CD133, Notch, and VEGF expressions in histological sections of primary and recurrent glioblastomas after radiotherapy and chemotherapy. In vitro study, the γ-secretase inhibitor inhibited NICD, Hes1 and pVEGFR2 expressions in GSCs. GSCs cultured under endothelial conditions undergo endothelial differentiation. Tumor samples were collected from 27 patients at the time of tumor recurrence. We used immunohistochemical techniques to compare expression of CD133, Notch-1 and VEGF. Expressions of CD133-, Notch-1-, and VEGF-positive glioma cells were higher in recurrent glioblastoma after radiotherapy and chemotherapy. To determine the clinical importance of Notch-1 expression in glioblastoma, we analyzed 15 patients who had received bevacizumab therapy followed by a second surgery at recurrence. OS was significantly longer in cases with Notch-1 negativity (8.8 months) than in those with I Notch-1 positivity (6.8 months). We noted that GSCs have the potential for endothelial differentiation with Notch activity. We believe that Notch-1 is a potential target and/or biomarker for antiangiogenic treatments.
No preview · Article · Feb 2015 · Brain Tumor Pathology
[Show abstract][Hide abstract] ABSTRACT: Objective: The inferior petrosal sinus (IPS) provides the best access route to the cavernous sinus in transvenous embolization (TVE) of cavernous sinus dural arteriovenous fistula (CS-dAVF). However, some cases require other access routes. We describe a case of CS-dAVF successfully treated with TVE via the superficial temporal vein (STV) from the common femoral vein.Case presentation: The patient was an 82-year-old woman with conjunctival hyperemia and exophthalmos of the left eye due to a left CS-dAVF. A cerebral angiogram showed that the IPS had occluded and the superior ophthalmic vein, middle temporal vein (MTV), and STV had dilated as the main drainer. We had planned to reach the CS via the IPS but were forced to abandon that route because it was not possible to guide the microcatheter into the CS. We therefore attempted to use the STV for access. On the first attempt, we had difficulty in inserting the microcatheter through the tortuous section between the MTV and STV. We were able to achieve passage with manual progress by epidermal compression. Finally, we successfully guided the microcatheter to the shunted pouch and targeted embolization was performed.Conclusion: Accessing the CS via the STV can be an option when TVE via the IPS is not possible in a patient with CS-dAVF.
[Show abstract][Hide abstract] ABSTRACT: Abstract Ocular ischemic syndrome occurs when ocular circulation becomes impaired owing to various causes, leading to disturbances in the visual function. It ultimately progresses to neovascular glaucoma and loss of sight. Therefore, the early diagnosis and treatment of patients with ocular ischemic syndrome has a major effect on their visual prognosis. Herein, we describe a patient who complained of decreased vision in one eye. The patient was subsequently diagnosed with internal carotid artery stenosis because of neovascularity (rubeosis iridis) around the iris in the anterior eye. The vision of the patient improved immediately after carotid artery stenting. A review of the literature indicated that the visual improvement could be attributed to the reversal of retrograde blood flow, caused by internal carotid artery stenosis, to normal levels; the resolution of rubeosis in the anterior eye; and improvement in the visual field constriction. (Received February 21, 2014; Accepted May 12, 2014; Published December 1, 2014).
