• 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.
A 63 year old male with a ruptured distal ACA aneurysm underwent coil embolization. The migration of a small coil into the parent vessel was observed procedurally, that had led to a thrombus formation. We successfully performed aggressive antithrombotic therapy with ozagrel sodium and aspirin as a conservative therapy immediately after the presentation of the thrombus. The five week follow up angiogram revealed a delayed worsening of the coil migration we eventually had to perform surgical intervention to resolve the adverse event. Coil migration is a relatively rare complication. However, it can lead to a critical prognosis if either parent vessel occlusion or distal embolization occurs. We herein report our case and discuss the management strategy including the endovascular and surgical approaches, and also provide a review of the relevant literature.
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