[Treatment for low grade glioma focusing on grade II glioma].
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Brain Neoplasms↗
Biomedical subjects
Takamasa Kayama
Publications and source records attributed to Takamasa Kayama.
Selective translocation of diacylglycerol kinase zeta in hippocampal neurons under transient forebrain ischemia.
The molecular mechanisms responsible for differential neuronal vulnerability to ischemic injury are incompletely understood. Previous studies have reported that the expression and activity of protein kinase C (PKC), some subtypes of which are activated by Ca(2+) and diacylglycerol (DG), are altered after ischemic insults. Therefore, DG kinase (DGK), which is responsible for controlling PKC activity through DG metabolism, may also be involved in this process. DGKzeta, which is abundantly expressed in the brain, contains a nuclear localization signal (NLS), suggesting its involvement in some nuclear processes in neuronal cells. To elucidate the functional implications of DGKzeta in ischemia, we examined detailed localization of DGKzeta in rat brain after ischemic insults. We used an ischemic model of global cerebral ischemia for 20 min by bilateral common carotid artery occlusion combined with hypotension and followed time-points of reperfusion. DGKzeta expression was evaluated by immunohistochemistry using affinity-purified anti-DGKzeta antibody. In sham-operated rats, a strong DGKzeta-immunoreactivity was observed in the nucleus of neurons in various parts of the brain. In the global ischemic model DGKzeta-immunoreactivity was reduced in intensity in the hippocampal formation and detected in the cytoplasm of CA1 pyramidal neurons throughout reperfusion time courses. Change in the subcellular localization was restricted to the pyramidal cells in CA1 and later in CA3, but not observed in other areas of hippocampus. No change was observed in the cerebral and cerebellar cortices. The present study suggests that DGKzeta might be involved in the process of selective vulnerability of hippocampal pyramidal neurons in postischemic brain.
Animals↗
[Asymptomatic brain tumor].
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Astrocytoma↗
Inhibition of angiogenesis in human glioma cell lines by antisense RNA from the soluble guanylate cyclase genes, GUCY1A3 and GUCY1B3.
Malignant gliomas, most of which show an elevated level of vascular endothelial cell growth factor (VEGF) expression, are well known for their hyper-vascularity. One of the possible inducers of VEGF in tumor cells is nitric oxide (NO), which is synthesized by NO synthase and stimulates soluble guanylate cyclase (GC) in tumor cells. Here, we report that 2 of 9 human glioma cell lines, CCF-STTG1 and U-87MG, overproduced cyclic GMP (cGMP) and showed increased expression of both or either subunits of soluble GC1, GUCY1A3 and GUCY1B3. Transfection of antisense GUCY1A3 or GUCY1B3 into these two glioma cell lines markedly reduced the content of cGMP and expression of VEGF. The angiogenic activity in vitro was subsequently inhibited, which was determined by induction of HUVEC cell growth. Furthermore, subcutaneous tumor formation by U-87MG cells in nude mice was dramatically suppressed to less than 0.05% in volume by transfection of either antisense GUCY1A3 or antisense GUCY1B3, which was accompanied by the significant decrease in vascular index to about 10%. These findings demonstrate that cGMP is an upstream mediator of VEGF expression in glioma cells and that soluble guanylate cyclases could be the target molecules for controlling neo-vascularization in a subset of human malignant gliomas.
Animals↗
[Significance and usefulness of corticospinal motor evoked potential monitoring for lesions adjacent to primary motor cortex].
This study evaluated the usefulness of intraoperative corticospinal motor evoked potential (MEP) monitoring in preventing postoperative motor deficits, and whether this procedure contributed to surgery on intrinsic brain lesions in the vicinity of the motor area. The subjects were 45 patients with brain tumors located in and around the primary motor area. MEP was recorded through the cervical epidural electrodes in response to stimulation of the motor cortex. The amplitude of D-response of MEP was compared at the beginning and at the end of surgery. Then MEP changes were divided into five groups; "increase", "no change", "diminish", "decrease" and "disappear". We used the DeJong classification for qualitative analysis of motor function, and reviewed these findings in relation to the change in MEP. It was possible to record MEP when the preoperative motor weakness was DeJong 3 or better. There was no postoperative motor deficit when the MEP amplitude was preserved at better than 50% of a control amplitude. If the amplitude decreased to less than 50%, motor deficits were encoutered. When MEP amplitude increased during the surgery, preoperative motor weakness was improved after the surgery. It is concluded that there is little possibility of causing motor deficits even if tumor removal is aggressively pursued, as long as the amplitude of D-response remains at 50% or more of the baseline. This monitoring procedure is expected to improve the overall surgical results in patients with intrinsic brain tumors around the motor area.
