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CT-ultrastructural correlation study of the blood brain barrier in cerebral gliomas
Monday, 7 July 1997
IP-2-229!
Dy"!amic free radical imaging due to ischemic rat brain
Masateru Nakajima', Kouki Katakura 1, Masahiro Akasaka 1, Jyun Maruya 1, Takamasa Kayama' , Midori Hiramatsu2. 1 Department of Neurosurgery, Yamagata University Schoolof Medicine, Yamagata, Japan, 2 Divisionof MedicalScience, Institute for Life Support Technology, Yamagata, Japan Introduction: An in vivo L-band electron spin resonance computed tomography (ESR-CT) system has been developed and ESR-CT images of rat brain have been obtained after administration of the stable spin-label free radical imaging agent, 3-carbamoyl-2,2,5,5-tetramethyl-l-pyrrolinylloxyl (C-PROXYL). In this study,free radicalchanges in imagesof ratbrain causedby brainischemia were obtained using a rapid scan L-band ESR-CT system. Material and Method: Male Wistar rats, weighing about 200 g were used. Occlusion of left middle cerebral artery was carried out using Longa's and Koizumi's methods. The rats were divided into three groups according to the duration of occlusion (2.4 and 8 hours), control and sham operated animals were prepared as well. C-PROXYL was injected intraperitoneally in a volume of 3 ml at a concentration of 0.3 M. ESR-CT was performed 20 minutes after injection of C-PROXYL. Dynamic imaging was performed every 5 minutesfrom 10 to 60 minutes after the C-PROXYL injection. Result: The resultsof ESR-CTimagingclosely corresponded to the ischemic lesionwhich was histologicallyproven.The rangeof the ischemicarea increased with the extension of the duration of ischemia. Dynamic ESR-CT revealed two peaks of the range of visualized area, the first peak at 20 minutes and the second one at 50-60 minutes after the C-PROXYL injection. Conclusion: These data suggest that ESR-CT is sensitive enoughto image regions of ischemic rat brain and dynamic ESR-CT can image the local redox cycle.
IP-2-230 I Spinal epidural cavernous hemangiomas. Report of 2 cases with special reference to magnetic resonance imaging (MRI)
D. Zevgaridis, A. Buettner, H.-J. Reulen, C. Hamburger. Neurosurgical Clinic, Ludwig-Maximilian University, Muenchen, Germany Introduction: Cavernous hemangiomas are vascular malformations that may affect any part of the neuraxis. Most of these lesions are encounteredintracranially. In the spine, lesions of the vertebral bodies are most frequently seen. Intramedullary, intradural and extramedullary manifestations of the spinal axis are uncommonand purely epidural lesionsare rare. We reporttwo cases of thoracal epidural cavernous hemangiomas. The patterns of clinical manifestation are described and imaging properties in MRI are discussed. Case Reports: Case 1: A 13-year-old boy was presented with a right T6 radiculopathy. MRI studies showed a mass isointensewith skeletal muscleand spinal cord on T 1-weighted images (Tj wi}, There was irregular enhancement after contrast medium injection. And hyperintensityon Tzwi. Totalextirpationof an epidural cavernoma was performed. Case 2: A 71-year-old man was presented with a progressive spinal cord syndrome. MRI studies showed a mass at T6 with similar imagingpropertiesas in case 1. Total extirpation of an epidural cavernomawas achieved. Discussion and Conclusions: Only 56 casesof spinalepiduralcavernomas have been reported in the literature and only 10 in the MRI era. Clinically, four patterns of manifestation are distinguished: a) slow, progressive spinal cord syndrome, b) acute spinal cord syndrome, c) local back pain and d) radiculopathy. In the MRI, they exhibit consistent imagingproperties.These characteristics permit us to distinguish between other lesions of the spine, which must be considered in the differential diagnosis as schwannoma, meningioma, lymphoma, Ewing sarcoma, spinal angiolipoma, vertebral chordoma, ependymoma or disk herniation. Complete excision of the lesion is the treatment of choice.
IP-2-231!
