The objective of this study was to investigate the distribution of 11C-methionine (MET) and F-18 fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) imaging and the hyperintense area in T2 weighted imaging (T2WI) in glioma with no or poor gadolinium enhancement in magnetic resonance imaging (GdMRI). Cases were also analyzed pathologically. We prospectively investigated 16 patients with non- or minimally enhancing (< 10% volume) glioma. All patients underwent MET-PET and FDG-PET scans preoperatively. After delineating the tumor based on MET uptake, integrated 3D images from FDG-PET and MRI (GdMRI, T2WI or FLAIR) were generated and the final resection plane was planned. This resection plane was determined intraoperatively using the navigation-guided fencepost method. The delineation obtained by MET-PET imaging was larger than that with GdMRI in all cases with an enhanced effect. In contrast, the T2WI-abnormal signal area (T2WI+) tended to be larger than the MET uptake area (MET+). Tumor resection was > 95% in the non-eloquent area in 4/5 cases (80%), whereas 10 of 11 cases (90.9%) had partial resection in the eloquent area. In a case including the language area, 92% resection was achieved based on the MET-uptake area, in contrast to T2WI-based partial resection (65%), because the T2WI+/MET- area defined the language area. Pathological findings showed that the T2WI+/MET+ area is glioma, whereas 6 of 9 T2WI+/MET- lesions included normal tissues. Tissue from T2W1+/MET+/FDG+/GdMRI+ lesions gave an accurate diagnosis of grade in six cases. Non- or minimally enhancing gliomas were classified as having a MET uptake area that totally or partially overlapped with the T2WI hyperintense area. Resection planning with or without a metabolically active area in non- or minimally enhancing gliomas may be useful for accurate diagnosis, malignancy grading, and particularly for eloquent area although further study is needed to analyze the T2WI+/MET- area.

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• Abstract • Objective: We report a rare case of multiple unruptured cerebral aneurysms associated with persistent primitive hypoglossal artery (PPHA). Case presentation: A 70-year-old female was admitted to our hospital for further examination of left hearing impairment and bilateral tinnitus. 3D-CTA and cerebral angiography showed a large aneurysm at the cavernous segment of the right internal carotid artery (ICA) and a small aneurysm at the top of basilar artery associated with PPHA. The patient underwent balloon-assisted coil embolization of the large aneurysm of the right ICA and rescue stenting for the protruding coil into the right ICA. Postoperative course was uneventful. Conclusion: This is the first report of a large unruptured aneurysm at the cavernous segment of the ICA in multiple cerebral aneurysms associated with PPHA.• Key words • persistent primitive hypoglossal artery, cerebral aneurysm, endovascular therapy 755-0151 750

Objective: Use of an epidural self-blood patch (EBP) is the most effective form of therapy for patients with cerebrospinal fluid (CSF) hypovolemia. However, even if the symptoms are resolved, other clinical aspects of this condition frequently prevent patients resuming social activity. In the present study, we investigated the clinical course of patients with CSF hypovolemia after treatment with an EBP to assess the factors affecting return to work or school, and considered the treatment of patients with progressive chronic subdural hematoma. Patients and Results: We investigated a group of 10 patients with CSF hypovolemia. After initial application of an EBP, 8 of these patients were completely relieved of postural headache and associated symptoms, and the other 2 recovered after a second application. However, 3 patients who had cervical spondylosis or psychosis were still unable to return to work or school. Two patients who were forced to retire have potential for rehabilitation after EBP. One patient has recovered from the illness, but could not return to school due to persistent medical history of psychosis. These patients had suffered symptoms for a long period before EBP (mean, 17.8 months; range 7 months to 3 years) relative to those who were able to resume social activity (mean, 2.0 months; range 7 days to 5 months) (P < 0.05). Three had progressive bilateral chronic subdural hematoma. One of these patients required emergency burr-hole drainage to resolve the neurological deterioration. Conclusions: Both physicians and patients need to be aware of CSF hypovolemia, and the fact that it requires appropriate treatment without delay. While application of an EBP is a fundamentally important therapy even for patients with hematoma, careful follow-up is required for patients showing marked neurological deterioration or an increasing hematoma volume with a brain midline shift, and burr-hole drainage must sometimes be considered in combination with EBP. T. Nishizaki et al.

Background: Febrile seizures (FSs) are the most frequent type of seizures in infancy and childhood. Epileptiform discharges (EDs) on electroencephalogram at the time of first FS recurrence can increase the risk of epilepsy development. Therefore, inhibition of EDs is important. Recently, WS-3, a transient receptor potential melastatin 8 (TRPM8) agonist, reportedly suppressed penicillin G-induced cortical-focal EDs. However, the effects of TRPM8 agonists on FSs remain unknown. In this study, we aimed to clarify the effects of the TRPM8 agonist, and the absence of TRPM8 channels, on hyperthermia-induced FS by analyzing the fast ripple band.Methods: Hyperthermia (43°C for 30 min) induced by a heating pad caused FSs in postnatal day 7 wild-type (WT) and TRPM8 knockout (TRPM8KO) mice. FSs were defined as EDs occurring during behavioral seizures involving hindlimb clonus and loss of the righting reflex. Mice were injected with 1% dimethyl sulfoxide or 1 mM WS-3 20 min before the onset of hyperthermia, and electroencephalograms; movies; and rectal, brain and heating pad temperatures were recorded.Results: In wild-type mice, WS-3 reduced the fast ripple amplitude in the first FS without changing rectal and brain temperature thresholds. In contrast, the anti-FS effect induced by the TRPM8 agonist was not observed in TRPM8KO mice and, compared with wild-type mice, TRPM8 deficiency lowered the rectal and brain temperature thresholds for FSs, exacerbated the fast ripple amplitude, and prolonged the duration of the initial FS induced by hyperthermia.Conclusion: Our findings suggest that TRPM8 agonists can be used to treat hyperthermia-induced FSs.