Johnson Jeremiah, Morcos Jacques, Elhammady Mohamed, Pao Christine L, Aziz-Sultan Mohammad Ali
Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
BMJ Case Rep. 2013 Dec 17;2013:bcr2013010966. doi: 10.1136/bcr-2013-010966.
We report a rare case of a renal cell carcinoma (RCC) metastasis occupying the cerebellopontine and cerebellomedullary cisterns, and describe an alternative strategy for embolizing hypervascular intracranial tumors. A middle aged patient with a distant history of RCC presented with headaches, nausea, and vomiting, and was found to have an enhancing mass in the left cerebellopontine and cerebellopontine cisterns. The initial surgical resection was aborted due to excessive bleeding. After an unsuccessful attempt at intra-arterial embolization, the patient returned to the operating room and the tumor was devascularized by direct needle puncture Onyx embolization under biplane fluoroscopy. The devascularized tumor was then successfully dissected from the brainstem and adherent lower cranial nerves. In properly selected cases, open surgical direct needle puncture embolization of intracranial vascular tumors under biplane fluoroscopy is a viable alternative devascularization method.
我们报告了一例罕见的肾细胞癌（RCC）转移瘤占据桥小脑角池和小脑延髓池的病例，并描述了一种栓塞高血运颅内肿瘤的替代策略。一名有RCC远处病史的中年患者出现头痛、恶心和呕吐，经检查发现左侧桥小脑角池和小脑延髓池有一强化肿块。由于出血过多，最初的手术切除中止。在动脉内栓塞尝试失败后，患者返回手术室，在双平面荧光透视下通过直接针穿刺用Onyx进行栓塞使肿瘤去血管化。然后成功地从脑干和粘连的低位颅神经上分离出去血管化的肿瘤。在适当选择的病例中，双平面荧光透视下颅内血管肿瘤的开放手术直接针穿刺栓塞是一种可行的去血管化替代方法。
