Monoamine acid metabolites in ventricular CSF of patients with brain tumours

Homovanillic acid (HVA) and 5-hydroxyindolacetic acid (5-HIAA) in ventricular CSF were determined in 19 patients (12 female 7 male) with brain tumours. No relationship was found between ventricular fluid pressure (VFP) and levels of HVA and 5-HIAA. A relationship was observed between ventricular CSF, HVA concentrations and tumour induced alterations in CSF dynamics. HVA concentrations were very high in patients whose tumours involved the third ventricle, the aqueduct, or the fourth ventricle, producing marked alterations in CSF flow. HVA concentrations significantly lower than in controls were observed in cases where tumours involved the lateral ventricles. Concentrations of acid metabolites in patients with little or no alteration in CSF dynamics corresponded with those in patients with other neurosurgical disorders.     

First degree atrioventricular block caused by a calcified tumor of the atrioventricular septum

First degree atrioventricular block occurred in a 69-year-old patient with a calcified atrioventricular septum tumour. The patient suffered several episodes of syncope and the only abnormality found in the routine clinical work-up was a remarkable first degree atrioventricular block. The echocardiogram, computed tomography (CT) and the magnetic resonance imaging (MRI) procedure showed a calcified tumour in the posterior part of the left ventricle, between the left atrium and left ventricle, just beneath the aortic root spreading to the interventricular septum. It was suggested that the first degree atrioventricular block was caused by the tumour. The symptoms were relieved by implantation of permanent cardiac pacemaker.     

Anteroventral third ventricle site of action for angiotensin induced thirst

The central site of action for angiotensin induced thirst was investigated in rats. Subfornical organ lesions resulted in a temporary abolition of drinking induced by lateral preoptic or lateral ventricle microinjections of angiotensin but drinking to anteroventral third ventricle microinjections of angiotensin (or carbachol) was unaffected. Drinking to elevated systemic levels of angiotensin was attenuated but not abolished by subfornical organ lesions. When spread of injected angiotensin via cerebrospinal fluid circulation was controlled by placing plugs at selected locations in the ventricles, drinking was elicited only when intracranial microinjections of angiotensin gained access to anteroventral third ventricle. It was concluded that subfornical organ is not the exclusive dipsogenic receptor for angiotensin, rather angiotensin exerts at least part of its dipsogenic effect by spread through the ventricular system to receptors in the vicinity of the anteroventral third ventricle.     

Transchoroidal approach to the third ventricle: an anatomic study of the choroidal fissure and its clinical application

OBJECTIVE: We review the anatomic features of the lateral ventricle, the foramen of Monro, the third ventricle, and the choroidal fissure, and we describe the transchoroidal approach to the third ventricle. This approach consists of opening the taenia fornicis of the choroidal fissure in the body of the lateral ventricle and approaching the third ventricle between the two internal cerebral veins. This route allows further posterior enlargement of the foramen of Monro without sacrificing any neural structures. When necessary, the anterior septal vein can be sacrificed. METHODS: Twenty adult cadaveric brains and four adult cadaveric heads were studied, using a magnification ranging from 3 times to 40 times, after perfusion of the arteries and veins with colored latex. RESULTS: The choroidal fissure is a natural cleft between the thalamus and the fornix, and it is identified by following the choroid plexus in the lateral ventricle. The choroid plexus in the body of the lateral ventricle originates from the tela choroidea of the roof of the third ventricle and is apparently attached to the fornix by the taenia fornicis and to the thalamus by the taenia choroidea. The taenia is actually the ependyma that covers the internal wall of the ventricular cavity and the choroid plexus. CONCLUSION: An understanding of the choroidal fissure is fundamental for use of the transchoroidal approach. Unlike transforaminal, subchoroidal, subforniceal, and interforniceal approaches to the third ventricle, which sacrifice some neural or vascular structures, the transchoroidal approach follows a natural route, and certainly it is one of the options to be considered when entry into the third ventricle is required.     

Hydrodynamic factors in Dandy-Walker and Arnold-Chiari malformations

The Dandy-Walker malformation (DWM) is hydrocephalus that primarily affects the fourth ventricle, whose overdistention involves also the aqueduct and third ventricle. However, just the opposite is true in the Arnold-Chiari malformation (ACM) since the hydrocephalus is limited to the lateral ventricles which squeeze the third ventricle between them and compress the aqueduct and fourth ventricle. The evidence indicates that both result from hydrodynamic stresses in embryonal and early fetal life. This communication is offered in rebuttal to some statements in an otherwise authoritative and comprehensive article.     

