A Case of Horizontal Stent-assisted Coiling for an Aneurysm Arising from Fenestration of the Vertebral Artery: A Technical Case Report.

Horizontal stenting protects the aneurysm neck with stent deployment across the aneurysm neck via the circle of Willis. A saccular aneurysm associated with intracranial arterial fenestration is very rare. Herein, we describe the first case of an unruptured aneurysm related to intracranial arterial fenestration treated with horizontal stenting. A 23-year-old woman presented with a 7-mm broad-necked aneurysm at the fenestration of the right intracranial vertebral artery (VA), which was incidentally found on magnetic resonance imaging. The patient underwent endovascular treatment with horizontal stenting via the vertebrobasilar junction from the contralateral left VA, followed by coil embolization using a jailed microcatheter from the ipsilateral right VA. The procedure was finished with sufficient embolization, and no complications occurred. Horizontal stent delivery via the vertebrobasilar junction for coil embolization of a broad-necked aneurysm arising from the fenestration of the VA is a safe and effective therapeutic strategy.

Thoracic spinal metastasis as recurrence of borderline Brenner tumor without local recurrence: A case report.

Background: Brenner tumor is a rare epithelial ovarian neoplasm that accounts for 2-3% of all ovarian neoplasms. Herein, we report the first case of thoracic spinal metastasis of recurrent Brenner tumor without local recurrence.Case Description.A 70-year-old female presented with a feeling of abdominal distension. Computed tomography revealed cystic lesions in her bilateral ovaries. Blood examination revealed high CA-125 [74.9 U/ml]. We excised bilateral ovaries, uterus, and omentum. Borderline Brenner tumor was diagnosed [Ki-67 labeling index: 10 %]. Follow-up abdominal echo and CA-125 examination revealed no local recurrence. 26 months later she developed paraplegia. Magnetic resonance imaging revealed tumor in the 5th-9th thoracic vertebra and compression of spinal cord at the 6th thoracic vertebra level. Her paraplegia was progressive. We performed semi-urgent partial resection of tumor and release of spinal cord compression. Spinal metastasis from Brenner tumor was diagnosed [Ki-67 labeling index: 50-60 %]. She received adjuvant radiation of 30 Gy in 10 fractions to the 4th-10th thoracic vertebra. After radiation and rehabilitation, she was discharged home on foot. She received adjuvant radiation and chemotherapy but died 11 months after spinal surgery. An autopsy has not been performed on her, and the cause of death is unknown. Conclusion: We report the first case of thoracic metastasis of recurrent Brenner tumor without local recurrence.

Thoracic spinal metastasis as recurrence of borderline Brenner tumor without local recurrence: A case report.

Background: Brenner tumor is a rare epithelial ovarian neoplasm that accounts for 2-3% of all ovarian neoplasms. Herein, we report the first case of thoracic spinal metastasis of recurrent Brenner tumor without local recurrence.Case Description.A 70-year-old female presented with a feeling of abdominal distension. Computed tomography revealed cystic lesions in her bilateral ovaries. Blood examination revealed high CA-125 [74.9 U/ml]. We excised bilateral ovaries, uterus, and omentum. Borderline Brenner tumor was diagnosed [Ki-67 labeling index: 10 %]. Follow-up abdominal echo and CA-125 examination revealed no local recurrence. 26 months later she developed paraplegia. Magnetic resonance imaging revealed tumor in the 5th-9th thoracic vertebra and compression of spinal cord at the 6th thoracic vertebra level. Her paraplegia was progressive. We performed semi-urgent partial resection of tumor and release of spinal cord compression. Spinal metastasis from Brenner tumor was diagnosed [Ki-67 labeling index: 50-60 %]. She received adjuvant radiation of 30 Gy in 10 fractions to the 4th-10th thoracic vertebra. After radiation and rehabilitation, she was discharged home on foot. She received adjuvant radiation and chemotherapy but died 11 months after spinal surgery. An autopsy has not been performed on her, and the cause of death is unknown. Conclusion: We report the first case of thoracic metastasis of recurrent Brenner tumor without local recurrence.

[Stepwise improvement of visual field after preoperative embolization and tumor resection of cerebral metastasis of alveolar soft part sarcoma].

We report a patient with a brain metastasis from an alveolar soft part sarcoma (ASPS) of the thigh whose visual field defect was resolved in a stepwise manner after preoperative embolization and tumor resection. A 29-year-old man who had undergone surgery to remove an ASPS situated in the thigh developed headaches and homonymous hemianopsia. His visual field defect was evaluated using a Goldmann perimeter. He was found to have a large, well-circumscribed mass in the right occipital lobe. This mass was visible on brain computed tomography and magnetic resonance imaging and was strongly and homogeneously enhanced following contrast administration. Selective angiography revealed a hypervascular mass supplied by branches of the right middle cerebral artery, and preoperative particulate embolization was performed to reduce intraoperative bleeding. A tumor-supplying branch of the middle cerebral artery was superselectively catheterized. For embolization, polyvinyl alcohol (PVA) particles of 90-180 µm in diameter were used. The visual field defect partially improved soon after the preoperative embolization. Surgical resection was performed 3 days after embolization, and the tumor was completely excised by a right occipital craniotomy. Preoperative embolization made the surgical resection easier. Intraoperative bleeding was easily controlled. The pathological diagnosis was ASPS. The intratumoral-embolized vessels were filled with PVA particles. After resection, the patient progressed well with further improvement in visual field function. Rapid improvement of the visual field can be used as an indicator of successful embolization without complications. (Received: July 16, 2013, Accepted: September 5, 2013).

Paraplegia caused by intratumoral hemorrhage within thoracic epidural granuloma.

An 84-year-old man presented with a rare case of spinal epidural granuloma with intratumoral hematoma resulting in acute paraplegia. He was admitted to our hospital because of lumbago and hematemesis following a fall 10 days before. Progressive paraparesis occurred 2 days after admission. Neurological examination showed paraplegia and hypesthesia below the T10 level. Thoracic radiography revealed some spondylotic changes of the thoracic vertebrae without osteolytic changes. Sagittal T(1)- and T(2)-weighted magnetic resonance imaging of the thoracic spine demonstrated a hyperintense epidural mass lesion compressing the dorsal portion of the thoracic spinal cord at T10-11 space. Emergency laminectomy was performed, and the epidural encapsulated hematoma and elastic yellowish mass adhered to the dura mater were totally removed. Histological examination of the excised specimens showed a granuloma. Motor weakness improved after surgery, and he could walk with a cane about 3 months after surgery. The minor spinal injury probably caused intratumoral hemorrhage within a previous epidural granuloma, suddenly resulting in the paraplegic symptoms.