Intraoperative ultrasonographically guided direct ethanol injection for a brain metastasis from renal cell carcinoma: case report

A 60-year-old man presented with a brain metastasis from renal cell carcinoma (RCC). Computer tomography revealed a homogeneously enhanced tumor, 3.0 cm in maximum diameter, in the right medial temporal lobe. Cerebral angiography revealed that the tumor was mainly fed by the right posterior cerebral artery. Surgery was performed via right temporal craniotomy. After craniotomy, under ultrasonography (US) guidance, a total of 3.0 mi of ethanol was injected into the tumor to diminish the intratumoral vascular flow. Ultrasonographic guidance was very useful in monitoring the intratumoral vascular flow. After a marked decrease in the vascular flow, the tumor was totally removed using piecemeal technique. During surgery, only minimal bleeding from the tumor was noted. The postoperative course was uneventful, with no evidence of injected ethanol-related complications. In conclusion, this can be a safe, easy, and effective therapeutic technique for diminishing vascular flow within brain tumors rich in vascularity, such as brain metastases from RCC.