No preview · Article · Dec 2014 · Brain and nerve = Shinkei kenkyū no shinpo
[Show abstract][Hide abstract] ABSTRACT: Temozolomide (TMZ) has become a key agent in treating malignant glioma; nevertheless, its survival benefit remains dismal
prognosis. Histone deacetylases are often overexpressed in cancer cells, and this leads to altered expression and activity
of numerous proteins involved in carcinogenesis. Recent evidence suggests that expression of class I histone deacetylases
is higher in malignant gliomas and is important in resistance to TMZ. Levetiracetam (LEV) is an antiepileptic drug that inhibits
histone deacetylases, but the therapeutic effects of a combination regimen comprising LEV and TMZ are poorly understood. In
this study, we found that the antitumor effects of LEV are potentiated by combining it with TMZ, especially in TMZ-resistant
cell lines. This combination significantly enhanced antitumor effects against the TMZ-resistant malignant glioma cell lines
T98 and U138. This enhanced antitumor effect correlated with LEV-mediated reduction in O6-methylguanine DNA methyltransferase
expression, which is important in cellular resistance to alkylating agents. In vitro, this combination enhanced apoptotic
and autophagic cell death and suppressed migratory activities in the TMZ-resistant cell lines. Furthermore, an in vivo efficacy
studies using an intracranial tumor model showed that combination therapy significantly increased median survival as compared
with monotherapy groups. Our results warrant further studies to test the efficacy of combined TMZ and LEV chemotherapy in
[Show abstract][Hide abstract] ABSTRACT: In 1999, a 50-year-old woman underwent ventriculoperitoneal (VP) shunt surgery for hydrocephalus after subarachnoid hemorrhage. She was hospitalized for fever and recurrent systemic seizures in November 2006. Head computed tomography (CT) showed only old changes. The seizures and fever were controlled by medicinal therapy. However, in December, her consciousness level suddenly decreased, and she showed progressive lower abdominal distension. Head CT showed marked ventriculomegaly, and abdominal CT showed a giant cystic mass at the shunt-tube tip in the lower abdominal cavity. Because thick pus was aspirated from the intra-abdominal mass, we diagnosed the patient with acute obstructive hydrocephalus due to an infected abdominal pseudocyst. Laparotomy and direct cyst drainage were performed, and antibiotic therapy against Streptococcus, the causative pathogen, was administered. The VP shunt tube was replaced. The postoperative course was uneventful, and postoperative CT showed hydrocephalus improvement and no pseudocyst recurrence. Abdominal pseudocysts, which are rare after VP shunt surgeries, usually occur after the subacute postoperative course in younger cerebral hemorrhagic cases. Our case was quite rare because the cyst developed in the chronic phase in an older patient and was caused by streptococcal infection. The cyst components should be examined before cyst drainage when choosing surgical strategies.
[Show abstract][Hide abstract] ABSTRACT: A 54-year-old woman presented to our hospital with progressive motor weakness of the right arm. She had a medical history of systemic lupus erythematosus (SLE) and hypothyroidism. Magnetic resonance imaging indicated a watershed infarction of the left hemisphere. Cervical echogram indicated severe stenosis of the internal carotid artery (ICA) without wall thickening. Cerebral angiography indicated left ICA occlusion, development of unilateral moyamoya vessels, and leptomeningeal anastomosis. Encephaloduroarteriosynangiosis (EDAS) was performed after cerebral (99) (m)Technetium-ethyl-cysteinate-dimer single-photon emission computed tomography indicated a decreased cerebral blood flow, diminished cerebrovascular perfusion reserve. Motor weakness finally disappeared 6 months after surgery. Moyamoya syndrome is a rare complication of both SLE and hypothyroidism, and the surgical indication remains controversial. By evaluating the decreased cerebral perfusion reserve capacity and the existence of leptomeningeal anastomosis, EDAS could be an efficient method for the treatment of moyamoya syndrome associated with SLE and hypothyroidism.
Full-text · Article · Aug 2012 · Case Reports in Medicine
[Show abstract][Hide abstract] ABSTRACT: A dolichoectatic aneurysm is a giant fusiform aneurysm characterized by elongation, tortuosity, and ectasia. It represents 0.1% to 0.7% of cerebral aneurysms, and usually presents with compression of the brain stem or occlusion of penetrating branches; however, there are no reports of acute total occlusion of the basilar artery in a patient with the dolichoectatic aneurysm and no prodromal symptoms. Here, we report a case of a 60-year-old man presenting to our emergency department with acute vertigo and disturbance of consciousness. He had a medical history of hypertension that was being treated with antihypertensives, and had visited another center three years previously for evaluation of vertigo, and was diagnosed as dolichoectatic aneurysm of the basilar artery. As he had no symptoms other than vertigo, antihypertensives were prescribed for blood pressure control. A cranial CT scan revealed a mass lesion adjacent to the right pons. Digital subtraction angiography (DSA) showed accumulation of contrast material in the peripheral segment of the left vertebral artery, indicating total occlusion of the basilar artery. Endovascular treatment was performed, with intra-arterial urokinase injection and mechanical fragmentation of the thrombosis in the occluded segment of the main trunk of the basilar artery. However, it was not possible to reopen the basilar artery and the patient developed cerebellar infarction. We performed immediate surgical decompression and ventricular drainage; however, he died on day 9 after admission. To our knowledge, this is the first report of acute total basilar artery occlusion in a patient with dolichoectatic aneurysms.
