SummaryWe present a rare case of temporal bone angiosarcoma diagnosed in a 26-year-old female patient at 36 week of pregnancy. The patient was referred with a 2 months history of left otalgia and tinnitus with a tender swelling above the mastoid. Cranial imaging studies showed a 7 × 5 × 4 cm hypervascularized mass located in the left middle fossa with lysis of the temporal bone and extension to the subcutis. After the baby was delivered by caesarean section, the patient entered the oncology protocol. Selective embolization of the feeding vessels was followed by gross total surgical resection using a combined supra-and infra-tentorial approach. Pathological findings were those of a poorly differentiated, highly malignant sarcoma with a large epitheloid component and immunohistochemical evidence of endothelial differentiation (CD31, Factor VIII related antigen, CD34), consistent with an angiosarcoma with epitheloid features. No extra-cranial tumor was found after extensive staging. The patient received adjuvant radiotherapy followed by a course of chemotherapy consisting of 6 cycles of paclitaxel. At 15 months follow-up, she developed multiple distant metastasis to a left postauricular lymph node and to the lungs and ribs. The patient was given a second line chemotherapy using doxorubicine and ifosfamide. Despite an initial good response, she died with metastatic disease 26 months after diagnosis. We present a rare case of primary temporal bone angiosarcoma and report our experience with a multimode therapeutic approach combining surgery, radiotherapy and chemotherapy.

In a suite with fully interactive computed tomography (CT) and C-arm fluoroscopy units, emergency and elective interventional procedures were performed successfully in 41 patients (overall time range, 40-180 minutes [mean, 80 minutes]). The table can be manually pivoted from the fixed CT position to the free-floating angiography position, in an overall working space of about 40 m(2), with room for anesthesiology and monitoring equipment and personnel.

Mandibular arteriovenous malformation (AVM) is a potentially life-threatening pathology requiring radical treatment. We report two female patients, aged 14 and 16 years, in whom occlusion of the AVM with Ethibloc after percutaneous transosseous puncture achieved definitive recovery. The first case was treated by direct injection of Ethibloc following inefficient arterial embolization with Ivalon particles. In the second case, Ethibloc was injected without previous arterial embolization. Control examinations performed at 6 months and 2 years confirmed complete calcification of the mandible in the first case and a total obliteration of the AVM on angiography in the second case.

To evaluate selective arterially enhanced CT angiography (ACT) and 3-D reformatting in the pretherapeutical assessment of intracranial aneurysms. A combined interactive CT and DSA suite deserved by a single pivoting table was used. Reformatted images were obtained using maximum intensity projection, volume rendering and surface shaded display with slicing. Thirty-four patients, 13 male and 21 female, mean age: 50 years , were explored in a prospective study. Forty-one intracerebral aneurysms were diagnosed. The aneurysmal index was measured on the reformatted images. Radiological findings were compared with surgery. In 31 operative cases, the aneurysmal index and morphological description of the aneurysm as defined by ACT were in agreement with surgical findings. ACT gave specific information in 6 cases which led to a change of the therapeutical approach. ACT facilitated the choice between surgery and endovascular embolization in 19 complex cases (surgery: 12, endovascular embolization:7). ACT improves the pretherapeutical assessment of intracranial aneurysms, particularly in complex cases. Determination of the aneurysmal index is more precise with ACT than with DSA.