A Case of Dermoid Cyst Arising in the Temporal Lobe.

Intracranial dermoid cysts are rare congenital lesions that result from abnormal sequestration of ectodermal cells during neural tube formation. These tumors are especially rare in lateral areas such as in the temporal lobe. In this study, we report a case of dermoid cyst located in the right temporal lobe. A 50-year-old man was referred for further treatment of a tumor. CT revealed a low-density mass lesion in the right temporal lobe, with calcification. MRI showed the lesion with high signal intensity on diffusion-weighted imaging, high-low mixed signal intensity on T1-weighted imaging, and iso-high signal mixed intensity on T2-weighted imaging; the capsule was enhanced with gadolinium. Differential diagnosis included dermoid cyst, epidermoid cyst, teratoma, and neurenteric cyst. We decided to perform surgery for the improvement of his symptom, histopathological diagnosis, and radical cure. A right temporal craniotomy was performed, and the tumor was found adherent to the surrounding brain tissue. The tumor was completely removed under subpial dissection. Hair was confirmed in the tumor content. On histopathology, the cyst wall was lined with stratified squamous epithelium, sebaceous glands, small vessel aggregates, and inflammatory infiltrate. Keratinized material and hair were found in the lumen. The patient was discharged 7 days after surgery with no new neurologic deficits. This case was unusual in terms of the effect of gadolinium enhancement on MRI, and the presence of adipose tissue and calcification were useful for diagnosis. It is vital to consider prevention of chemical meningitis due to intrathecal dissemination of the tumor content intraoperatively.

Usefulness of Hybrid Surgery Combining CEA and CAS for Carotid Artery Stenosis with a Large Amount of Vulnerable Plaque.

Objective: For carotid artery stenosis with a large amount of vulnerable plaque in a wide range, we performed a hybrid surgery combining carotid endarterectomy (CEA) and carotid artery stenting (CAS), and report the results of treatment. Methods: Surgical treatment for carotid artery stenosis in 216 patients was performed between January 2016 and June 2018. Of these, 15 patients were treated in a hybrid operating room because both CEA and CAS were judged to be risky. We treated these patients with preparation of stenting for remote lesions far from the CEA arterial incision. The perioperative treatment results were retrospectively examined. Results: Of the 15 patients treated in a hybrid operating room, 10 were stented after CEA. All these cases were treated by retrograde stent placement in the proximal common carotid artery (CCA). Treatment was completed in all patients, and no cerebral infarction, myocardial infarction, or death was observed in the perioperative period. There were no cases of additional neurological events during the follow-up period, but asymptomatic restenosis was observed in one patient. Conclusion: Hybrid surgery combining CEA and CAS was considered to be an effective treatment for carotid artery stenosis with a large amount of vulnerable plaque.

A Case of Nervus Intermedius Neuralgia.

BACKGROUND: Nervus intermedius neuralgia is an extremely rare craniofacial neuralgia characterized by paroxysmal episodes of pain located deep in the ear, typically triggered by sensory or mechanical stimuli at the wall of the auditory canal without underlying pathology. Pain is sometimes associated with disorders of lacrimation, salivation, and taste. CASE DESCRIPTION: We present a case of a surgically treated 68-year-old man with left paroxysmal deep ear pain for 20 years before presentation. Preoperative 3-dimensional magnetic resonance cisternography/magnetic resonance angiography (3D-MRC/MRA) fusion imaging showed severe compression of the facial nerve by the anterior inferior cerebellar artery in the cisternal portion with associated nerve deformity. We suspected nervus intermedius neuralgia and decided to perform microvascular decompression of the facial nerve. Transposition of the artery led to sufficient decompression of the nerve. The pain disappeared immediately after surgery. CONCLUSIONS: It is important to keep in mind the possibility of nervus intermedius neuralgia in patients who present with intermittent episodes of pain located deep in the ear. Furthermore, 3D-MRC/MRA fusion imaging is useful for decision-making in surgery. Microvascular decompression was highly effective in our case. Based on radiological findings, microvascular decompression should be considered a viable treatment option.