吉野 義一

Ruptured intracranial aneurysms are rare in the pediatric population compared to adults. This has incited considerable discussion on how to treat children with this condition. Here, we report a child with a ruptured saccular basilar artery aneurysm that was successfully treated with coil embolization. A 12-year-old boy with acute lymphoblastic leukemia and accompanying abdominal candidiasis after chemotherapy suddenly complained of a severe headache and suffered consciousness disturbance moments later. Computed tomography scans and cerebral angiography demonstrated acute hydrocephalus and subarachnoid hemorrhage caused by saccular basilar artery aneurysm rupture. External ventricular drainage was performed immediately. Because the patient was in severe condition and did not show remarkable signs of central nervous system infection in cerebrospinal fluid studies, we applied endovascular treatment for the ruptured saccular basilar artery aneurysm, which was successfully occluded with coils. The patient recovered without new neurological deficits after ventriculoperitoneal shunting. Recent reports indicate that both endovascular and microsurgical techniques can be used to effectively treat ruptured cerebral aneurysms in pediatric patients. A minimally invasive endovascular treatment was effective in the present case, but long-term follow-up will be necessary to confirm the efficiency of endovascular treatment for children with ruptured saccular basilar artery aneurysms.

OBJECTIVE: This report presents 12 consecutively managed patients with aneurysmal subarachnoid hemorrhage (SAH) associated with acute subdural hematoma (ASDH) who underwent decompressive craniectomy (DC) with special attention to their clinical characteristics and surgical outcomes. METHODS: We retrospectively reviewed medical charts, radiologic findings, surgical notes, and video records. RESULTS: Among these 12 patients (mean age 59.1 years, 4 men, 8 women), the Hunt and Kosnik clinical grade was grade V in 7 patients (58.3%), grade IV in 2 patients (16.7%), grade III in 2 patients (16.7%), and grade II in 1 patient (8.3%). The aneurysms were located on the internal carotid artery in four patients, the middle cerebral artery in six patients, and the anterior communicating artery in two patients. Computed tomography findings on admission revealed ASDH in all patients. In addition, SAH was seen in 11 patients. An intracerebral hematoma was found in eight patients, intraventricular hemorrhaging occurred in four, and an acute hydrocephalus was seen in one patient. All patients underwent a microsurgical clipping procedure and an additional DC. Symptomatic vasospasm was confirmed in six (50%), and eight patients with chronic hydrocephalus received a ventriculoperitoneal shunt (67%). The Glasgow Outcome Scale at discharge showed good recovery in five patients (41.7%), severe disability in four (33.3%), vegetative state in two (16.7%), and death in one patient (8.3%). A favorable outcome was achieved in five patients (41.7%). CONCLUSIONS: We suggest that the DC was effective for reducing morbidity and mortality in poor grade patients with SAH presenting with ASDH.

Hypereosinophilic syndrome (HES) is a rare disorder that can cause ischemic stroke. We present a patient with middle cerebral artery (MCA) occlusion resulting from HES. Transarterial thrombolysis resulted in MCA recanalization and adjuvant therapy may have contributed to stabilization of the underlying HES in our patient. (C) 2009 Elsevier Ltd. All rights reserved.

Acute subdural hematoma (ASDH) patients presenting in a severe condition tend to have poor outcomes due to the significant brain edema required to maintain the ICP at less than 20-25 mmHg. This study compared the surgical outcomes of 16 critically ill patients with ASDH who underwent hematoma irrigation with trephination therapy (HITT) based on their initial ICP values. The initial mean GCS score upon admission was four. A unilateral dilated pupil was seen in one and bilateral dilated pupils were seen in seven patients. The co-existence of a brain contusion was seen in seven patients, brain swelling was noted in six patients, and both basal cistern effacement and a midline shift greater than 5 mm were observed in all patients. The mean initial ICP value was 45 mmHg (range: 3 to 85 mmHg). Ten patients (62.5%) underwent a rapid external decompression to evacuate the hematoma. By using the Glasgow Outcome Scale upon discharge a score of good recovery (GR) was assigned to two (12.5%), moderate disability (MD) to four (25.0%), vegetative state (VS) to two (12.5%), and death (D) to eight (50.0%) patients. All six patients who showed an initial ICP greater than 60 mmHg died despite intensive care. Eight patients who showed an initial ICP less than 40 mmHg had a favorable outcome, but two patients deteriorated due to a traumatic cerebrovascular disorder. It seems that the initial ICP monitoring with HITT for ASDH patients in critical condition may be an important factor for predicting both surgical outcome and clinical course.

