PMC9128551_01
A 52-year-old man complained of blurred vision and unsteady gait for 2 months. The physical examination results showed left hemianopsia, and both VOS and VOD were 0.1. The MRI results revealed a falcotentorial meningioma, which had an isointense signal on T1-/T2-weighted imaging and homogeneous enhancement on contrast-enhanced MRI. The magnetic resonance venography results showed that the straight sinus was occluded (A). We implanted an Ommaya reservoir at 1 week before tumor resection and maintained the drainage at 200 ml per day. The patient then underwent tumor resection using the occipital interhemispheric approach. During the operation, the majority of the tumor base was located at the falx end and the tentorium. The tumor was removed in a piecemeal fashion. Finally, the tumor and the base were totally removed (Simpson grade I resection). The postoperative CT showed no hemorrhage or infarction (B). The pathology examination results revealed that the tumor was a hemangiopericytoma, WHO grade I.
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T1-/T2-weighted imaging and homogeneous enhancement on contrast-enhanced MRI. The MRV showed that the straight sinus was occluded (Figure 2A). The postoperative CT showed no hemorrhage or infarction (Figure 2B).
PMC9128551_02
A 33-year-old man complained of headache for 2 months. The CT results revealed a mixed-density, right occipital lesion. The MRI results revealed a right occipital, mixed-signal lesion and flow voids on T1- and T2-weighted imaging. The lesion showed obvious enhancement on contrast-enhanced MRI. The magnetic resonance venography results showed an obstructed sagittal sinus (A). We performed the operation in a hybrid operating room. The cerebral digital subtraction angiography (DSA) results revealed abundant tumor blood. The feeding arteries were the right posterior cerebral artery (PCA), right external carotid artery (ECA), right meningiohypophyseal trunk, and left ECA (B). Onyx-18 was used for feeding artery embolization for the right PCA, right occipital artery, and left occipital artery. The DSA reexamination results showed that 90% of the blood supply was embolized (C). Craniotomy was then performed. The occipital interhemispheric transtentorial approach was used to reach the tumor under navigation. The tumor was tenacious, with partial calcification. Piecemeal removal was performed, and we achieved a Simpson grade II resection. The postoperative CT results showed no hemorrhage or infarction (D). The pathology examination results revealed that the tumor was a hemangiopericytoma.
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T2-weighted imaging. The lesion showed obvious enhancement on contrast-enhanced MRI. The MRV showed an obstructed sagittal sinus (Figure 3A). The feeding arteries were the right posterior cerebral artery (PCA), right external carotid artery (ECA), right meningiohypophyseal trunk, and left ECA (Figure 3B). The DSA reexamination showed that 90% of the blood supply was embolized (Figure 3C). The postoperative CT results showed no hemorrhage or infarction (Figure 3D).