Adolescent↗
[A case of bilateral extracranial carotid artery aneurysms caused by Takayasu's arteritis].
We describe here successful surgical treatment of a rare case of a rapidly enlarged aneurysm due to Takayasu's arteritis. A 22-year-old woman presented with a 1-month history of hoarseness and left neck pain. Contrast-enhanced computerized tomography showed an unruptured partially thrombosed aneurysm, and angiography revealed a large aneurysm of the common carotid artery. After hospitalization, the symptoms, interestingly, resolved spontaneously. While angiography at 2 weeks after admission showed the aneurysm to have reduced in size, 2 months later it showed the left common carotid artery aneurysm to be substantially enlarged in size and aneurysmal formation of the right external carotid artery. Surgical intervention was performed for the left common carotid artery aneurysm because rapid enlargement indicated the risk of aneurysmal rupture, and the thrombosis might cause embolic occlusion of the cerebral arteries. The left common carotid artery including enlarged aneurysm was trapped and anastomosed with a Gore-Tex graft (6-mm inner diameter) to left internal carotid artery. Histological examination of the arterial wall showed inflammatory change, destruction of the medial elastic fibers, and granulation with multinucleated giant cells. The postoperative course was uneventful, and no new vascular lesion was observed 3 years after operation. We demonstrated the bilateral extracranial carotid artery aneurysms caused by Takayasu's arteritis, which was the first case to be reported in the literature.
Adult↗
[A rare case of aqueductal stenosis due to venous angioma].
Aqueductal stenosis is induced by widely various causes. These causes include congenital stenosis, tumor or inflammation. Among them vascular malformation is a very rare cause. In this paper we present a rare case of aqueductal stenosis caused by venous angioma. The patient was a 28-year-old female, who suffered from headache and double vision. On admission, CT and MRI showed lateral and third ventricular dilatation not but fourth ventricle, suggested aqueductal stenosis. Gd-DTPA enhanced T1-weighted MR image showed an abnormal draining vein passing through the orifice of the aqueduct. Angiography demonstrated the umbrella sign which was specific sign of the venous angioma. We performed endoscopic third ventriculostomy. Postoperative neuroradiological examination showed shrinkage of the ventricles and the symptom of the patient improved markedly. In the past literatures, five cases of aqueductal stenosis due to venous angioma have been reported. Although venous angioma is congenital, all five cases had been symptomatic at adult stage. Detailed evaluation of pre-and post-operative MRIs suggest that aqueductal stenosis induced enlargement of the lateral and third ventricles, which led narrowing of the suprachiasmatic cistern and the peri-mesencephalic cistern, and downward displacement of medulla and tonsil into the foramen magnum. As a result, hydrocephalus is aggravated gradually.
Adult↗
Analysis of the extent of astrocytic tumour resection evaluated by magnetic resonance images.
One of the most important prognostic factors in brain tumours is the extent of tumour resection. Its evaluation has been difficult on computed tomography (CT); however, magnetic resonance imaging (MRI) can clearly determine the extent of tumour resection. Using MRI, we analyzed 77 patients with astrocytic tumours that were surgically treated at our department from 1994 to 2001. The tumours were classified into the following types: (a) well-circumscribed: single lesions that can be distinguished from normal brain; (b) localised: single lesions that are localised in one gyrus; and (c) diffuse: other tumours. Our treatment of glioma resection is to use sulcus opening and gyrectomy, a technique based on identification and dissection of the sulcus adjacent to the tumour followed by en bloc tumour resection. Almost total tumour resection (> or =95% resection) was achieved in 76.8% in the well-circumscribed type, 100% in the localised type, and only 10.5% in the diffuse type. Nearly total resection was achieved in 61%, which is considerably more than in the literature of the CT era (10.4-23.5%). The sulcus opening and gyrectomy technique based on MRI achieved radical glioma removal in cases which could be identified by MRI, resulting in a better tumour removal rate than that based on CT.