Acute epidural hematomas (AEDH) are generally managed with rapid surgical hematoma evacuation and bleeding control. However, the surgical outcome of patients with serious brain edema is poor. This study reviewed the clinical outcome for AEDH patients and evaluated the efficacy of the DC, especially in patients with associated massive brain swelling. Eighty consecutive patients surgically treated with AEDH were retrospectively assessed. The patients were divided into two groups: (a) hematoma evacuation (HE: 46 cases) and (b) HE+ an external decompression (ED: 34 cases). The medical charts, operative findings, radiological findings, and operative notes were reviewed. In the poor outcome group, there were 18 patients (72%), with a GCS score of less than 8 (severe injury), and 22 patients (88%) who showed pupil abnormalities. Many more patients showed a midline shift, basal cistern effacement, and brain contusion in comparison to the favorable outcome group. In the favorable outcome group, almost all of the patients (98%) showed less than 12 mm of a midline shift. The influential factors may be age, GCS, pupil abnormalities, size, midline shift, basal cistern effacement, coincidence of contusion and swelling. We conclude that an A DC may be effective to manage the AEDH patients with cerebral contusion or massive brain swelling.

Purpose Decompressive craniectomy for traumatic brain injury patients has been shown to reduce intracranial hypertension, while it often results in increased brain edema and/or contralateral space-occupied hematoma. The purpose of this study was to determine the prognosis of bilateral decompressive craniectomy in severe head injury patients with the development of either bilateral or contralateral lesions after ipsilateral decompressive craniectomy. Methods Twelve patients underwent bilateral decompressive craniectomy among 217 individuals who had been treated with decompressive craniectomy with dural expansion from September 1995 to August 2006. The following patient data were retrospectively collected: age, neurological status at admission, time between injury and surgical decompression, time between first and second decompression, laboratory and physiological data collected in the intensive care unit, and outcome according to the Glasgow Outcome Scale. Results Patient outcomes fell into the following categories: good recovery (three patients); mild disability (one patient); severe disability (two patients); persistent vegetative state (one patient); and death (five patients). Patients with good outcomes were younger and had better pupil reactions and neurological statuses on admission. Other factors existing prior to the operation did not directly correlate with outcome. At 24 h post-surgery, the average intercranial pressure (ICP), cerebral perfusion pressure (CPP), glucose level, and lactate level in patients with poor outcomes differed significantly from those of patients with a good prognosis. Conclusion Head injury patients with either bilateral or contralateral lesions have poor prognosis. However, bilateral decompressive craniectomy may be a favorable treatment in certain younger patients with reactive pupils, whose ICP and CPP values are stabilized 24 h post-surgery.

Epstein-Barr virus (EBV) encephalitis is a rare neurological complication, usually only reported in pediatric patients. We present a 20-year-old, previously healthy male who developed hemorrhagic encephalitis caused by EBV. He was admitted to our hospital with a I-week history of fever, diarrhea, headache, and confusion, Brain T2-weighted MRI showed a focal area of increased signal in the right temporal lobe. Brain MRI and CT scans on day 2 revealed progression of the lesion, with partial hemorrhagic change, acute brain swelling, and severe midline shift. The patient underwent external decompression and external ventricular drainage. EBV DNA was identified in brain biopsy specimens by polymerase chain reaction. The postoperative course was uneventful. To Our knowledge, this is the second report of hemorrhagic EBV encephalitis in an adult. Published by Elsevier Ltd.

