Recent experimental data have shown that levels of matrix metalloproteinase-9 (MMP-9) increase after traumatic brain injury (TBI), degrading components of the basal lamina disrupting the blood-brain barrier. However, the post-traumatic secretion patterns of MMP-9 in humans are unknown. We measured the concentration of MMP-9 in plasma after TBI at the same time as the concentration of interleukin-6 (IL-6) in serum. Levels of MMP-9 and IL-6 in systemic arterial and jugular venous blood from seven patients with TBI were measured on days 0 and 1 post-injury. All patients underwent hypothermia at 32-35 degrees C as soon as possible after admission. Before induction of hypothermia, levels of MMP-9 in arterial and internal jugular venous blood exceeded the normal range. Higher MMP-9 levels were detected in internal jugular venous blood than in arterial blood. After hypothermia had been induced, MMP-9 levels in arterial blood and internal jugular venous blood decreased significantly, to within the normal range. In addition to these changes, a significant correlation was seen between levels of MMP-9 and IL-6 in internal jugular venous blood during the investigation period. These results indicate that MMP-9 is elevated in patients with acute TBI, and may play an important role in traumatic brain damage. The elevation of MMP-9 is associated with inflammatory events following TBI. Hypothermic intervention may suppress the elevation of MMP-9 with suppression of the inflammatory response, affording neuroprotection in TBI.

This study demonstrates the clinical usefulness of image-guided fractionated stereotactic radiosurgery with the CyberKnife system. Twenty-one patients with pituitary adenomas received image-guided stereotactic radiosurgery with the CyberKnife, and were followed up for more than 18 months. The patients consisted of 14 with non-functioning adenomas, 3 with prolactinomas, 2 with acromegaly, and 2 with ACTH-producing tumors. In 20 cases, fractionated radiosurgery was performed. The change in the tumor volume, visual acuity, hormonal function, and complications by this therapy were analyzed in each case. The volume of the tumors ranged from 0.2 cm (3) to 34.9 cm (3) (mean +/- SD: 11.3 +/- 9.2 cm (3)). The mean volumes of the non-functioning and functioning adenomas were 13.3 cm (3) and 7.5 cm (3), respectively. The marginal irradiation dose ranged from 6.4 Gy to 27.7 Gy (mean: non-functioning adenomas 12.6 Gy, functioning adenomas 17.5 Gy), as a dose of a single fraction. The follow-up periods ranged from 18 months to 59 months (mean +/- SD: 35.3 +/- 10.7 months). The tumor control rate was 95.2 %. In 1 case, visual acuity worsened due to cystic enlargement of the tumor. Hormonal function improved in all of the 7 functioning adenomas. The hormone level normalized in 1 prolactinoma, and decreased to less than normal in 1 ACTH-producing adenoma. In 2 cases, hypopituitarism occurred after the therapy. Image-guided stereotactic radiosurgery with the CyberKnife is effective and safe against relatively large pituitary adenomas. Careful long-term follow-up of the patients is necessary because of delayed cystic enlargement of the tumor in rare cases.

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Early diagnosis of pachymeningitis using magnetic resonance imaging is important for the treatment of pachymeningoencephalitis, because diffuse involvement of the dura mater and brain parenchyma can make en bloc excision difficult.

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