L~ca! neurosarcoidosis.ra~iographically misdiagnosed as a memngloma
M. Willmann, S. Hussein, A. Fedorowski. Neurochirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Germany Introduction: Neurosarcoidosis primarily involvesthe leptomeninges, however, parenchymalinvasion-occurs. Clinical findings includecranial nervepalsiesand focal epilepsy.The MR-Imageshows plaque like lesionsalong the dural pattern and involve the dural sinuses. The spinal fluid may show mild pleocytosis and the angiotensin converting enzyme (ACE) level is elevated in about 50% of cases. Plaque forming meningiomas show a similar finding in MRI and CT·Scans. The differential diagnosis is difficult. In this paper we present cases of neurosarcoidosis misdiagnosedas meningioma. Patients and Methods: Two of the three patients presented with focal epilepsy, all of them had a partial optical disorder and diffuse headache. The MRI-Showeda plaque-likelesion of the falx-tentorial region, in one case a mass lesion with involvement of the upper sagittal sinus. Angiography of the latter
Imaging in Neurosurgery
S85
case showed twice a vascularisation of the lesion by the meningial branches. The chemical imaging presented no pathological findings. In the CSF a mild pleocytosiswas diagnosed with a lymphocyticpattern without specific findings. After surgery in 2 cases and biopsy in one the pathologicaldiagnosis was granulomatousinflammatory infiltrationof the leptomeningeswithout caseous center and without cells of the Langhanstype, suggestive of sarcoidosis. Discussion: The neuroradiological examination of the three patients suggested a meningioma. The sarcoidosiswas suspectedpreoperatively in one. In about 50% of the cases with neurosarcoidosis the CSF is inconspicuous. The elevated ACE value representsthe systemic disease activity and is only to be expected in patients with active extracerebral manifestation. In the reported cases we found in the MRT with KM, that Tt weighted sequencesshow enhancedplaque-forming lesion spared the dural spaces and infiltrated the leptomeninges. We conclude that this finding is suggestive of sarcoidal inflammation rather than meningioma. This report may be helpful for diagnosisof neurosarcoidoses. A verificationof the diagnosis by biopsy remains obligatory.
I P-2-232I MR findings, their clinical and pathological correlation in cranio-cerebral erosion LakshmanDas, B. Iyenger. Departments of Neurosurgery, Radiodiagnosis and Institute of Pathology Safdarjang HospitalNew Delhi, Japan
Cranio-Cerebral Erosion is an uncommonbut importantposttraumatic sequelae in children between the ages of 3-11 yrs. Most of the series reported in the English literature consists of less than half a dozen of cases. Information on M.R. Findings in this disease entity is scanty. Most of the earlier knowledge is based on Ventriculograms and Pneumoencephalograms. Only in recent years some account of CT. findings in Cranio-Cerebral Erosion is available. Authors have analysed their 31 cases of Cranio-Cerebral Erosion between Feb 1982 and May 1996 using plain films and C.T.examination. 13 of these patients were subjected to an additional M.R. imaging. Dural thickening, Gliosis, Fibroglial scaring and supple ventricular tenting were the findings not detected on early C.T. scans. An attempt was done to correlate these findings with clinical status of the patients and histopathological observations.
IP-2-233I
Bilateral occipital calcification: A new syndrome
M. Padoin,J.A. Maingue, K. Hoffmann, N. Regattieri. Departmentof Neurosurgery, HospitalUniversitaario Evangelico de Curitiba; Curitiba, Brazil The combination of epilepsy, bilateral occipital calcification (COB) and coeliac disease has been reportedrecentlyas a new syndrome of which characteristics are not well defined. We reportthe case of a male patient,21 years old, with epilepsy and unusual tomographic images, that show cortical and subcortical calcifications in both occipital lobes. The patient presented with complex visual crisis, sometimes followed by absence periods. Intestinal biopsy was done. The presenceof bad absorptionin patients with COB is well established, but the relationship between both pathologiesstill needs to be clarified.
IP-2-234I
CT-ultrastructural correlation study of the blood brain barrier in cerebral gliomas
Jinfeng Chen, Zhixiong Lin, Wei Wang. Dept. of Neurosurgery, TheFirst AffiliatedHospitalof Fujian, MedicalUniversity, FuzhouFujian, China Aim: To study the correlation between CT-imageand blood brain barrier (BBB) in cerebral gliomas. Method: The ultrastructure of the BBB in cerebral gliomas (18 astrocytomas, 2 oligodendrogliomas and 2 medulloblastomas) was studied by means of transmissionelectronic microscopy(TEM). The findings concerning the BBB in tumor specimens were compared with those in hydrops and normal brain tissue. Furthermore, the results were correlated with CT-findings. Results: The blood brain barrier of tumor and edematous tissues showed different abnormalities. 1) When edema was obvious, the capillaries showed swelling of the endothelium with pinocytosis, narrowing of the lumen and an irregular basement membrane. The local glia membrane was interrupted and swollen; the tight junction between the endothelial cells was damaged. 2) The BBB in the area without edema was similar to that in normal brain tissue. The low-density areas seen on the nonenhanced CT-scans showed a good correlation with the abnormality of BBB. Conclusion: This study was helpful in the treatment of gliomas.