Computed tomography (CT) is an important tool for the evaluation of subarachnoid hemorrhages caused by ruptured aneurysms. However, an unusual radiologic presentation of blood can result in the misdiagnosis of the rupture site. We report a case of ruptured right internal carotid-posterior communicating (IC-PC) artery aneurysm with an unusual radiologic presentation of hemorrhage. The CT scans images of this patient were indicative of blood clots in the cisterna magna and the ventricles with no blood collection in the suprasellar cistern or sylvian fissure. The intraventricular clots were mainly distributed in the fourth ventricle, with few clots in the lateral ventricles. On the basis of these findings, we suspected the origin of the hemorrhage was an unknown ruptured posterior fossa aneurysm. However, angiography revealed a right internal carotid-posterior communicating (IC-PC) artery aneurysm. Twenty-three days after onset, a repeat CT confirmed that the origin of the hemorrhage was the right IC-PC aneurysm. Possible factors involved in this case were: (1) formation of adhesions in the subarachnoid cisterns due to an earlier minor leakage, (2) the orientation of the aneurysm (posteroinferior direction), and (3) early wash out of the blood clot.

We report a rare case of chronic encapsulated intracerebral hematoma (CEIH) after radiosurgery for a cerebral arteriovenous malformation (AVM). Seven years after radiosurgery, magnetic resonance imaging revealed a high-intensity mass in the right basal ganglia with a peripheral low signal ring and fluid level on both T1- and T2-weighted images, which was compatible with CEIH. Stereotactic evacuation and placement of an Ommaya reservoir were performed. The concentration of vascular endothelial growth factor was high in the hematoma, suggesting that CEIH may be similar to chronic subdural hematoma.

Dolichoectasia is an angiopathy characterized by dilatation, elongation, and tortuosity of the brain arteries. It most frequently involves the vertebral and basilar arteries; involvement of both the vertebrobasilar and carotid systems is rare. We present a patient with fatal dolichoectasia involving both the vertebrobasilar and carotid artery systems. (C) 2009 Elsevier Ltd. All rights reserved.

Ruptured aneurysms typically present as subarachnoid hemorrhage (SAH) however, they can also cause intracerebral hemorrhage (ICH) that can be mistaken for hypertensive hemorrhage. We report a rare case of a ruptured middle cerebral artery bifurcation aneurysm presenting as putaminal hemorrhage without subarachnoid hemorrhage (SAH). A 47-year-old man, with a past history of hypertension, presented with a decreased level of consciousness. Neurological examination revealed hemiparesis of the right side. A CT scan on admission demonstrated left putaminal hemorrhage without SAH. Three-dimensional CT and conventional angiograms demonstrated a superiorly directing aneurysm of the M1/M2 portion of the left middle cerebral artery (MCA). We performed aneurysmal clipping and hematoma evacuation. The postoperative course was uneventful. This case suggested that ruptured aneurysms situated on the middle cerebral artery can present as putaminal hemorrhage without SAH.

Ruptured aneurysms located at the non-branching sites of the internal carotid artery, including blister-like aneurysms, possess unique clinical and technical features. This report presents nine consecutively managed patients with these types of aneurysm, detailing the clinical and radiological characteristics and surgical Outcomes. The initial angiography identified aneurysmal lesions in six of the nine patients with two of these patients requiring additional three-dimensional (3D) angiography. In three patients the aneurysm was only diagnosed on second or third angiograms. Six patients had blister-like aneurysms, and two had saccular-shaped aneurysms diagnosed on the basis of intraoperative findings. One patient with a saccular aneurysm died without surgery. Eight patients underwent a microsurgical procedure: clipping in five, clipping on wrapping with suturing in two and trapping in one. Three of these eight patients had an intraoperative rupture. A favorable Outcome was obtained in seven patients. Advances in microsurgical techniques to prevent premature rupture and 3D radiological diagnosis with careful pre-operative consideration of the surgical Strategies will be required for a further improvement of the clinical outcome. (C) 2008 Elsevier Ltd. All rights reserved.