No preview · Article · Jan 2012 · Surgery for Cerebral Stroke
[Show abstract][Hide abstract] ABSTRACT: A 14-year-old was girl admitted to our hospital with a subcutaneous mass of the occipital head. The mass had grown for 6 years, after she had sustained a head injury at the age of 6, and was located directly under a previous wound. Skull X-ray Photograph (xp), computed tomography (CT), and magnetic resonance imaging (MRI) showed a bony defect and cystic changes in the skull corresponding to a subcutaneous mass. Bone scintigraphy revealed partial accumulation. The patient underwent total removal of the skull mass, and the diagnosis from the pathological findings of the cyst wall was fibrous dysplasia (FD). The radiographic findings for cystic cranial FD can be various. Progressive skull disease has been reported to be associated with head trauma, but the relationship between cranial FD and head trauma has not been previously reported. Previous studies have suggested that
gene expression is a key mechanism in injury-induced FD.
Full-text · Article · Aug 2011 · Case Reports in Medicine
[Show abstract][Hide abstract] ABSTRACT: we investigated the clinical efficacy of intra-arterial administration of fasudil hydrochloride for cerebral vasospasm.
we reviewed 90 cases treated with intra-arterial administration of fasudil hydrochloride between August 1998 and April 2009 and investigated the clinical efficacy for cerebral vasospasm.
angiographic improvement of vasospasm was noted in all procedures. Eight had ischemic lesion on CT at discharge in Group A, which included 39 patients who presented angiographic and symptomatic vasospasm. However, 4 (50%) of these eight were recovered with a condition of GR. No patients showed ischemic lesion on CT in Group B, which included 51 patients who presented angiographic vasospasm without symptoms. Two (3.3%) of 59 patients who presented angiographic vasospasm without symptoms at the initial follow-up angiography had ischemic lesion on CT at discharge. The 1-year follow-up showed 78.9% of GR. No patient showed any adverse effects resulting from intra-arterial administration of fasudil hydrochloride.
intra-arterial administration of fasudil hydrochloride was an effective and safe management technique for vasospasm.
No preview · Article · Jan 2011 · Acta neurochirurgica. Supplement
[Show abstract][Hide abstract] ABSTRACT: Two patients were treated for intracranial infections involving methicillin-resistant Staphylococcus aureus (MRSA). A 30-year-old woman was admitted to our hospital for intracerebral hemorrhage related to arteriovenous malformation. After decompressive craniectomy, the patient developed an epidural ab- scess. MRSA was isolated from the pus culture. The infection did not improve after intravenous van- comycin (VCM) administration for 15 days. However, after administration of linezolid (LZD) for 14 days, the infection had improved, and the white blood cell count and C-reactive protein values had nor- malized. A 53-year-old woman had previously undergone 3 operations for craniopharyngioma before the age of 35 years. She was admitted to our hospital with fever and disturbance of consciousness. Mag- netic resonance imaging with contrast medium revealed a brain abscess caused by MRSA. After 14 days of intravenous administration of VCM, the infection had not improved and intravenous administration of LZD was initiated. After administration of LZD for 14 days intravenously and 14 days orally, the in- fection had improved, and the white blood cell count and C-reactive protein values had normalized. VCM is highly effective against MRSA infection, but penetration into the central nervous system (CNS) is poor. LZD has good CNS penetration, so should be considered for secondline antibiotic therapy for VCM-resistant intracranial MRSA infection.