IP-2-229!
Dy"!amic free radical imaging due to ischemic rat brain
Masateru Nakajima', Kouki Katakura 1, Masahiro Akasaka 1, Jyun Maruya 1, Takamasa Kayama' , Midori Hiramatsu2. 1 Department of Neurosurgery, Yamagata University Schoolof Medicine, Yamagata, Japan, 2 Divisionof MedicalScience, Institute for Life Support Technology, Yamagata, Japan Introduction: An in vivo L-band electron spin resonance computed tomography (ESR-CT) system has been developed and ESR-CT images of rat brain have been obtained after administration of the stable spin-label free radical imaging agent, 3-carbamoyl-2,2,5,5-tetramethyl-l-pyrrolinylloxyl (C-PROXYL). In this study,free radicalchanges in imagesof ratbrain causedby brainischemia were obtained using a rapid scan L-band ESR-CT system. Material and Method: Male Wistar rats, weighing about 200 g were used. Occlusion of left middle cerebral artery was carried out using Longa's and Koizumi's methods. The rats were divided into three groups according to the duration of occlusion (2.4 and 8 hours), control and sham operated animals were prepared as well. C-PROXYL was injected intraperitoneally in a volume of 3 ml at a concentration of 0.3 M. ESR-CT was performed 20 minutes after injection of C-PROXYL. Dynamic imaging was performed every 5 minutesfrom 10 to 60 minutes after the C-PROXYL injection. Result: The resultsof ESR-CTimagingclosely corresponded to the ischemic lesionwhich was histologicallyproven.The rangeof the ischemicarea increased with the extension of the duration of ischemia. Dynamic ESR-CT revealed two peaks of the range of visualized area, the first peak at 20 minutes and the second one at 50-60 minutes after the C-PROXYL injection. Conclusion: These data suggest that ESR-CT is sensitive enoughto image regions of ischemic rat brain and dynamic ESR-CT can image the local redox cycle.
IP-2-230 I Spinal epidural cavernous hemangiomas. Report of 2 cases with special reference to magnetic resonance imaging (MRI)
D. Zevgaridis, A. Buettner, H.-J. Reulen, C. Hamburger. Neurosurgical Clinic, Ludwig-Maximilian University, Muenchen, Germany Introduction: Cavernous hemangiomas are vascular malformations that may affect any part of the neuraxis. Most of these lesions are encounteredintracranially. In the spine, lesions of the vertebral bodies are most frequently seen. Intramedullary, intradural and extramedullary manifestations of the spinal axis are uncommonand purely epidural lesionsare rare. We reporttwo cases of thoracal epidural cavernous hemangiomas. The patterns of clinical manifestation are described and imaging properties in MRI are discussed. Case Reports: Case 1: A 13-year-old boy was presented with a right T6 radiculopathy. MRI studies showed a mass isointensewith skeletal muscleand spinal cord on T 1-weighted images (Tj wi}, There was irregular enhancement after contrast medium injection. And hyperintensityon Tzwi. Totalextirpationof an epidural cavernoma was performed. Case 2: A 71-year-old man was presented with a progressive spinal cord syndrome. MRI studies showed a mass at T6 with similar imagingpropertiesas in case 1. Total extirpation of an epidural cavernomawas achieved. Discussion and Conclusions: Only 56 casesof spinalepiduralcavernomas have been reported in the literature and only 10 in the MRI era. Clinically, four patterns of manifestation are distinguished: a) slow, progressive spinal cord syndrome, b) acute spinal cord syndrome, c) local back pain and d) radiculopathy. In the MRI, they exhibit consistent imagingproperties.These characteristics permit us to distinguish between other lesions of the spine, which must be considered in the differential diagnosis as schwannoma, meningioma, lymphoma, Ewing sarcoma, spinal angiolipoma, vertebral chordoma, ependymoma or disk herniation. Complete excision of the lesion is the treatment of choice.
IP-2-231!