Optimal surgical management of ruptured aneurysms of the distal anterior cerebral artery continues to provide unique technical challenges. This study presents 20 consecutively managed such patients, with special attention given to the clinical and radiological characteristics, as well as the surgical outcomes. Intracerebral hematoma was seen in 11 of the 20 patients, and intraventricular hemorrhage occurred in 4 (20%). Angiography revealed that 9 (45%) patients had multiple aneurysms. Three patients (15%) had "mirror" distal anterior cerebral arterial aneurysms on the contralateral side. Eleven patients (55%) had aneurysms located at the supracallosal portion of the anterior cerebral artery, while 9 patients (45%) had aneurysms located below the genu of the corpus callosum. The mean aneurysmal diameter was 3.85 mm; 18 aneurysms (90%) were less than 6 mm in diameter. Eighteen patients (90%) underwent a microsurgical procedure; 2 (10%) underwent endovascular coiling due to poor clinical grade. A favorable outcome was achieved in 14 (70%) patients. Advances in microsurgical techniques will be required to further improve clinical outcome. Published by Elsevier Ltd.

The recurrence or metastasis of intracranial pure germinomas as germ cell tumours of different histological types has rarely been reported. The present report concerns the first case in the literature of intracranial recurrence of a germinoma transformed into a choriocarcinoma. A 17-year-old man presented with a 1 month history of headache. MRI revealed a homogeneously enhanced mass within the pineal and suprasellar regions. The tumour was resected, and histological examination identified it as a pure germinoma. After resection, the patient underwent chemotherapy and radiotherapy and the mass disappeared. At 5 years and 5 months later, the patient presented with nausea and headache, and recurrence of the tumour was revealed in the left lateral ventricle. The tumour was resected and histological diagnosis identified it as a choriocarcinoma. The patient was treated with chemotherapy and radiotherapy, but died due to dissemination 1 month later. An autopsy was not performed.

We report a rare case of dissecting aneurysm of the distal anterior inferior cerebellar artery (AICA). A 63-year-old woman who complained of severe headache and nausea was admitted to our hospital. A computed tomography (CT) scan revealed subarachnoid hemorrhage, intraventricular hemorrhage, and acute hydrocephalus. Left vertebral angiogram revealed a dissecting aneurysm at the meatal loop of the distal AICA. On the next day, left suboccipital craniotomy was performed, and the fusiform aneurysm was trapped. The patient did not exhibit cranial nerve palsy after the operation. A left vertebral angiogram obtained after the operation showed that the dissecting aneurysm of the distal AICA had completely disappeared. Dissecting aneurysm of the distal AICA is a rare condition. Thus far, only 9 cases have been reported in the literature. We reviewed these cases and discussed the treatment for and outcome of dissecting aneurysms of the distal AICA.

Object. A miltimodal neuronavigation system using metabolic images with PET and anatomical images from MR images is described here for glioma surgery. The efficacy of the multimodal neuronavigation system was evaluated by comparing the results with that of the conventional navigation system, which routinely uses anatomical images from MR and CT imaging as guides. Methods. Thirty-three patients with cerebral glioma underwent 36 operations with the aid of either a multimodal or conventional navigation system. All of the patients were preliminarily examined using PET with L-methyl-[(11)C] methionine (MET) for surgical planning. Seventeen of the operations were performed with the multimodal navigation system by integrating the MET-PET images with anatomical MR images. The other 19 operations were performed using a conventional navigation system based solely on MR imaging. Results. The multimodal navigation system proved to be more useful than the conventional navigation system in determining the area to be resected by providing a clearer tumor boundary, especially in cases of recurrent tumor that had lost a normal gyral pattern. The multimodal navigation system was therefore more effective than the conventional navigation system in decreasing the mass of the tumor remnant in the resectable portion. A multivariate regression analysis revealed that the multimodal navigation systern-guided Surgery benefited patient survival significantly more than the conventional navigation-guided surgery (p = 0.016, odds ratio 0.52 [95% confidence interval 0.29-0.88]). Conclusions. The authors' preliminary intrainstitutional comparison between the 2 navigation systems suggested the possible premise of multimodal navigation. The multimodal navigation system using MET-PET fusion imaging is an interesting technique that may prove to be Valuable in the future. (DOI: 10.3171/2008.4.17569)

Aneurysms of lenticulostriate artery (LSA) have rarely been reported. We present an extremely rare case of bilateral aneurysm of LSA, which spontaneously disappeared. A 59-year-old man presented to us with a decreased level of consciousness. Twice repeated blood culture was negative. Computed tomography (CT) showed bilateral basal ganglia hemorrhage with intraventricular extension and acute hydrocephalus. We performed external ventricular drainage. Cerebral angiograms, on 3 days after the onset, disclosed two aneurysms on the left LSA and one aneurysm on the right LSA. Cerebral angiography after 9 weeks demonstrated complete disappearance of three aneurysms.

