[A Case of Primary Intracranial Epithelioid Hemangioendothelioma].

Epithelioid hemangioendotheliomas(EHEs)most commonly occur in the liver, lung, bone, and soft tissues, but rarely in the brain. Here, we describe a case of primary intracranial epithelioid hemangioendothelioma manifested by an epileptic attack. A 53-year-old woman with no previous convulsive history presented at our hospital after experiencing a seizure. Magnetic resonance imaging revealed a mass in her right frontal lobe, with edema, which was well enhanced with gadolinium. Systemic computed tomography, on the other hand, did not show any tumor involvement in other organs. The patient underwent surgery, and a complete resection of the intracranial tumor was successfully performed. The histological diagnosis was an EHE. There was no evidence of tumor recurrence either in the brain or other organs at 3 years and 7 months after surgery. Because of its rarity, the exact prognosis of patients with an intracranial EHE has not been clearly established. Moreover, tumor recurrence following complete resection has been reported and thus regular follow-up examinations are considered necessary.

[A Case of Multiple Tumor Neurosurgery for Brain Metastasis of Colorectal Cancer].

We report a patient with brain metastasis of rectal cancer who underwent metastatic tumor resection 3 times. In March 2012, a 76-years-old man, diagnosed with Stage III a rectal cancer, underwent Hartmann's operation. The lung metastasis was confirmed in July and November 2013, surgical resection for pulmonary metastasis was performed 2 times. In January 2016, he had difficulty of speaking, and isolated brain tumor was found. We performed surgical resection of brain metastasis in February 2016. In March and July 2016, the gamma knife radiosurgery was performed for other brain metastasis. In July 2016, he occurred nausea, headache and right identity hemi-blindness. Two new brain tumors were revealed. We performed surgical resection again. Three months after second brain surgery, he had dysarthria and a solitary brain tumor was confirmed. We performed third neurosurgical resection. All tumors of brain were found to be metastasis from rectal cancer in histological study. Currently, 16 months have passed since the first diagnosis of brain metastasis of this patient, and the quality of life was good relatively. The prognosis of the patients with brain metastasis is poor generally. However, this case suggested that multiple surgical resection of brain metastasis could improve prognosis and quality of life of patients. Accumulation of further cases is needed.

Detection of the microcatheter tip using a novel microguidewire during coil embolization of cerebral aneurysms - technical note - .

Detection of the position of the microcatheter tip is important for safe and effective coil embolization of cerebral aneurysms, but is sometimes difficult, especially in the final stage with a high density of embolized coils. We report a new technique to deduce the position of the microcatheter tip using a novel microguidewire during coil embolization of cerebral aneurysms. The novel microguidewire (ASAHI CHIKAI 10; Asahi Intecc, Nagoya, Aichi), with a radiopaque portion of 30 mm, is advanced into the microcatheter until the distal end of the radiopaque portion reaches the coil mass edge at the neck of the aneurysm. The distance between the second marker of the microcatheter and the proximal end of the radiopaque portion of the microguidewire is checked. The position of the microcatheter tip is deduced from the distance and curve of the microguidewire. Microcatheter tips can be easily detected with this technique without complications. This technique is safe, simple, and useful for deducing the position of the microcatheter tip during coil embolization of cerebral aneurysms.

[Prevalence and risk factors for silent lacunar infarct in white matter lesion--brain multiphasic screening].

To clarify difference of significant risk factors and that of prevalence with increasing age between white matter lesion (WML) and silent lacunar infarction (SLI), 946 brain check-up subjects were investigated. Twelve risk factors including age, sex, and hypertension were analyzed using multiple logistic regression analysis. A case of WML, which changed into infarction, was presented. Significant (P < 0.01) risk factors for WML were aging (odds ratio; 1.12/year) and hypertension (3.66), while those for SLI were aging (1.10/year), hypertension (4.89), and retinal arteriosclerosis (3.46). Both WML and SLI emerged in middle age and thereafter the prevalence rates increased with age, although WML emerged earlier and was more frequent throughout than SLI. The results indicated that WML was essentially aging phenomenon, while SLI was strongly affected by vascular risk factors, although WML might possibly chang into infarction.