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Case report
Renal cell carcinoma metastasis to the cerebellopontine cistern: intraoperative Onyx embolization via direct needle puncture
  1. Jeremiah Johnson,
  2. Jacques Morcos,
  3. Mohamed Elhammady,
  4. Christine L Pao,
  5. Mohammad Ali Aziz-Sultan
  1. Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr M A Aziz-Sultan, Department of Neurosurgery, University of Miami Miller School of Medicine, Lois Pope LIFE Center, 1095 NW 14 Terrace, Miami, FL 33136, USA; brainsurg{at}gmail.com

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.

  • Brain
  • Liquid Embolic Material
  • Tumor
  • Metastatic
  • Technique

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