Traumatic vertebral artery injuries are frequently accompanied by cervical spine injury. Transverse process fracture from C6 to C1 has been reported as a high risk factor for vertebral artery injury. We report a rare case of vertebral artery occlusion caused by transverse process fracture of C7. A 22-year-old man was admitted to our hospital after a motor-cycle accident. Neurological examination revealed almost normal findings. Axial computed tomography (CT) at the C7 level revealed soft-tissue swelling of the neck and right transverse process fracture. Further, a bony fragment protruding in the anterolateral direction was observed. Magnetic resonance (MR) image showed normal findings. MR angiography (MRA) revealed right vertebral artery occlusion at the V1 segment. Vertebral artery angiography revealed right vertebral artery occlusion, normal basilar artery, and retrograde flow of the right vertebral artery. The patient was treated with heparin and aspirin and discharged 28 days after admission. A follow up MRA at 2 months after admission demonstrated no change in right vertebral artery occlusion, and he was still asymptomatic 3 months after admission. We conclude that the transverse process fracture of C7 complicated with soft-tissue swelling of the neck could cause vertebral artery injury, and MRA and angiography are recommended for diagnosis and treatment, respectively.

Background: Patients with poor-grade aneurysmal subarachnoid hemorrhage (SAH) presenting with large intracerebral (ICH) or sylvian hematomas (SylH) have poor outcomes due to the mass effect of significant brain stem compression following mass effect. On the other hand, decompressive craniectomy (DC) can reduce morbidity and mortality in critically ill patients with massive ischemic infarction and severe head injury. However, the role of DC in SAH patients is not fully understood. We investigated the outcome of DC in poor-grade SAH presenting with large ICH or SylH. Methods: 110 consecutive patients with poor-grade SAH (Hunt & Kosnik (H&K) grades IV and V, and Fisher group 4) were admitted to our hospital between April 1, 1993, and July 30, 2004. We treated 57 of those who presented with large ICH or SylH using DC. We retrospectively reviewed medical charts, radiological findings, operative notes, and video records. Results: Among the 57 patients (mean age 57.8, male 29, female 28), 25 were classified as H&K grade IV and 32 as grade V. Ruptured aneurysms were located on the internal carotid artery in 11 and the middle cerebral artery in 46 patients. 50 of the aneurysms were small, 5 were medium, and 2 were large. Rerupture was preoperatively confirmed in 13 (22.8%). Hypothermia was applied to 17 (29.8%). The Glasgow Outcome Scale on discharge showed good recovery, moderate recovery, severe disability, vegetative state, and death in 8 (14.0%), 13 (22.8%), 16 (28.1%), 8 (14.0%), and 12 (21.1%), respectively. The outcomes of grade IV patients were favorable and poor in 14 (56.0%) and 10 (40.0%), respectively, and 1 (4.0%) died. Conclusion: Several experimental studies have also indicated that DC significantly improves outcome due to reduced intracranial pressure or increased perfusion pressure. Urgent DC for poor-grade SAH with space-occupying hematoma can lead to survival with good recovery in some patients. Copyright (C) 2008 S. Karger AG, Basel

