Two Patients with Large Aneurysms in Whom Coil Embolization with Overlapping LVIS Stents Was Performed.

Objective: We report two patients with unruptured large aneurysms treated by overlapping stent-assisted coil embolization using low-profile visualized intraluminal support (LVIS) stents. Case Presentation: Case 1: An 80-year-old woman presented with abducens nerve palsy due to an internal carotid artery aneurysm. Case 2: A 75-year-old man presented with a partially thrombosed fusiform aneurysm in the vertebral artery (VA). Both patients were treated by overlapping LVIS stent-assisted coil embolization (overlapping LSACE). Digital subtraction angiography (DSA) a few months after embolization demonstrated complete occlusion of the aneurysm, although immediate angiography revealed dome filling. Conclusion: Overlapping LSACE may be an effective treatment method for aneurysms that are difficult to treat by standard SACE and result in better flow-diverting effects.

[A Case of Brain, Lung, and Adrenal Metastasis from Colorectal Cancer Controlled by Loco-Regional Surgery].

A 64-year-old man presented with the chief complaint of weakness in the left half of his body. He fell down on the road while riding a bicycle and was transported to the emergency room. A contrast-enhanced brain MRI revealed a 28mm ringshaped mass in the right frontal lobe. A craniotomy was performed 14 days later. The histopathological diagnosis showed the tumor as a well-differentiated tubular adenocarcinoma. Postoperative examination revealed a rectal cancer and a left lung mass. A low-anterior resection was performed 1 month after the craniotomy, and a partial lung resection was performed 2 months after the rectal excision. Metachronous solitary metastasis of the left adrenal gland was noticed 10 months after the removal of the lung metastasis and we subsequently performed a left adrenalectomy. The patient is not undergoing any active treatment 13 months after the adrenalectomy, but has no signs of recurrence. The loco-regional surgery was enabled for local control of multi-relapsed lesions from rectal cancer.

[Case of postpartum intracerebral hemorrhage due to pregnancy induced hypertension].

A 32-year-old woman, gravida 0, para 0, was admitted to the obstetrics department of our hospital after a cesarean section at 35 weeks of gestation. The cesarean section was performed because pregnancy induced hypertension (PIH) had worsened. The next day, she suddenly became drowsy and developed right hemiparesis and anisocoria. Computed tomography of the brain showed intracerebral hemorrhage in the parietal lobe with uncal herniation. She underwent an urgent craniotomy and removal of the hematoma. Five days later, magnetic resonance angiography (MRA) of the brain showed vasospasm of the bilateral intracranial internal carotid arteries, middle cerebral arteries, and anterior cerebral arteries. Thirteen days later, cerebral angiography showed cessation of vasospasm and vascular abnormalities such as moyamoya disease, arteriovenous malformation and cerebral aneurysm were not observed. Twenty-one days later, MRA showed the absence of vasospasm in those arteries, but her right hemiparesis and sensory aphasia persisted. Twenty-six days later, she was transferred to another hospital for further rehabilitation. Neurosurgeons should be aware of the possibility of intracerebral hemorrhage caused by PIH. In this manuscript, we provide a case presentation and review of the literature.

Radiological predictive factors for regrowth of residual benign meningiomas.

The pre- and postoperative radiological predictive factors for the regrowth of residual benign meningiomas were investigated in 80 of 327 patients who underwent first surgery for intracranial meningioma, who met the following conditions: residual tumor observed on postoperative imaging, follow up for more than 5 years or until regrowth of the residual tumor, histological diagnosis of World Health Organization grade I, and no additional therapy performed within 1 month after surgery. These 80 patients were divided into those with no regrowth during the follow-up period (Group A, n = 54) and those with regrowth (Group B, n = 26), and the clinical characteristics and pre- and postoperative imaging findings were compared. Univariate analysis of factors influencing regrowth showed 6 factors were significant: tumor size ≥4 cm (p = 0.043), tumor volume ≥30 cm(3) (p = 0.026), presence of edema (p = 0.036), unclear brain-tumor interface (p < 0.001), presence of a pial-cortical blood supply (p = 0.031), and residual tumor volume ≥3.0 cm(3) (p < 0.001). Multivariate analysis showed only residual tumor volume ≥3.0 cm(3) was significant (p = 0.001). Generally, the significant imaging findings on univariate analysis suggest malignant meningioma. Similar findings may be observed even in grade I cases, and residual tumors may regrow in such cases. The possibility is particularly high if the residual tumor volume exceeds 3.0 cm(3), so early radiotherapy should be performed to prevent regrowth.