Epithelioid glioblastoma (E-GBM) is a rare variant of glioblastoma (GBM), characterized by epithelioid cells with eosinophilic round cytoplasm devoid of stellate cytoplasmic processes. A number of studies have demonstrated that more than half of E-GBMs harbor a valine to glutamic acid substitution at position 600 of the serine/threonine-protein kinase BRAF (BRAF V600E). However, there are no previous reports on E-GBM with telomerase reverse transcriptase (TERT) promoter mutation in addition to BRAF V600E mutation. Here, we report an E-GBM case in an 18-year-old man with BRAF V600E and TERT promoter mutations. The tumor composed of 80% E-GBM and 20% diffuse astrocytoma-like components, and BRAF V600E and TERT promoter mutations were detected in both. E-GBM generally arises as a primary lesion; however, a few previous cases have been demonstrated to accompany low-grade areas. Demonstration of concurrent BRAF V600E and TERT promoter mutations in low- and high-grade lesions strongly suggested their identical origin, and acquisition of each mutation may be an early event, possibly playing a pivotal role in the genesis and subsequent progression to E-GBM.

BACKGROUND A vertebral artery–anterior spinal artery (VA-ASA) aneurysm is very rare. The authors report a case of successful coil embolization of a ruptured aneurysm of the VA-ASA. OBSERVATIONS A 54-year-old man with World Federation of Neurosurgical Societies grade II subarachnoid hemorrhage presented with an aneurysm located at the region involving the origin of ASA on the VA. Endovascular treatment was chosen to prevent rerupture and preserve the perforating branches. The catheter shape was modified with steam forming to allow access to the aneurysm. Partial embolization was performed to preserve the ASA. The authors also prevented further rupture. On day 16, angiography showed thrombosis within the aneurysm and preserved blood flow in the ASA despite a neck remnant. The patient was discharged home with a modified Rankin Scale score of 0. Careful follow-up has been continued. LESSONS Endovascular coiling in the acute phase of rupture of a VA-ASA aneurysm achieved favorable results. The aneurysm could be safely treated by selecting the appropriate device and catheter geometry.

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Summary:Five patients with ruptured vertebrobasilar dissecting aneurysms, to which parent artery occlusion cannot be applied, were treated by using Enterprise VRD. The location of the dissecting aneurysms was the vertebral artery in three patients and basilar artery in two. In all patients, Enterprise VRD was successfully deployed in the dissecting segment, and the coils were inserted in the aneurysmal dilatation by semi-jailing technique. Ischemic complication occurred in two patients and rebleeding occurred in one patient four months after the treatment. Favorable outcomes were obtained in four of the five patients. Enterprise VRD provides easy access to the lesion, is less stressful to the parent artery in the deployment, is conformable to the tortuous parent artery, and is suitable for the semi-jailing technique.Stent-assisted coil embolization using Enterprise VRD can be a feasible and effective treatment in selected patients with ruptured vertebrobasilar dissecting aneurysms not suitable for parent artery occlusion.