Introduction Controversy exists as to whether Matrix coils are an improvement over bare platinum coils in preventing aneurysm recanalization in endosaccularly coiled large aneurysms. We investigated Matrix coils in a dog model of a wide-necked large bifurcation aneurysm. Methods Six experimental aneurysms were created in dogs and these aneurysms were endosaccularly coiled with 100% Matrix coils. Angiographic and histopathological data were analyzed at 2 weeks and at 3 months. Results Average aneurysm dimensions were length 17.8 mm, width 8.3 mm, and neck 6.2 mm. Aneurysm coil filling ranged 24.1 - 41.8% by volume. At 14 days, three of six Matrix-treated aneurysms showed coil compaction and aneurysm recanalization. At 3 months, one additional Matrix-treated aneurysm showed delayed coil compaction and aneurysm recanalization. At 3 months, in three harvested aneurysms, the average measured neck neointima was 0.150 +/- 0.14 mm. However, in two of the three aneurysms harvested at 3 months, aneurysm recanalization had occurred with neointimal tissue not completely covering the aneurysm orifice. Thick connective fibrous intercoil tissue was observed. No immediate or delayed thrombus formation had occurred. Conclusion Based on limited data in an experimental bifurcation aneurysm in dogs, Matrix coils appear to induce a thicker aneurysm neck neointima tissue and intercoil granulation response but appear prone to coil compaction and aneurysm recanalization. Modifications to the Matrix coil are likely needed to improve angiographic results in large aneurysms.

We reported a 72-year-old man presented with gustatory disturbance. He lost bitter, salty, sour and sweet sensation on the left half of the tongue. No other neurologic signs were observed. Brain MRI showed the cerebral infarction in the left middle cerebellar peduncle. The lesion was suspected of affecting the gustatory tract running from the nucleus solitalius to the pontine taste area in the upper pons. The gustatory tract is generally recognized to be located medially from the medial lemniscus and the reticular formation. Our case suggests that the tract would be located laterally from the medial lemniscus and the reticular formation.

Malignant gliomas are typically angiogenic and secrete high levels of VEGF. Hypoxia has been identified as an important regulator of VEGF. However, malignant gliomas express high levels of VEGF in both hypoxic perinecrotic and vital tumor areas. In this study, we examined intracellular signaling pathways involved in the secretion of VEGF in glioma cells under normoxic conditions. Human malignant glioma cell lines, T98G, U373MG, U87MG, and A172, and human fetal lung fibroblasts (HFL) were cultured both with and without IL-1 beta under normoxic conditions. VEGF, IL-1, IL-6 and TNF-alpha were measured with ELISA. VEGF mRNA levels were estimated by RT-PCR. Inhibitors of COX-2, MAPK, and phosphatidyl inositol 3-kinase (PI3-K), and blocking antibodies to TGF-beta II and TNF-alpha, or IL-1 receptor antagonist, were used to examine their effects on VEGF secretion. Phosphorylation of MAPK was examined by immunoblotting. The basal levels of VEGF secretion were significantly higher in U87MG, U373MG, and T98G, than HFL. IL-1 beta significantly stimulated VEGF secretion in these glioma cells. Inhibitors of p38 MAPK and/or JNK significantly suppressed VEGF secretion both in the presence and absence of IL-1 beta, while inhibitors of COX-2, ERK1/2, and PI3-K. did not. Constitutive phosphorylation of p38 MAPK and JNK was observed in these glioma cells. The levels of IL-1 beta in U87MG were significantly higher than in other glioma cell lines, and IL-1 receptor antagonist suppressed basal secretion of VEGF from U87MG. In conclusion, p38 MAPK and JNK pathways play an important role in VEGF secretion from malignant glioma cells under normoxic conditions, possibly contributing to VEGF-induced angiogenesis in malignant gliomas at vital tumor areas where there is no hypoxia.

We developed an experimental canine model in which four types of aneurysm-bifurcation, side-wall, small branch-artery, and arterial-stump-were surgically created in the same animal. These experimental aneurysms are exposed to simultaneous but different hemodynamic stresses correlating to human intracranial aneurysms in different locations. Because this model allowed for the creation of four aneurysms, each with different hemodynamic features, it seems to offer advantages from ones previously described. This model may foster investigation of new and current endovascular devices.

In our experience with the canine model, sidewall aneurysms made with an oblique-cut arteriotomy were less likely to thrombose than were those made with a standard technique.

