title: Renal cell carcinoma metastasis to the cerebellopontine cistern: intraoperative Onyx embolization via direct needle puncture.
abstract: 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.
authors.affiliation: Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Johnson
authors.forename: Jacques
authors.initials: J
authors.lastname: Morcos
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elhammady
authors.forename: Christine L
authors.initials: CL
authors.lastname: Pao
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Aziz-Sultan
mesh_terms: D001158:Arteries / Q000601:surgery; D001932:Brain Neoplasms / Q000098:blood supply / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D001933:Brain Stem / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000473:pathology*; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008875:Middle Aged; D009339:Needles; D011145:Polyvinyls / Q000627:therapeutic use*; D011677:Punctures / Q000379:methods*; D013635:Tantalum / Q000627:therapeutic use*
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum
keywords: Brain; Liquid Embolic Material; Metastatic; Technique; Tumor