Primary Meningeal Melanocytoma in the Thoracic Spine: A Case Report

Meningeal melanocytoma is a rare benign melanotic tumor arising from melanocytic cells in the leptomeninges. Preoperative differential diagnosis of meningeal melanocytoma from other melanotic tumors is difficult based on magnetic resonance imaging (MRI). Definitive diagnosis of meningeal melanocytoma from other melanotic tumors is done on the basis of histopathological and immunohistochemical analyses. The prognosis of this tumor is not always favorable with occasional local recurrence, especially in cases of subtotal gross resection. The authors report on a case of a 58-year-old man who presented with a melanocytoma located at the T7-8 level. The patient underwent on a total surgical excision for successful control of the tumor. During a follow-up period of 2 years, the patient presented no signs of recurrence. We emphasize the importance of discrimination of meningeal melanocytoma from other melanotic tumors to facilitate appropriate treatment. Complete resection is the treatment of choice for spinal melanocytoma. Radiation therapy should be reserved for those cases in which complete resection is not possible or in which there is recurrence.

Clinical Features of Distal Anterior Cerebral Artery Aneurysm and Treatment Outcomes / 대한뇌혈관외과학회지

OBJECTIVE: Distal anterior cerebral artery (DACA) aneurysms are relatively uncommon and surgical management presents some unique technical difficulties. We retrospectively reviewed our experience with 35 DACA aneurysm cases, their clinical features and treatment outcomes to assess the characteristics and treatment outcomes of DACA aneurysms. MATERIALS AND METHODS: The medical records of 33 patients with 35 ruptured and unruptured DACA aneurysms were reviewed. Of these, 29 had undergone surgery and four were treated by coil embolization at our institution between September 1992 and January 2010. The clinical presentation, radiologic features and surgical and endovascular treatment outcomes were analyzed. RESULTS: In our series, the incidence of DACA aneurysms was 35 of 1106 (3.1%) aneurysms. The most common location of these 35 aneurysms was the bifurcation of the pericallosal and callosomarginal arteries (51%). Multiple aneurysms were found in nine patients (27%) and associated vascular anomalies such as azygous anterior cerebral artery and Moyamoya disease were found in six patients (18%). Ninety four percent of the aneurysms were less than 10 mm in diameter. Twenty nine patients were treated by surgical clipping and four patients were treated by coil embolization. Premature rupture of aneurysms and mortality or morbidity directly related to the aneurysmal surgery or endovascular treatments were not observed. CONCLUSION: DACA aneurysms have a tendency to rupture before becoming large or giant in size. We achieved favorable outcomes (modified Rankin Scale <4) in 29 of the 33 patients with a tailored surgical approach and coil embolization. Therefore, DACA aneurysms should be treated aggressively even if they are <10 mm in diameter and early surgery can reduce the rate of rebleeding.