Troubles neurologiques

Emergency Extracranial- Intracranial Bypass during Surgery for Anterior Clinoid Process Hemangiopericytoma with ICA Invasion—Case Report.

Abstract

Yu-Ning Chen, Po-Hsuan Lee, Yin-Ren Chen and E-Jian Lee

Hemangiopericytoma (HPC) is a rare tumor, accounting for less than 1% of intracranial tumors. Though it’s notoriously difficult to distinguish HPC from meningioma in pre-op images, HPC presents bone and vascular invasion, high local recurrence and distal metastasis clinically, as a surgically challenging malignancy. High-flow extracranial-intracranial (EC-IC) bypass is a skill demanding surgery and is usually performed as a wellprepared elective surgery. However, emergency EC-IC bypass is indicated for unplanned major artery loss during surgery and sometimes as the final rescue for the patient. We present a case of 46 year-old man, who was diagnosed of a left anterior clinoid process (ACP) tumor with presentation of gradually visual loss. As the dura tail sign and MRI signal, we performed left pterional approach tumor excision for the impression of ACP meningioma. However, due to the vascular invasion of tumor, left ICA perforation was noted intraoperatively and finally the bleeding was controlled with ICA clipping. Emergency EC-IC bypass from common carotid artery to middle cerebral artery was performed. The patient recovered to oriented consciousness, independent ambulation but mild aphasia in our outpatient department follow-up.