Hemangiopericytoma of the third ventricle. Case report

The authors present the first reported case of a hemangiopericytoma (HPC) occurring in the third ventricle. Most of these lesions are based in the meninges. There is only one other reported case of an intraventricular HPC; in that case the lesion was found in the lateral ventricle. A 40-year-old right-handed man presented with a 3-month history of headaches. Clinical evaluation, including computerized tomography and magnetic resonance imaging studies, revealed a 1-cm enhancing lesion in the third ventricle. Given the findings on the preoperative imaging studies, the lesion was not consistent with some of the more commonly occurring tumors of the third ventricle, namely colloid cysts. A transcortical approach and resection of the lesion was performed without complication. The final pathological findings were consistent with those of an HPC. Hemangiopericytomas rarely occur in the ventricles and may pose a difficult diagnostic dilemma based on their radiographic and gross appearances, as shown in this case. Because of this difficulty, histological confirmation is required to make a definitive diagnosis. These lesions have a propensity to recur and metastasize in the central nervous system and periphery, thus making the goal of treatment a complete surgical resection followed by postoperative radiation therapy in most cases.     

Colloid cysts of the third ventricle --report of one operated and one autopsied case (author's transl)

Colloid cysts of the third ventricle are considered as a relatively rate benign tumor, consituting approximately 0.5% of the whole brain tumors, but the surgical cases have rarely been reported in Japan. In this paper, two cases of colloid cyst are reported and the pathogenesis, the importance of the clinical diagnosis and dramatic results after complete extirpation was emphasized. In Case 1, a 29 year-old right handed male, who showed definite symptoms of increased intracranial pressure without lateralizing signs, was diagnosed as colloid cyst of the third ventricle, and operated on with dissecting microscope on April 20, 1973. The colloid cyst was totally removed and postoperatively V-A shunt was performed for adhesive arachnoiditis. Patient did well after surgery and has returned to the previous work. In Case 2, a 41 year-old male, who suffered from sudden onset of severe headache and bouts of frequent vomiting, was admitted to Tokyo Wome's Medical College Hospital on October 11, 1974. Right cerebral angiography revealed findings of increased intracranial pressure and third ventricle tumor was suspected. On October 13, progressively disturbed consciousness occurred. Immediate ventricular tap and continuous ventricular drainage could not regain consciousness and patient expired on October 30. In necropsy, colloid cyst to the third ventricle was found. As far as these are concerned, these cysts might be reasonably said as ventricular epithelial origin in view of the operative and histological findings. Some emphasis was also made in terms of dissecting microscope in removing this tumor, completely preserving the ventricular walls as well as the terminal veins under magnification.     

Angiographic demonstration of blood supply of right atrial myxoma

A 53-year-old woman underwent cardiac catheterization for assessment of coronary arterial disease. An unexpected finding of a gradient between right atrium and right ventricle led to the discovery of an unsuspected right atrial myxoma. The diagnosis was established by the presence of a filling defect in the right atrial angiocardiogram and by the demonstration of "tumour vessels" by selective right coronary angiography. Selective coronary angiography can visualize the blood supply to an intracardiac tumour and thus confirm the diagnosis preoperatively.     

Does a short loop feedback mechanism for the control of luteinizing hormone secretion exist in the ewe?

It is not known whether a short loop feedback mechanism for the regulation of LH exists in sheep. This study on ovariectomized ewes investigated whether a bolus injection (10, 1, and 0.1 microg LH or 1 microg BSA; n 4) or a 3-h continuous infusion of exogenous LH (100 or 1 ng/min; n = 7) into the third ventricle through a permanent indwelling cannula could influence the activity of the GnRH pulse generator, as determined by measurement of endogenous LH secretion. To assess the potential for involvement in a LH short loop feedback system and to estimate the level of LH in the hypothalamic milieu, the concentrations of LH in the peripheral circulation, portal circulation, and third ventricle were measured during an estradiol-induced preovulatory LH surge (n = 4). Neither the bolus nor continuous administration of LH into the third ventricle had any effect on the mean interpulse interval, nadir, pulse amplitude, or circulating level of systemic LH. Furthermore, despite portal LH concentrations being more than 20-fold higher than jugular LH concentrations, LH levels in third ventricular cerebrospinal fluid remained barely detectable and did not reflect dynamic secretory events in the peripheral or hypothalamo-hypophyseal portal blood. These data demonstrate that in ewes, little pituitary LH reaches the third ventricle, and the small amount that does is unable to affect peripheral gonadotropin release. Our study suggests, therefore, that a short loop feedback system for LH does not exist in the ewe.     

