Brain metastasis from colorectal cancer is infrequent and carries a poor prognosis. Herein, we present a patient alive 10 years after the identification of a first brain metastasis from sigmoid colon cancer. A 39-year-old woman underwent sigmoidectomy for sigmoid colon cancer during an emergency operation for pelvic peritonitis. The pathological finding was moderately differentiated adenocarcinoma. Eleven months after the sigmoidectomy, a metastatic lesion was identified in the left ovary. Despite local radiotherapy followed by chemotherapy, the left ovarian lesion grew, so resection of the uterus and bilateral ovaries was performed. Adjuvant chemotherapy with tegafur-uracil (UFT)/calcium folinate (leucovorin, LV) was initiated. Seven months after resection of the ovarian lesion, brain metastases appeared in the bilateral frontal lobes and were treated with stereotactic Gamma Knife radiosurgery. Cervical and mediastinal lymph node metastases were also diagnosed, and irradiation of these lesions was performed. After radiotherapy, 10 courses of oxaliplatin and infused fluorouracil plus leucovorin (FOLFOX) were administered. During FOLFOX administration, recurrent left frontal lobe brain metastasis was diagnosed and treated with stereotactic Gamma Knife radiosurgery. In this case, the brain metastases were well treated with stereotactic Gamma Knife radiosurgery, and the systemic disease arising from sigmoid colon cancer has been kept under control with chemotherapies, surgical resection, and radiotherapy.

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Summary:We experienced 5 cases of nonbranching site aneurysms arising from the internal carotid artery system in the past 5 years. Two cases were successfully treated with neck clipping and 2 cases were treated with trapping. Wrapping by gauze and fibrin glue was used in 1 unruptured case.The outcome was good in all cases (mRS 0-2).However, non-branching site aneurysms have fragile walls, the neck is not clearly defined and postoperative rebleeding can easily occur. We believe the sacrifice of a normal parent artery is necessary to prevent re-bleeding. For this reason, we believe interception of the parent artery should always be considered to prevent postoperative rebleeding.When parent artery interception is of concern regarding postoperative ischemic events, a high-flow EC-IC bypass may be needed. On the other hand, the issue of separation of the neck is possible at all sides and the possibility of clipping strangling part of the parent artery also exists.

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