Ryokichi Yagi

Objective: We report a ruptured internal carotid artery–ophthalmic artery (ICA–OphA) aneurysm in which morphological variation of the C2 segment, including marked medial deviation of the ICA, was suggested to be associated with aneurysm formation and may have influenced the endovascular strategy.Case Presentation: A 52-year-old woman presented with subarachnoid hemorrhage. CTA revealed a right ICA–OphA aneurysm accompanied by pronounced medial deviation of the right ICA at the C2 segment. This deviation created an acutely angled ICA–OphA bifurcation, with the OphA originating from the medial aspect of the ICA. Emergency coil embolization was performed, and the aneurysm was successfully occluded.Conclusion: The patient exhibited well-developed anterior clinoid process and optic strut morphology, which may have contributed to medial deviation of the ICA and to aneurysm formation at the ICA–OphA bifurcation. Recognition of such morphological variations is important because they may obscure OphA visualization and affect device selection. In these settings, preshaped S-type microcatheters may facilitate stable catheterization and safe coil embolization.

Cerebral embolic stroke caused by a thrombus in the pulmonary vein stump after left pulmonary lobectomy is a serious complication. We retrospectively analyzed four patients who underwent mechanical thrombectomy for large-vessel occlusion after left pulmonary lobectomy between January 2014 and March 2022. Two cases occurred after left upper lobectomy and the others occurred after left lower lobectomy. All patients presented with cerebral embolic stroke from the day after surgery to the 9th postoperative day, and successful reperfusion was achieved in all cases. Two patients had good outcomes at 90 days. Thrombus in the pulmonary vein stump is the probable cause of cerebral embolism, and mechanical thrombectomy is effective. Further studies are required to establish preventive measures and perioperative management strategies.

Giant cell tumor (GCT) of bone is essentially benign but locally aggressive, and the rate of local recurrence is high when the resection is not enough. En bloc resection is recommended as an ideal solution for GCT to decrease the risk of local recurrence, but it remains challenging for cervical GCT. In this technical case report, we present a case of extensively infiltrating GCT of the cervical spine completely encasing the vertebral artery (VA) on one side. The tumor was distributed to layers A-D, sectors 3-8 based on the Weinstein-Boriani-Biagini staging. Combined posterior and anterior surgical approach for the cervical spine was successfully performed and followed by postoperative adjuvant pharmacological therapy. This kind of multimodal management may be one of the solutions for advanced cervical GCT.