Adolescent↗
Effect of suture size and carotid clip application upon blood flow and infarct volume after permanent and temporary middle cerebral artery occlusion in mice.
Problems with the intraluminal suture method for induction of focal cerebral ischemia in genetically altered mice include occurrence of subarachnoid hemorrhage (SAH) and variability of infarct volume. We hypothesized that use of 5-0 curved or 6-0 straight suture for carotid cannulation might decrease SAH and that the application of a microvascular clip to the common carotid artery (CCA) might decrease variability of infarct volume. The purpose of this study is to evaluate and explain the results of these technical modifications. Strain related differences in vascular anatomy were evaluated. Male C57BL/6 mice were divided into two groups for permanent and temporary middle cerebral artery occlusion (MCAO). Results of 5-0 curved suture and 6-0 straight suture insertion with and without CCA clip application were examined. Cerebral perfusion was monitored by laser-Doppler flowmetry and infarct volume was measured. After permanent MCAO, larger and more consistent infarct volumes resulted using CCA clip application with a 6-0 but not with a 5-0 suture. After temporary MCAO, the SAH rate was 12.5% with a 5-0 curved suture and 11.1% with a 6-0 straight suture. A 40% rate was observed in a pilot study with 5-0 straight suture. Infarct volume after temporary MCAO with a CCA clip was significantly larger and variability of infarct volume was smaller than without the CCA clip using 5-0 curved and 6-0 straight suture. In summary, SAH is less frequent using a 5-0 curved or 6-0 straight suture. Infarct volume is enlarged by application of a CCA clip (249).
Animals↗
Overexpression of rat heat shock protein 70 is associated with reduction of early mitochondrial cytochrome C release and subsequent DNA fragmentation after permanent focal ischemia.
Although protective effects of heat shock protein 70 (HSP70) overproduction after ischemic injury have been shown both in vitro and in vivo in neurons, the mechanisms are not fully understood. The hypothesis of this study is that transgenic mice overexpressing HSP70 (HSP70 Tg) show reduced mitochondrial cytochrome c release into cytosol and diminished apoptotic cell death after permanent focal ischemia in comparison to wild-type (Wt) mice. Permanent middle cerebral artery occlusion (pMCAO) was produced by intraluminal suture cannulation in HSP70 Tg and Wt mice. DNA fragmentation was evaluated with DNA gel electrophoresis and terminal deoxynucleotidyl transferase-mediated biotinylated UTP nick end labeling (TUNEL) 24 h after pMCAO. Mitochondrial cytochrome c release into cytosol was assessed with Western blotting and immunohistochemistry 4 h after pMCAO. Cytochrome c levels in the cytosolic fraction were significantly reduced and immunoreactivity of cytochrome c in both cortex and striatum was significantly less in HSP70 Tg mice compared with Wt mice after 4-h pMCAO. DNA laddering, which was clearly observed in Wt mice, was markedly attenuated in HSP70 Tg mice 24 h after pMCAO. The number of TUNEL-positive cells was significantly reduced in HSP70 Tg mice compared with Wt mice. Results are consistent with an association between overexpression of HSP70 and reduction of cytochrome c release with subsequent DNA fragmentation. This may contribute to the HSP70-mediated neuroprotective effect observed after cerebral ischemia.
Animals↗
Differential cerebral protein synthesis and heat shock protein 70 expression in the core and penumbra of rat brain after transient focal ischemia.
