March 05, 2014
Renal cell metastasis can be quite challenging to remove, due to their highly vascular nature. This is a 58 year old male, with history of progressive mental status decline. As well as a history of renal cell carcinoma. CT scan demonstrated a ring enhancing lesion in the right frontal lobe. A large one. As well as a small one situated more posteriorly. Most of the edema was attributed to the larger lesion, and therefore the larger region. I'm sorry, and therefore the larger lesion was the surgical target. Right frontal craniotomy was completed here, as a Sylvian fissure. You can see the tumor coming to the surface of the pier. Small cap of brain over-lying the posture bore. The tumor was removed. The best strategy for resection of these hypervascular metastatic lesions, is to stay outside of the tumor capsule, and remove the tumor and block when possible. Early entry into the nidus of the tumor often leads to excessive bleeding. Right frontal lobe is relatively non-functional. Therefore I created a generous operative space for disconnecting the metastatic lesion from the surrounding normal brain. Cottonoid patties were used to maintain the dissection planes. MCA branches along the inferior border of the tumor were carefully protected. The dissection was kept as appeal as possible, without entering to the Sylvian cisterns. This tumor is relatively large. Some of the vessels directly entering the tumor were quite delayed and uncut. Tumor was rolled more medially and superiorly out of our resection cavity. So it's apex can be disconnected. It is almost completely disconnected. Further inspection of the resection cavity revealed no evidence of a residual tumor. And the post-operative CT scan demonstrated complete removal of the mass. The smaller and non-contiguous mass was treated subsequently with radiosurgery. Thank you.
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