Object. The authors investigated whether HydroCoils decreased coil compaction and aneurysm recanalization in a canine model of a large, wide-necked, high-flow bifurcation aneurysm. Methods. Eleven experimental aneurysms were created. Two aneurysms were untreated (Group 1); three were treated with standard platinum coils (Guglielmi Detachable Coils; Group 2); and six were treated with platinum framing coils and filling HydroCoils (Group 3). Comparative angiographic and histopathological data were analyzed at 2 weeks and again at 3 months. At 3 months, the Group 1 aneurysms remained patent without spontaneous thrombosis. After coil placement the percentage of aneurysm filling by volume ranged from 59 to 90% (mean 75.4%) for Group 3 (HydroCoil-treated) and 34.3 to 48.9% (mean 39.6%) for Group 2 (GDC-treated) (p < 0.05). At 14 days, two of the three Group 2 aneurysms exhibited coil compaction and aneurysm recanalization at the neck; in both cases the condition worsened at 3 months. At 14 days and 3 months, five of the six Group 3 aneurysms were 100%, and one of six was 90% occluded and remained stable. At 3 months, the neointima of the aneurysm neck was significantly thicker in the Group 3 lesions, which had been treated by HydroCoils (0.329 +/- 0.191 mm), than in Group 2 lesions, which had been treated with GDCs (0.026 +/- 0.018 mm) (p < 0.001). No thrombus formation occurred in Group 2; however, in two of the six aneurysms in Group 3, thrombus formed at the coil-neck interface. Conclusions. The experimental canine bifurcation aneurysm model overcomes the limitations of side-wall aneurysm models. In this model, HydroCoils resulted in significantly denser coil packing, less follow-up coil compaction, and thicker neointimal tissue at the neck of the lesion. HydroCoils also appeared more thrombogenic at the aneurysm neck-parent artery interface.

Purpose: Tumor necrosis factor (TNF)-alpha elicits two opposing effects, the induction of apoptosis and the transcription of antiapoptotic genes. We have recently shown that cisplatin sensitizes glioma cells to TNF-induced apoptosis, but only in some cell lines. To understand the mechanism involved in the different susceptibilities, we examined both the activation of caspases and cytoprotective signaling by TNF-alpha. Experimental Design: Caspase activation was examined by estimating the cleavage of substrate peptides and by immunoblot to identify the cleavage of procaspases. Peptide inhibitors of caspases were used to reverse the cytotoxicity. The binding of TNF-alpha to the receptor was analyzed by flow cytometry. Nuclear factor (NF)-KB activation was assayed by the binding of NF-KB to oligonucleotides containing the consensus binding site. Interleukin (IL)-1beta, IL-6, IL-8, and manganous superoxide dismutase (MnSOD) were measured by enzyme-linked immunoassays. Results: T98G and U87MG underwent apoptosis on treatment with cisplatin and TNF-alpha, but U373MG and A172 were resistant. Caspases 2, 3, and 6-10, but not caspases 1, 4, and 5, were activated in sensitive cells, and none were activated in resistant cells. The binding of TNF-alpha to the receptor was the same in all four of the cell lines. In the sensitive cells, NF-KB activation and the production of IL-1beta, IL-6, IL-8, and MnSOD were significantly elevated by TNF-alpha. However, in the resistant cells, the production of IL-1beta and IL-6 were specifically impaired in response to TNF-alpha. Conclusions: Our results indicate that both apoptotic and cytoprotective pathways are impaired in glioma cells that are resistant to treatment with cisplatin and TNF-alpha.

BACKGROUND This case illustrates that although percutaneous subdural tapping for patients with chronic subdural hematoma (CSDH) is successful and minimally invasive, it can be complicated by acute epidural hematoma. CASE PRESENTATION A 62-year-old woman presented with headache two months after minor head trauma. Computed tomography (CT) scanning revealed CSDH with mixed density on the right side. Prior to percutaneous subdural tapping, twist-drill craniostomy was performed at the parietal tuber. When the drill-needle reached the dura mater, the patient began to complain of headache, which was followed by altered consciousness. CT scanning disclosed acute epidural hematoma abutting the CSDH; both hematomas were evacuated by emergency craniotomy. At surgery, no definite bleeding source was identified apart from oozing on the dura mater. CONCLUSION Hemorrhagic complications after percutaneous subdural tapping are rare. The formation of acute epidural hematoma during twist-drill craniostomy has not been reported in the literature. This complication can occur when the blunt tip of the drill-needle remains on the dura mater without penetrating into the subdural hematoma cavity. (C) 2000 by Elsevier Science Inc.