OBJECTIVE: The purpose of this study was to correlate the cerebral protein synthesis (CPS) reductions in the ischemic core and penumbra with the metabolic stress response indicated by heat shock protein 70 (HSP70) synthesis. METHODS: Rats were subjected to 90 minutes of temporary focal cerebral ischemia produced by occlusion of the middle cerebral artery, using the endovascular suture model. Regional CPS was qualitatively evaluated, with [(35)S]methionine autoradiography, after reperfusion for 2 to 72 hours. The observed changes were correlated with HSP70 immunoreactivity, as assessed in the same brain sections. The ischemic core in the striatum was characterized by HSP70 expression only in endothelial and/or glial cells, with an absence of expression in neurons. The penumbra was delineated as the cortical middle cerebral artery territory region in which HSP70 was also expressed in metabolically stressed neurons. RESULTS: After 2 hours of reperfusion, CPS was reduced to 30 +/- 16% of the homologous contralateral hemisphere value in the core and to 75 +/- 22% in the penumbra (P < 0.05). This difference was still present at 72 hours, when CPS values were 62 +/- 21% and 98 +/- 29% of the nonischemic contralateral hemisphere values in the core and penumbra, respectively (P < 0.05). CONCLUSION: Persistent inhibition of CPS in regions in which neuronal HSP70 expression is absent may distinguish core areas of infarction from penumbral regions in which neuronal HSP70 is present, which eventually recover from sublethal metabolic stress during reperfusion after temporary focal ischemia.
Animals↗
Overexpression of rat heat shock protein 70 reduces neuronal injury after transient focal ischemia, transient global ischemia, or kainic acid-induced seizures.
OBJECTIVE: Transgenic (Tg) mice overexpressing rat heat shock protein 70 (hsp70) demonstrated less infarction than did wild-type (WT) littermates after permanent focal cerebral ischemia. The purpose of this study was to determine whether neuronal injury and apoptosis were reduced in hsp70 Tg mice after transient focal ischemia. The effects of hsp70 overexpression were also evaluated after transient global ischemia or kainic acid (KA)-induced seizures, to verify the results in other excitotoxic stress models. METHODS: Transient focal ischemia was produced with middle cerebral artery occlusion via intraluminal suture cannulation. Infarction volumes were assessed 24 hours after 30 minutes of middle cerebral artery occlusion. Transient global ischemia was produced with 25 minutes of bilateral common carotid artery occlusion. KA (30 mg/kg) was administered subcutaneously, and seizure activity was evaluated. The number of eosinophilic neurons was assessed in the CA1 region 72 hours after bilateral common carotid artery occlusion and in the CA3 region 24 hours after KA administration. RESULTS: The infarction volume after transient middle cerebral artery occlusion was significantly smaller in hsp70 Tg mice than in WT mice (9.1 +/- 5.7 mm(3) versus 22.4 +/- 16.8 mm(3), P < 0.05). The number of eosinophilic neurons in the CA1 area after bilateral common carotid artery occlusion and in CA3 after KA injection was significantly lower in hsp70 Tg mice than in WT mice (949.1 +/- 1095.5 versus 2406.9 +/- 1380.3, P < 0.05, and 33.8 +/- 45.3 versus 119.4 +/- 112.1, P < 0.05, respectively). Fewer terminal deoxynucleotidyl transferase-mediated biotinylated deoxyuridine triphosphate nick end-labeling-positive cells were observed in hsp70 Tg mice than in WT mice in each model. CONCLUSION: The results demonstrate that overexpression of hsp70 reduces neuronal injury after ischemia and seizures. The reduction in the number of terminal deoxynucleotidyl transferase-mediated biotinylated deoxyuridine triphosphate nick end-labeling-positive cells in hsp70 Tg mice suggests that hsp70 overexpression might reduce apoptotic cell death.
Animals↗
Direct evidence that sustained dysfunction of left atrial appendage contributes to the occurrence of cardiogenic brain embolism in patients with paroxysmal atrial fibrillation.
