Resection of Vascular Metastasis

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Here's a short video describing the techniques for Resection of Vascular Metastasis. This is a 60 year-old female with headaches and history of renal cancer. MRI evaluation revealed this metastasis within the inferior right frontal lobe, potentially affecting one of the MCA branches. It's peeking through the inferior frontal gyrus, and our route of approach would be through this area. The right frontotemporal craniotomy was completed. Here, you can see the Sylvian fissure, the tumor is evident. Went ahead and completed a small corticotomy in this area. Getting into these metastases can lead to a significant amount of bleeding and it's best to remove them and block if possible, and circumferentially disconnect their capsule from the surrounding normal brain. This is the strategy that was used in this case. You can see a branch of the MCA encasing the tumor. I'm going to dissect the tumor in this case, and may have to leave a small amount of tumor on the artery to protect it. Again, here is removing the bulk of the mass and then small amount of tumor on the artery, in order to protect its patency. The gliotic margins are also carefully inspected to make sure they're very clean, hemostasis secured. I don't see any major residual tumor on the brain. Papaverine-soaked Gelfoam was used to bathe the vessels and relieve any vasospasm. And here's the postoperative CT scan, demonstrating good resection of the tumor without any complicating features. This video again, illustrates the important point that, vascular metastatic tumors such as renal cell carcinomas, can be quite bloody and it's best to dissect them around their capsule rather than getting into their bulk as they can bleed a lot. Obviously preservation of neurovascular structures is critical because no matter how effective gross-total tumor resection is, there's still some residual tumor and therefore, maximal resection should not sacrifice any function or affect neurovascular structures. Thank you.

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