No preview · Article · Jun 2010 · Neurologia medico-chirurgica
[Show abstract][Hide abstract] ABSTRACT: Two patients were treated for intracranial infections involving methicillin-resistant Staphylococcus aureus (MRSA). A 30-year-old woman was admitted to our hospital for intracerebral hemorrhage related to arteriovenous malformation. After decompressive craniectomy, the patient developed an epidural abscess. MRSA was isolated from the pus culture. The infection did not improve after intravenous vancomycin (VCM) administration for 15 days. However, after administration of linezolid (LZD) for 14 days, the infection had improved, and the white blood cell count and C-reactive protein values had normalized. A 53-year-old woman had previously undergone 3 operations for craniopharyngioma before the age of 35 years. She was admitted to our hospital with fever and disturbance of consciousness. Magnetic resonance imaging with contrast medium revealed a brain abscess caused by MRSA. After 14 days of intravenous administration of VCM, the infection had not improved and intravenous administration of LZD was initiated. After administration of LZD for 14 days intravenously and 14 days orally, the infection had improved, and the white blood cell count and C-reactive protein values had normalized. VCM is highly effective against MRSA infection, but penetration into the central nervous system (CNS) is poor. LZD has good CNS penetration, so should be considered for secondline antibiotic therapy for VCM-resistant intracranial MRSA infection.
No preview · Article · Jun 2010 · Neurologia medico-chirurgica
[Show abstract][Hide abstract] ABSTRACT: In recent years, incidence of invasive fungal infection has been increasing, mostly due to advances in + medicine that may produce immunocompromised individuals. Candidial infection in the central nervous system (CNS) is one of the most serious forms of blood stream infection of Candida sp. and mortality is known to be more than 50%. In this research, we employed 27 autopsies with confirmed in vasive CNS yeast infection which were confirmed. In addition to detailed morphological analysis of yeast cells in lesions, in situ hybridization was carried out with an originally designed Candida-specific peptide nucleic acid (PNA) probe to identify the candidial infection of each patient. This was followed by histopathological investigation: invasiveness, shape, and distribution of yeast or yeasts with pseudohyphal growth, and a study regarding the correlation between histological characteristics and number of leukocytes in the peripheral blood just before death. Results showed that the, supratentorial region was the most common area of disseminated candidial infection in CNS, and that density was highest in the cerebral gray matter followed by the white matter and basal ganglia. On the other hand, regarding the lesions developed in the cortical area, the average distance from the brain surface was 4.026 mm. This area corresponding to the deeper cortex has a characteristic arterial structure that refers hairpin curving reverse. The structure may contribute to the high incidence of candidial foci in the deeper cortex, because of the increase in shear stress.
No preview · Article · Jan 2010 · Nippon Ishinkin Gakkai Zasshi
[Show abstract][Hide abstract] ABSTRACT: As methods of cancer diagnosis and treatment improve, interest in metastatic brain tumors continues to increase. In the present study, we attempted to characterize genetically the dynamic changes occurring during brain metastasis formation by DNA microarray, and attempted to compare these findings with histological observations. Lewis lung carcinoma cells were injected into C57BL/6Ncrj mice carotid arteries. The mice were sacrificed at days 1-9 after injection. We performed histological observation and genome-wide expression profiling using a DNA microarray. In histological observation, tumor cells were observed in capillary vessels at day 1 after injection. At day 3, the tumor cells had begun to proliferate. At day 6, the metastatic foci showed "perivascular proliferations". Next, we performed a pairwise comparison of gene expression microarray data from day 1 to day 9 after injection. The first major change occurred between Phase Two and Phase Three. When hierarchical clustering was performed between different samples using the 867 genes, they could be classified into identical clusters for days 1 and 2, identical clusters for day 3 to day 5, and identical clusters for day 6 to day 9. For time course analysis, we extracted 623 genes by the pairwise comparison. By using the quality threshold (QT) nonhierarchical clustering method, we identified 37 expression patterns. These patterns can be separated into eight clusters by using the k-means method. The microarray results reported here strongly suggest that a large number of genes exhibit a spike pattern, which is tantamount to phase-specific expression.