Simplified assessment of asphyxia at birth

A choroid plexus papilloma of the lateral ventricle presenting in early infancy and producing symptoms purely by secretion of cerebrospinal fluid with formation of a large cyst is presented. Initial conservative management by cyst-peritoneal shunt was followed by late recurrence of symptoms due to reformation of the cyst when the shunt blocked. Excision of the tumour afforded definitive relief.     

The kinetics of competitive antagonists on guinea-pig ileum

Echo-encephalographic examinations were performed in 144 patients after subarachnoid hemorrhage. Ninety-three of the patients received antifibrinolytic treatment (AMCA). The width of the third ventricle could be measured in all the patients, and lateral ventricle measurements were obtained in 94 patients. Third ventricular dilatation developed in 78 patients (54 per cent), and lateral ventricle enlargement was seen in 55 patients (58 per cent of those examined). The incidence of third ventricle dilatation was higher in the AMCA-treated group (62.5 per cent) than in the non-treated group (39.2 per cent), and this difference was statistically significant (P less than 0.05). The hydrocephalus in most cases developed 2-3 weeks after the bleeding, and reached its peak within the first 2-3 months, with subsequent complete or partial normalization of the ventricular size. At later follow-up examinations 1-4 years after the bleeding, only nine patients had persisting dilatation of moderate or pronounced degree. There was no indication that the dilatation was more severe or pronounced degree. There was no indication that the dilatation was more severe or protracted in the AMCA-treated group than in the non-treated group. In 11 patients the hydrocephalus required a shunt-operation, but the frequency of shunt-operations was not significantly different in the two groups. It is concluded that although AMCA-treated patients in comparison with non-treated patients are exposed to a somewhat higher risk of complicating hydrocephalus after subarachnoid hemorrhage, this risk cannot at present be considered as any serious contraindiction to this sort of treatment.     

Chemokine-induced fever: intracerebroventricular actions of MIP-1 and MIP-1 alpha in rats

The central pyrogenic actions in the rat of doublet macrophage inflammatory protein-1 (MIP-1) and MIP-1 alpha were determined by their intracerebroventricular infusion. Doses of 560 pg and 11.2 ng of MIP-1 or 10.0 ng MIP-1 alpha infused into the third cerebral ventricle induced a long lasting fever. However, MIP-1 alpha was much less potent than MIP-1 in terms of intensity and longer latency. Overall, these cytokines are pyrogenic when acting on the walls of the third ventricle; however, a dose 10 times greater than that injected directly into the anterior hypothalamus is required to evoke fever, as based on earlier experiments. Finally, circulating MIP-1 could act centrally by its entry through the choroid plexus into the ventricular system of the brain.     

An unusual consequence of stereotactic colloid cyst aspiration: case report

The removal of a colloid cyst of the third ventricle by stereotactic cyst aspiration is frequently performed as an alternative to a transcortical-transventricular or transcallosal operative route. A consequence of a CT-guided stereotactic aspiration, where residual colloid cyst material has been dislodged into the lateral ventricle and likened to an intraventricular mouse, is described.     

A beta-3 adrenergic agonist (BRL-37,344) decreases food intake

This study evaluated the effect of peripheral injections of a beta3 adrenergic agonist, BRL-37,344 on food intake and whether this inhibition could be blocked by a nonspecific beta-adrenergic antagonist, propranolol, given peripherally or into the central nervous system. When BRL-37,344 was injected intraperitoneally (i.p.) into lean and obese Zucker rats, food intake was decreased. The reduction of food intake by BRL-37,344 was attenuated when propranolol was administered i.p. prior to giving the beta adrenergic agonist. When propranolol was administered into the third cerebral ventricle, it increased food intake in lean rats, but not the fatty rats. Propranolol administered into the third cerebral ventricle attenuated the effect on food intake of i.p. injection of BRL-37,344. These studies support the hypothesis that there are peripheral beta-3 adrenergic receptors that can reduce food intake and that there are central beta2 or beta3 adrenergic receptors that mediate the peripheral effect of the beta3 agonist.     

Double-chamber right ventricle: a case report

The double-chamber right ventricle is a congenital cardiac malformation usually associated with other cardiac defects, seldom isolated and in adult subject. It is characterized by the presence of an anomalous bundle that divides the right ventricle into two chambers. The clinical and electrocardiographic signs of isolated double-chamber right ventricle are few and not specific. An echocardiographic diagnosis of isolated double-chamber right ventricle is reported. In a 18-year-old asymptomatic male with systolic murmur 2/6 at third space over the left sternal border, right ventricular hypertrophy and intraventricular conduction delay at ECG, two-dimensional echo showed an anomalous transversal muscle bundle that divided the right ventricle into two chambers, superior and inferior. Color Doppler showed a diastolic tricuspidal-like flow through a paraseptal discontinuity of the bundle and a systolic jet that reached the right atrium, with a pressure gradient of 30.9 mmHg. The absence of symptoms and other cardiopathy, without significant right outflow tract obstruction, was considered as an index of a good prognosis; therefore cardiac catheterization was not advised.     

