Utsunomiya H

Subarachnoid hemorrhage after preoperative embolization of a cystic meningioma

We present a case of cystic meningioma accompanied by hemorrhage in the cyst and adjacent subarachnoid space that occurred while preoperative embolization in feeders of the tumor was being applied. The possible reason for the hemorrhage was the sudden dynamic changes in blood flow triggered by the embolization. The changes could have caused multiple ruptures of pathologic small vessels. We recommend that preoperative embolization should be used cautiously in treating cystic meningiomas because of a possible increase in bleeding from pathologic weak vessels.

Thoracic and Lumbo-sacral Spinal Lipoma in an Infant

We reported a case of thoracic and lumbosacral spinal lipoma in an 8 month-old boy. He was born in asphyxia. Six months after birth, spastic paraparesis developed gradually at both lower extremities and secondary funnel chest due to shallow thoracic movement and scoliosis in the thoracic region was observed. MRI was then performed where tumor mass demonstrated by the high signals in both T1 and T2 in ages was confirmed in the thoracic and lumbo-sacral regions. Surgery was performed only for the thoracic lesion which was considered primary. The tumor in the Th3-4 level had developed subdurally, while the tumor in the Th5-10 extradurally. Only partial removal could be done for the subdural tumor because its boundary with the spinal cord was not clearly identified. Postoperative histological study revealed it as lipoma. During the following 6 months only slight recovery from paraparesis was observed. Surgical intervention against the mass in the lumbosacral region was not performed for the conus medullaris was found located in its normal position and no concomitant symptoms could be observed. In summary, it is considered that spinal lipoma is rare (1% of total spinal tumor) and commonly associated with other types of congenital anomalies (in 31% of spinal lipoma). Particularly in infants, spinal lipoma in the thoracic region as experienced in our case is extremely rare and any medical treatment started after clinical symptoms once developed seems ineffective.