• Abstract • Objective: We report the utility of low-concentration n-butyl 2-cyanoacrylate (NBCA) for preoperative embolization of meningioma. Methods: Twelve patients who were preoperatively diagnosed with meningioma were included in the study. Preoperative meningioma embolization with NBCA at 10-20% concentration was performed for 22 feeding vessels in 12 patients. We assessed the extent of intratumoral embolization and its effect on tumor removal. Results: Intratumoral embolization was possible in 17 feeding vessels (77.3%). In particular, 10-12.5% warmed NBCA effectively penetrated the tumor. The effect on tumor removal was good or excellent in 58.3% of patients. Conclusion: Preoperative embolization of meningioma with ultra-low concentrations of NBCA was useful. Understanding the relationship between the adhesion, the viscosity and the concentration of NBCA is essential for effective preoperative embolization.•
The cerebellomedullary fissure CMF is the deepest and widest fissure among the cerebellobrainstem fissures. The CMF is a cleavage plane between the cerebellar hemisphere and medulla oblongata and is usually closed by arachnoidal adhesion. The trans CMF approach provides a wide and safe operative field without a neural tissue incision. The trans CMF approach is also useful for posterior inferior cerebellar artery PICA lesions, in addifion to fourth ventricle or brain stem lesions. In the case of a vermian tumor, the feeding arteries of the tumor arising from PICA can be easily identified after opening the CMF. When the tonsillo medullary segment course has a high position relative to the CMF or the proximal portion of the telovelo tonsillar segment of the PICA was used as the recipient artery, the trans CMF fissure approach provides a sufficient and safe operative field for bypass surgery.
The authors experienced a curious phenomenon in an adult moyamoya patient. Mouth opening caused reversible occlusion of the donor superficial temporal artery (STA), and the patient exhibited transient cerebral ischemic symptoms. The aim of this study was to assess the incidence of such occlusion and the mechanisms behind this phenomenon.
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