L~ca! neurosarcoidosis.ra~iographically misdiagnosed as a memngloma
M. Willmann, S. Hussein, A. Fedorowski. Neurochirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Germany Introduction: Neurosarcoidosis primarily involvesthe leptomeninges, however, parenchymalinvasion-occurs. Clinical findings includecranial nervepalsiesand focal epilepsy.The MR-Imageshows plaque like lesionsalong the dural pattern and involve the dural sinuses. The spinal fluid may show mild pleocytosis and the angiotensin converting enzyme (ACE) level is elevated in about 50% of cases. Plaque forming meningiomas show a similar finding in MRI and CT·Scans. The differential diagnosis is difficult. In this paper we present cases of neurosarcoidosis misdiagnosedas meningioma. Patients and Methods: Two of the three patients presented with focal epilepsy, all of them had a partial optical disorder and diffuse headache. The MRI-Showeda plaque-likelesion of the falx-tentorial region, in one case a mass lesion with involvement of the upper sagittal sinus. Angiography of the latter
Imaging in Neurosurgery
S85
case showed twice a vascularisation of the lesion by the meningial branches. The chemical imaging presented no pathological findings. In the CSF a mild pleocytosiswas diagnosed with a lymphocyticpattern without specific findings. After surgery in 2 cases and biopsy in one the pathologicaldiagnosis was granulomatousinflammatory infiltrationof the leptomeningeswithout caseous center and without cells of the Langhanstype, suggestive of sarcoidosis. Discussion: The neuroradiological examination of the three patients suggested a meningioma. The sarcoidosiswas suspectedpreoperatively in one. In about 50% of the cases with neurosarcoidosis the CSF is inconspicuous. The elevated ACE value representsthe systemic disease activity and is only to be expected in patients with active extracerebral manifestation. In the reported cases we found in the MRT with KM, that Tt weighted sequencesshow enhancedplaque-forming lesion spared the dural spaces and infiltrated the leptomeninges. We conclude that this finding is suggestive of sarcoidal inflammation rather than meningioma. This report may be helpful for diagnosisof neurosarcoidoses. A verificationof the diagnosis by biopsy remains obligatory.
I P-2-232I MR findings, their clinical and pathological correlation in cranio-cerebral erosion LakshmanDas, B. Iyenger. Departments of Neurosurgery, Radiodiagnosis and Institute of Pathology Safdarjang HospitalNew Delhi, Japan
Cranio-Cerebral Erosion is an uncommonbut importantposttraumatic sequelae in children between the ages of 3-11 yrs. Most of the series reported in the English literature consists of less than half a dozen of cases. Information on M.R. Findings in this disease entity is scanty. Most of the earlier knowledge is based on Ventriculograms and Pneumoencephalograms. Only in recent years some account of CT. findings in Cranio-Cerebral Erosion is available. Authors have analysed their 31 cases of Cranio-Cerebral Erosion between Feb 1982 and May 1996 using plain films and C.T.examination. 13 of these patients were subjected to an additional M.R. imaging. Dural thickening, Gliosis, Fibroglial scaring and supple ventricular tenting were the findings not detected on early C.T. scans. An attempt was done to correlate these findings with clinical status of the patients and histopathological observations.
IP-2-233I
Bilateral occipital calcification: A new syndrome
M. Padoin,J.A. Maingue, K. Hoffmann, N. Regattieri. Departmentof Neurosurgery, HospitalUniversitaario Evangelico de Curitiba; Curitiba, Brazil The combination of epilepsy, bilateral occipital calcification (COB) and coeliac disease has been reportedrecentlyas a new syndrome of which characteristics are not well defined. We reportthe case of a male patient,21 years old, with epilepsy and unusual tomographic images, that show cortical and subcortical calcifications in both occipital lobes. The patient presented with complex visual crisis, sometimes followed by absence periods. Intestinal biopsy was done. The presenceof bad absorptionin patients with COB is well established, but the relationship between both pathologiesstill needs to be clarified.
IP-2-234I
CT-ultrastructural correlation study of the blood brain barrier in cerebral gliomas
Jinfeng Chen, Zhixiong Lin, Wei Wang. Dept. of Neurosurgery, TheFirst AffiliatedHospitalof Fujian, MedicalUniversity, FuzhouFujian, China Aim: To study the correlation between CT-imageand blood brain barrier (BBB) in cerebral gliomas. Method: The ultrastructure of the BBB in cerebral gliomas (18 astrocytomas, 2 oligodendrogliomas and 2 medulloblastomas) was studied by means of transmissionelectronic microscopy(TEM). The findings concerning the BBB in tumor specimens were compared with those in hydrops and normal brain tissue. Furthermore, the results were correlated with CT-findings. Results: The blood brain barrier of tumor and edematous tissues showed different abnormalities. 1) When edema was obvious, the capillaries showed swelling of the endothelium with pinocytosis, narrowing of the lumen and an irregular basement membrane. The local glia membrane was interrupted and swollen; the tight junction between the endothelial cells was damaged. 2) The BBB in the area without edema was similar to that in normal brain tissue. The low-density areas seen on the nonenhanced CT-scans showed a good correlation with the abnormality of BBB. Conclusion: This study was helpful in the treatment of gliomas.