Rapid immunohistochemistry (R-IHC) can contribute to the intraoperative diagnosis of central nervous system (CNS) tumors. We have recently developed a new IHC method based on an alternating current (AC) electric field to facilitate the antigen-antibody reaction. To ensure the requirement of R-IHC for intraoperative diagnosis, 183 cases of CNS tumors were reviewed regarding the accuracy rate of diagnosis without R-IHC. The diagnostic accuracy was 91.8% (168/183 cases) in which definitive diagnoses were not provided in 17 cases because of the failure of glioma grading and differential diagnosis of lymphoma and glioma.To establish the clinicopathological application, R-IHC for frozen specimens was compared with standard IHC for permanent specimens. 33 gliomas were analyzed, and the Ki-67/MIB-1 indices of frozen specimens by R-IHC were consistent with the grade and statistically correlated with those of permanent specimens. Thus, R-IHC provided supportive information to determine the grade of glioma. For discrimination between glioma and lymphoma, R-IHC was able to provide clear results of CD20 and Ki-67/MIB-1 in four frozen specimens of CNS lymphoma as well as standard IHC. We conclude that the R-IHC for frozen specimens can provide important information for intraoperative diagnosis of CNS tumors. (192 words)

Background. Noninvasive measurements of cerebral circulation and metabolism may be useful for diagnosis in patients with brain tumors. The authors tested the prognostic significance of circulatory and metabolic values or ratios determined by positron emission tomography (PET) in patients with gliomas. Methods. The subjects were 23 patients, who underwent a complete PET study of cerebral circulation and metabolism with long‐term follow‐up of at least 57 months. Regional cerebral blood flow (rCBF), blood volume (rCBV), oxygen extraction fraction, and the metabolic rates of oxygen (rCMRO2) and glucose (rCMRGl) were measured before treatment. Data regarding tumors, the contralateral gray matter and white matter, and the ratio between tumor and gray matter or between tumor and white matter were compared with survival time from the time of the PET study. Prognostic factors were tested using Cox's regression analysis. Results. Among clinical parameters, histologic grade and performance status were important variables regulating survival. When survival times of patients with values or ratios equal to or higher than the median were compared to those of patients with values or ratios lower than the median, significant determinant PET measurements were tumor rCMRGl and the ratios of tumor:gray rCMRGl and tumor:white rCMRGl. Median survival time in the patients with an rCMRGl value of 4.4 mg/100 ml/minute (median value) or more indicated 9 months, which was significantly shorter than greater than 113 months in the patients with a value lower than the median (P = 0.003 by the generalized Wilcoxon test). Patients with a higher value of gray rCBF, rCBV, or rCMRO2 had significantly longer survival times than those with a lower value. Conclusions. Cerebral circulation and metabolism as determined by PET can be of ancillary significance in predicting the prognosis of patients with gliomas.

Vascular closure staple clips made of titanium were originally developed for microvascular anastomosis. Clinical applications for these clips include arteriotomy closure for carotid endarterectomy, extracranial-intracranial bypass, and dural closure. This is the first report in which vascular closure staple clips have been used successfully for direct repair of a tear on the internal carotid artery (ICA). This report involves a 65-year-old man who presented with sudden onset of headache. Admission computerized tomography scans demonstrated a diffuse and thick subarachnoid hemorrhage in the basal cisterns. Cerebral angiograms demonstrated a broad-based, small bulge on the superomedial wall of the left ICA. Intraoperatively, an extremely thin-walled aneurysm was seen on the segment of the ICA at the C-2 vertebral level. The aneurysm ruptured abruptly, although no surgical manipulation was being performed on the aneurysm itself. After temporary clips were applied on the vessel, a large tear of the ICA was repaired with vascular closure staple clips. Reconstruction with the vascular closure staple clips required only a short period of temporary occlusion of the ICA. Postoperative angiograms revealed reduction of the aneurysm bulge and good patency of the ICA. The postoperative course was uneventful, and the patient has been free of symptoms. The vascular closure staple clipping procedure is useful for urgent repair of an aneurysm tear. This method is a new treatment option for these fragile aneurysms in cases in which other options, such as encircling clips or bypass procedures, may have drawbacks or be impossible.

This special group of aneurysms is very rare, is located exclusively in the intradural space, and carries the risk of SAH. The results of surgical treatment for this aneurysm are quite satisfactory.

Dissemination of glioblastoma was once considered rare but is now increasingly encountered with longer survival of glioblastoma patients. Despite the potential negative impact of dissemination on clinical outcome, however, molecular markers useful for prediction of dissemination risk still remains ill defined. We tested in this study for an association between the expression of stem cell marker CD133 and the risk of dissemination in 26 cases of glioblastoma (16 with dissemination and 10 without dissemination). The protein expression of CD133 was examined by western blot analysis of tumor specimens, and the CD133 expression levels were quantified by densitometry and normalized to beta-actin. The results indicated that CD133 expression levels are significantly higher in glioblastomas with dissemination (mean 10.3, range 0.20-27.8) than in those without (mean 1.18, range 0.07-3.58). The results suggest that CD133 could be a molecular predictor of glioblastoma dissemination, and also give rise to an intriguing idea that CD133-positive cancer stem cells may be implicated in the initiation of disseminated lesions.