[Show abstract][Hide abstract] ABSTRACT: As methods of cancer diagnosis and treatment progress, interest in metastatic brain tumours continues to increase. There are many studies using various methods of animal model and we considered that each model reflects different pathological processes because of the unique composition of the brain. We prepared metastatic brain tumour models using three different methods. In this study, we attempted to elucidate the roles of the pia mater in brain metastasis. The metastatic foci showed an angiocentric pattern, forming collars of neoplastic cells, and were designated 'perivascular proliferations'. Furthermore, we observed neoplastic cells that infiltrated the brain parenchyma, the border of which had become indistinct. These were labelled 'invasive proliferations'. The internal carotid artery injection model reflects haematogenous metastasis. In this model, both perivascular and invasive proliferations were observed. The intrathecal injection model reflects leptomeningeal carcinomatosis. In this model, metastasis to the meninges was observed. In the stereotactic injection model, the tumour proliferation at the injection site and the infiltration into the brain parenchyma were observed. The pia-glial membrane serves as a scaffold when neoplastic cells spread to the perivascular space forming angiocentric pattern. The pia-glial membrane is found between the brain parenchyma and blood vessels. Blood vessels penetrate the brain through tunnels known as perivascular spaces that are covered by pia mater. Three different methods which we prepared reflect three different pathological processes. Our findings suggest that the pia mater is a critical factor in brain metastasis.
Full-text · Article · Mar 2008 · International Journal of Experimental Pathology
[Show abstract][Hide abstract] ABSTRACT: Abstract
We evaluated regional cerebral blood flow (rCBF) during vasospasm after subarachnoid haemorrhage (SAH) using automated voxel-based analysis of brain perfusion single-photon emission computed tomography (SPECT).
Brain perfusion SPECT was performed 7 to 10 days after onset of SAH. Automated voxel-based analysis of SPECT used a Zscore map that was calculated by comparing the patient’s data with a control database.
In cases where computed tomography (CT) scans detected an ischemic region due to vasospasm, automated voxel-based analysis of brain perfusion SPECT revealed dramatically reduced rCBF (Z-score ≤ −4). No patients with mildly or moderately diminished rCBF (Z-score> −3) progressed to cerebral infarction. Some patients with a Z-score≤ −4 did not progress to cerebral infarction after active treatment with angioplasty. Three-dimensional images provided detailed anatomical information and helped us to distinguish surgical sequelae from vasospasm.
In conclusion, automated voxel-based analysis of brain perfusion SPECT using a Z-score map is helpful in evaluating decreased rCBF due to vasospasm.
No preview · Article · Jan 2008 · Acta neurochirurgica. Supplement
[Show abstract][Hide abstract] ABSTRACT: There have been very few reports in Japan of patients with allergic fungal sinusitis (AFS). We describe two cases caused by Bipolaris spicifera and Schizophyllum commune. The patients were a 70-year-old male (Case 1) and a 55-year-old female (Case 2). Both presented with nasal obstruction and purulent nasal discharge. CT scans revealed each to have a soft tissue mass extending from the ethmoid sinus to the sphenoid sinus. In addition, pathological studies on the contents of the paranasal sinuses of both patients revealed the presence of fungal elements in the allergic mucin. Microbiological studies resulted in the recovery of Bipolaris spicifera from Case 1 and Schizophyllum commune from Case 2. To date there have been no reports of AFS due to these two fungi in Japan. It is very important in the diagnosis of AFS to demonstrate the presence of fungal elements in the allergic mucin. Squash cytology of the paranasal sinus contents was especially useful for proving the presence of fungi.
No preview · Article · Oct 2007 · Medical Mycology
[Show abstract][Hide abstract] ABSTRACT: We describe a case of giant cervical internal carotid aneurysm successfully treated by endovascular trapping. A 57-year-old woman with a history of maxillary contusion seven years before presented with pharyngeal discomfort during swallowing. MRI revealed a 4 cm mass in the right parapharyngeal space. A common carotid angiogram revealed a giant aneurysm with a wide neck originating from the cervical internal carotid artery; kinking of the internal carotid artery was noted at a point distal to the carotid bifurcation. Analysis of cerebral blood flow by SPECT during a balloon occlusion test showed no hypoperfusion areas, and the patient underwent endovascular trapping. There were no neurological or other complications after the procedure. A follow-up MRI revealed complete thrombosis of the aneurysm. Our results show that endovascular trapping for pseudoaneurysm of the cervical internal carotid artery can be a reliable and effective treatment in patients who tolerate a balloon occlusion test.