OBJECTIVE: The goal of this study was to investigate transesophageal echocardiographic (TEE) findings after the termination of atrial fibrillation to clarify the direct evidence for occurrence of acute cardiogenic brain embolism (CBE) in patients with paroxysmal atrial fibrillation (PAF). PATIENTS AND METHODS: Among 98 consecutive patients with CBE, we investigated TEE in 16 patients with PAF (Group CBE, 72 +/- 10 years) within 7 days of the onset and 2 weeks after the first study, in comparison with 15 age-matched PAF patients without CBE (Group N). The duration from reversal to normal sinus rhythm to first TEE was 6 +/- 1 days in both groups. RESULTS: There were no significant differences in left atrial dimension and emptying flow velocity of the left atrial appendage (LAA-eV) between groups. Group CBE had significantly larger LAA area (4.3 +/- 1.3 cm2 vs. 3.1 +/- 1.0 cm2, p < 0.05), smaller LAA fractional area change (LAA-FAC) (43 +/- 25% vs. 80 +/- 22%, p < 0.001), and a higher incidence of left atrial spontaneous echo contrast (LAA-SEC) (25% vs. 7%, p < 0.05) than group N, and those abnormalities in group CBE were significantly improved at the second TEE (LAA area: to 3.2 +/- 0.9 cm2, p < 0.05; LAA-FAC: to 84 +/- 26%, p < 0.001; LAA-SEC: to 0%, p < 0.05), respectively. CONCLUSION: LAA-FAC is a more sensitive marker for LAA dysfunction than the widely used index, LAA-eV, and a sustained deterioration of LAA-FAC may be direct evidence for thrombus formation and occurrence of acute CBE in patients with PAF.
Aged↗
[Surgery for giant intracranial aneurysms using advanced technology].
PURPOSE: Outcome of surgery for giant intracranial aneurysms is still unsatisfactory. The reason for complications is occlusion of perforators or parent arteries by the aneurysmal clipping itself or temporary occlusion of the main arteries. We report the surgical outcome of treatment of giant aneurysms using several advanced techniques which we devised to prevent these complications. MATERIALS AND METHODS: The subjects were eight patients with giant intracranial aneurysms who underwent surgery during the recent five years. Six patients had ruptured and two had unruptured aneurysms. Aneurysms were located at the ICA in five and the MCA in three patients. Aneurysmal sizes ranged from 25 to 50 mm. Preoperative 3DCTA was performed to investigate the aneurysm and the surrounding vessels in all cases. Patients with unruptured aneurysms at the ICA underwent balloon occlusion tests to check the potential for safe temporary occlusion of the parent artery, with SEP monitoring and Xe-SPECT. Intraoperative angiography and neuroendoscopes were used to prevent problems and complications which might be caused by aneurysmal clipping. RESULTS: In seven of eight cases, the aneurysmal neck was completely obliterated with clips and in one case the aneurysm was trapped with STA-MCA anastomosis. Glasgow Outcome Scale of the patients showed good recovery in six, moderately disabled (MD) in one and dead in one. The patient demonstrating MD developed hemiparesis due to vasospasm. One patient died from rebleeding of the aneurysm caused by slippage of the aneurysmal clip despite the confirmation of complete obliteration by intraoperative angiography. CONCLUSIONS: A better surgical outcome of treatment for giant aneurysms was obtained by temporary clips whose placement was based on the results of balloon occlusion test, as well as the use of intraoperative angiography and neuroendoscopes.
Aged↗
[A successfully treated case of cerebrospinal fluid fistula caused by fracture of the sella turcica].
Fracture of the sella turcica is rare and is associated with many complications. We successfully treated a cerebrospinal fluid fistula caused by a fracture of the sella turcica. A 66-year-old male in a motor vehicle accident was admitted to an outside hospital with disturbance of consciousness. A computed tomography (CT) scan of the head revealed a subarachnoid hemorrhage and pneumocephalus. Cerebrospinal fluid rhinorrhea developed after admission. Repair of the fistula was attempted without success, and the patient was transferred to our hospital for further examination and treatment. A fracture of the sella turcica was clearly visualized on coronal and sagittal head CT and on a three-dimensional reconstructed CT (3D-CT) image. The source of the CSF fistula was thought to be the anterior wall of the sella turcica. Through a bifrontal interhemispheric approach, the cerebrospinal fluid fistula was repaired microscopically with the assistance of endoscopy. Postoperatively, the fistula stopped completely. Coronal and sagittal head CT and 3D-CT images are useful for making a diagnosis of CSF leakage. Endoscopic images can assist in observation of the dead angle of the microscope.
