In this study, we evaluated the wall of saccular cerebral aneurysms (SCAs) using two-dimensional double inversion recovery black-blood sequence (BBDI). We examined 14 patients with an unruptured SCA (USCA). The BBDI was peripheral-pulse gated, and was acquired during the mid-diastolic period. We evaluated whether the aneurysmal wall could be visualized with BBDI, and the wall thickness in the neck and dome portion of the aneurysm was measured in cases with acceptable imaging quality. BBDI demonstrated the USCA walls in ten patients. In four patients, the USCA walls were poorly delineated from the adjacent brain parenchyma or cerebrospinal fluid. The mean aneurysm size was 8.0 mm. The mean thickness of the aneurysmal wall in the neck portion was 0.60 AE 0.13 mm in 10 cases. The mean thickness at the dome portion was 0.46 AE 0.05 mm in five cases. In this study, BBDI revealed some portion of the USCA wall, despite the limited spatial and contrast resolution for delineation of the entire USCA wall. In our opinion, this technique may be used as an additional imaging tool for the evaluation of the aneurysmal wall.

The preservation rate of ipsilateral vision was 25%, while that of contralateral vision was 83% (P<0.001). There was no remarkable endocrine improvement after surgery. The overall and progression-free survival rates at 5 years were 93.6 and 52.4%, respectively. In our study, the predictors for tumor progression were children younger than 5 years of age (p=0.023) and of female gender (p=0.022). Because of the variable course of OPG, treatment policy should be optimized individually according to patient's status.

The authors conclude that delayed development and disturbed functional status in patients in whom FVM was diagnosed prenatally are closely related to the presence of certain accompanying anomalies. On postnatal examination, more than half of the patients in whom the diagnosis of FVM was based on ultrasonography findings and whose parents were offered prenatal neurosurgical consultation were found to have additional anomalies that were not detected prenatally. Because of the possibility of additional undiagnosed anomalies, consulting neurosurgeons should be cautious in giving a prognosis in cases of FVM, even when prenatal ultrasonography reveals isolated ventriculomegaly and tests for intrauterine infection and chromosomal abnormality yield negative results.

A 62-year-old man was admitted to our hospital after attempting to commit suicide with a pneumatic nail gun. Six nails were launched. Because the nail head acted as a brake, the launched nail could make a hole in the skull but could not entirely pass it.

Vestibular schwannomas (VSs) are relatively slow growing tumors. However, some rapidly regrow or recur after surgical resection. The objective of this study was to identify those molecular characteristics predicting rapid recurrence after surgical resection. Immunohistochemically determined expressions of several cell cycle regulators and apoptosis-associated proteins in 12 cases of aggressive VS (AVS) and in 15 control cases of usual VS (UVS) cases were compared. The expressions of p53 and Bax (pro-apoptotic protein), Bcl-2 (anti-apoptotic protein), Fas, and Fas-L (apoptotic death receptor and ligand), caspase 3 (apoptotic effector caspase proteins), and p27 and p21 (cyclin-dependent kinase inhibitors) were analyzed using tissue array blocks. Loss of p27 expression was observed in 8 of 12 AVS cases (67%) and in 3 UVS cases (20%); p21 was expressed in all cases. Loss of Bax was observed in 3 AVS and 3 UVS cases. The anti-apoptotic protein, Bcl-2, was expressed in 9 AVS (75%) and 11 UVS (73%), and p53, Fas-L, and caspase 3 were negative and Fas was positive in all AVS and UVS cases. Of these, only the loss of p27 was statistically significant (P = 0.02). The loss of p27 in AVS may explain the unusually high proliferative potential of AVS versus UVS, and p27 may be a predictor of VS aggressiveness. The expressions of other apoptosis associated proteins were not significantly different in the two groups. This may be the first report to identify a molecular entity associated with aggressive VS. However, further studies are required.