There is an unusual vascular network at the base of the brain in patients with moyamoya disease. We detected various histologic lesions in the perforating arteries of 22 patients. Vessels showing rupture ranged from 50 to 530 microns in diameter; they were dilated, some had fibrin deposits in the wall, fragmented elastic laminae and attenuated media. Non-ruptured perforating arteries (diameter 200 to 550 microns) revealed microaneurysm formation, focal fibrin deposits and marked attenuation of the wall thickness with diminution of the elastic lamina. These changes seem to predispose to rupture of perforating arteries. Stenotic changes such as fibrous intimal thickening, collapse of the lumen and thrombosis were detected in 14 out of 22 cases. Morphometric analysis of perforating arteries indicated that arteries showing extreme degrees of stenosis or dilatation were more frequent in the patients with moyamoya disease than in the control cases. Dilative arteries were more frequent in the young patients and stenotic vessels were, in contrast, less frequent in the young patients.

Chronic subdural hematoma can be treated with tranexamic acid without concomitant surgery. Tranexamic acid might simultaneously inhibit the fibrinolytic and inflammatory (kinin-kallikrein) systems, which might consequently resolve CSDH. This medical therapy could prevent the early stages of CSDH that can occur after head trauma and the recurrence of CSDH after surgery.

The microsurgical anatomy of the superficial cortical veins was examined in 20 cerebral hemispheres. The superficial cortical veins are divided into three groups based on whether they drain the lateral, medial, or inferior surface of the hemisphere. The veins on the three surfaces are further subdivided on the basis of the lobe and cortical area that they drain. The superficial cerebral veins collect into four groups of bridging veins: a superior sagittal group, which drains into the superior sagittal sinus; a sphenoidal group, which drains into the sphenoparietal and cavernous sinuses on the inner surface of the sphenoid bone; a tentorial group, which converges on the sinuses in the tentorium; and a falcine group, which empties into the inferior sagittal or straight sinus or their tributaries. The superior sagittal group drains the superior part of the medial and lateral surfaces of the frontal, parietal, and occipital lobes and the anterior part of the basal surface of the frontal lobe. The sphenoidal group drains the parts of the frontal, temporal, and parietal lobes adjoining the sylvian fissure. The tentorial group drains the lateral surface of the temporal lobe and the basal surface of the temporal and occipital lobes. The falcine group drains an area that includes the cingulate and parahippocampal gyri and approximates the cortical parts of the limbic lobe of the brain. The relationship of these veins to the venous lacunae was also examined.

No abstract

Nineteen fatal cases of occlusion of the circle of Willis, so-called Moyamoya disease, were examined clinicopathologically. Fresh and massive cerebral haemorrhage was confirmed in 14 and cerebral infarcts of 4 of 19 patients. Among these 14 patients, massive haemorrhage was found in the basal ganglia, thalamus and hypothalamus of 9, and in the thalamus, cerebral peduncle and midbrain of 5. Pathologically, fibrosing stenoses or occlusions involved the circle of Willis and its major branches in all cases. In 13 of 17 patients numerous collateral channels, muscular in type, paralleled the circle, bypassing the occluded natural passages, Rupture of dilated small muscular collateral arteries was demonstrated in fresh and old haemorrhagic lesions in 3 of the 14 patients. Saccular aneurysm of cerebral arteries in the subarachnoid spaces was present in two of the 19. No rupture involved the perforating arteries in the subarachnoid space. These findings strongly suggest that in patients with Moyamoya disease rupture of overgrown perforating arteries as collaterals in brain may be main cause of single or repeated cerebral haemorrhage. Stenoses or occlusions of these perforators are presumably an important factor in the occurrence of cerebral infarcts.

Neuroendoscopic procedures can permit a precise histological diagnosis of intracranial germinomas and are safe and effective in the management of hydrocephalus associated with these tumors. The risk of tumor dissemination due to the neuroendoscopic procedures appears to be minimal when the appropriate chemotherapy and radiotherapy are provided postoperatively.

To compare the benefits of physiological saline solution and artificial cerebrospinal fluid (CSF) as perfusates, we investigated 12 patients with presumed symptomatic aqueductal stenosis by clinical course and CSF analysis. In all patients, endoneurosurgical third ventriculostomy and cine magnetic resonance imaging confirmed the patency of ventriculostomy. After endoneurosurgery, patients who received the saline solution experienced high fever, headaches, and elevated cell count in lumbar CSF. Saline solution provoked a striking inflammatory reaction in the CSF. In contrast, the artificial CSF reduced these conditions to a minimum. Artificial CSF used as a physiological perfusate during endoneurosurgery can suppress host reactions within the CSF pathway and is also available for routine neurosurgical procedures.

Thromboplastic and fibrinolytic activities of 14 lines of cultured human cancer cells were estimated by modified Astrup's methods. High tissue thromboplastic activity was found in one line of urinary-bladder cancer, 2 lines of gastric cancer and one line of lung cancer, but no activity was found in 6 lines of lung cancer. High fibrinolytic activity was noted in one line of gastric cancer and 2 lines of lung cancer, but no activity was seen in 6 lines of lung cancer and one line of gastric cancer. No plasmin activity was found. The tumour cell lines could be classified into 3 groups on the basis of the 2 activities. Cancer cell lines could also be classified into 2 groups: with high or low release of thromboplastin into culture media. Fibrinolytic activity was found in the culture media of all cell lines with high fibrinolytic activity. Fibrinolytic activity, but not thromboplastic activity, seemed to be influenced by the constituents of culture media. No definite correlation was found between the 2 activities and the histological types of the parent tumours of the cultured cells. Images Fig. 1 Fig. 2 Fig. 3