Aged↗
[A case of cranial fasciitis induced by trauma].
We present a 20-month-old boy with a rapid growing occipital mass after head trauma, that was pathologically diagnosed as cranial fasciitis. Cranial fasciitis, first described as a specific entity by Lauer and Enzinger in 1980, is a benign fibroblastic lesion occurring in children that resembles nodular fasciitis pathologically. Nodular fasciitis also shows benign proliferation of fibroblasts and myofibroblasts in the subcutaneous tissues. This disease was firstly reported in 1955. This lesion is arising in the upper and lower extremities and trunk in adult commonly. The rapid growth, abundant cellularity, and mitotic activity cause these lesions to be misdiagnosed as sarcomas frequently. However, these lesions recur rarely, do not develop metastases, and are readily cured only by surgical excision. Cranial fasciitis is similar to nodular fasciitis in clinical cause and pathology. Therefore cranial fasciitis should be considered a variant of nodular fasciitis, although it differs from noduler fasciitis in its frequent site and age. Cranial fasciitis occurs in skull bone and in childhood. The cause of them are still unknown. However, we speculate on the relationship between head trauma and cranial fasciitis making reference to the fact that 5-15% of nodular fasciitis were caused by trauma. So we investigated this relationship in cranial fasciitis, then 8 cases of 40 cases(20%), that we could trace in the world literatures, had histories of previous head trauma. From this result, head trauma is one of a cause of cranial fasciitis probably.
Craniocerebral Trauma↗
[Two cases of severe vertigo occasioned by neck rotation and its correlation with the direction of vertebral artery at its origin].
We report two cases of severe vertigo with neck rotation. The first case is that of a 54-year-old woman. She suffered from severe vertigo during neck rotation to the right. Angiography demonstrated that the origin of the left vertebral artery (VA) became kinked when she turned her head to the right. The second case is that of a 59-year-old man. He suffered from severe vertigo during neck rotation to the left. Angiography demonstrated that the kink in the right VA at its origin became worse with the patient's turning his head to the left. We resected nerve fibers from the stellate ganglion at the origin of the respective vertebral arteries and corrected the kink in the arteries at their origin. Both patients were relieved of vertigo after the operation the fact that there was vertigo occasioned by neck rotation. The direction of neck rotation was identical with that of a kink in the VA at its origin in both patients. Therefore, the direction of neck rotation is useful information for the diagnosis of vertigo induced by neck rotation. In terms of the treatment, though vascular reconstruction such as vein graft bypass between the VA and the carotid artery or transposition of the VA onto the subclavian artery has been established for VA stenosis and occlusion, the resection of nerve fiber from the stellate ganglion at the origin of VA is also effective and safe, especially when a kink in the VA at its origin accompanies with neck rotation.
Female↗
[A dura-based intracranial schwannoma in the temporal fossa: a case report].
We report a rare case of a dura-based intracranial schwannoma in the temporal fossa. A 77-year-old man admitted to our hospital with a 5 months history of mild recent memory disturbance. Magnetic resonance imaging (MRI) revealed a slight enhanced solid mass with a cystic mass in the right temporal lobe. Preoperative diagnosis was glioma and then total resection was performed by the transsylvian approach. Dense adhesion of the tumor to dura matter of the middle cranial fossa was confirmed during surgery. Microscopic examination of the tumor showed biphasic pattern with cellular Antoni A and hypocellular Antoni B areas. Immunohistochemically, the tumor was positive for S-100, vimentin and Schwann/2E and was negative for GFAP. From these findings, the tumor was diagnosed as a schwannoma arising from the dura matter of the middle fossa. The patient was discharged from our hospital with no neurological deficits. Intracranial schwannomas, which are not associated with cranial nerves, are rare. Our case was classified according to the origin into dura-based intracranial schwannoma. To our knowledge, only 14 cases of dura-based intracranial schwannoma have been reported, mostly in children and young adults. This represents the oldest case in the literature of dura-based intracranial schwannoma.
Aged↗