Human immunodeficiency virus-1 infection among patients with sexually transmitted diseases in Bombay

Modern neuro-imaging caused a renewed interest in endoscopic techniques. Several indications for stereotactic endoscopy are illustrated. A prototype of a new four channel endoscope is used. Lesions in the posterior part of the third ventricle an even the fourth ventricle are reachable for biopsy. Cystic intra- or paraventricular lesions can be approached stereotactically and treated. Continuous rinsing is mandatory to preserve a clear vision.     

Apico-aortic shunt: a support technique during surgery on the descending thoracic aorta

Although colloid cysts of the third ventricle are unusual in children, we have recently encountered six examples. Histologically they were lined by cuboidal, pseudostratified or columnar ciliated and mucous-secreting epithelial cells. Two cases showed small microcysts within the fibrovascular stroma surrounding the main cyst. The outermost layer consisted of a glial-ependymal envelope, in keeping with the postulated supraventricular origin of colloid cysts. Scanning electron microscopy showed 10-40% ciliated cells, and no ballooning of non-ciliated cells. Aspiration of cyst contents was performed in three patients, two of whom subsequently required surgical resection 4 months and 8 years after drainage, respectively. In adults colloid cysts may be asymptomatic, whereas in children they have not been documented as incidental findings at autopsy. Two of our six cases died, both before a diagnosis was established. A colloid cyst of the third ventricle must be included in the evaluation of acute neurological deterioration in children, in whom they are more frequently lethal.     

5-Aminolevulinic acid induced endogenous porphyrin fluorescence in 9L and C6 brain tumours and in the normal rat brain

A new approach in photodynamic therapy is the use of endogenous porphyrins for sensitisation of tumours to light. The induction of endogenous porphyrins after intravenous injection of 5-aminolevulinic acid (ALA, 200 mg kg-1) was studied in 23 rats, bearing intracranial 9L or C6 tumours. After 0, 2, 4, 6, 8, and 22 hours the rats were sacrificed and the fluorescence distribution of endogenous porphyrins was studied in brain tissue sections with a standard fluorescence microscope and a confocal laser scanning microscope. The role of blood-brain barrier disruption on porphyrin production was studied in 2 rats with a cryo-lesion of the cortex. Additionally, 9L and C6 tumour cell cultures were incubated with ALA for 8 hours in vitro. Fluorescence was measured with a fluorescence spectrophotometer in cell cultures and in the brain sections. Porphyrins were detected in vitro in the tumour cells from 2 hours onwards and ex vivo in the tumour sections mainly from 2 to 8 hours, by 22 hours porphyrin fluorescence had almost disappeared. The contralateral brain showed low fluorescence levels between 2 and 6 hours after ALA administration. At the site of the cryo-lesions low fluorescence was measured 6 hours after ALA administration. The 9L tumours fluoresced homogeneously, with a sharp demarcation towards normal brain tissue. Fluorescence in the C6 tumours was patchy, with a poorly fluorescing edge. In both tumour models fluorescence was also detected in brain surrounding the tumour and sometimes in contralateral white matter and ventricle ependyma and pia mater. The slight increase of porphyrin fluorescence in the normal brain of tumour bearing rats, compared to the absence of this in rats without a tumour, was attributed to transport by bulk flow of porphyrins made in the tumours, and possibly also of circulating porphyrins or ALA leaking from the tumour vessels.     

Increased intrusions during verbal recall in traumatic and nontraumatic lesions of the temporal lobe.

The mesial temporal and lateral frontal lobes were the most common sites of parenchymal abnormality on magnetic resonance imaging (MRI) scans for 12 patients with chronic traumatic brain injury (TBI). Ventricular widening was also common, and 3 patients showed increased size of the upper third ventricle. Of 10 right-handed TBI patients with no evidence of learning disability, 6 showed dominant temporal lesions and 3 showed an increase in the size of the upper third ventricle. Only patients with dominant temporal lesions (4 of 6) exceeded the normal confidence interval (based on 20 non-TBI controls) for intrusion errors on delay trials of the California Verbal Learning Test (CVLT), though other patients also demonstrated impaired recall. The pattern of increased intrusions during CVLT delay trials was confirmed in non-TBI patients who had undergone dominant temporal surgery or had dominant or bilateral temporal lesions, even when frontal changes could be ruled out. (PsycINFO Database Record (c) 2010 APA, all rights reserved)