We present multicentric glioblastomas radiologically mimicking metastatic tumors. A 57-year-old female presented with multiple brain masses accompanied by generalized seizures. Since there was no primary lesion considered to be the origin, the patient underwent craniotomy to remove the mass. The mass was pathologically diagnosed as glioblastoma, IDH-wildtype. When we found a multicentric tumor mass in the brain, a metastatic tumor was first suspected, and radiotherapy without surgical resection was believed to be acceptable. However, glioblastoma, which requires intensive chemoradiotherapy, rarely demonstrates multiple lesions as in the presented case. Therefore, surgical resection should be considered to make a diagnosis and treat multiple brain tumors, especially in cases with no certain primary lesion.

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We herein show a case of symptomatic common carotid artery occlusion that underwent bonnet bypass (contralateral superficial temporal artery (STA) -saphenous vein (SV) -cortical segment (M4) of the middle cerebral artery (MCA) bypass) using an SV graft. STA-MCA bypass surgery has been established for the prevention of secondary cerebral infarction of symptomatic internal carotid artery occlusion. On the other hand, there has been no standard surgical treatment for symptomatic common carotid artery occlusion. It has been reported that bonnet bypass using donor grafts is effective for these pathological conditions. We herein performed bonnet bypass surgery using an SV graft as a donor graft. The vascular reserve was improved in quantitative single photon emission computed tomography, the bypass patency was also spared, and the postoperative course was uneventful.

Background: Initial three-dimensional computed tomography angiography and cerebral angiography fail to identify any aneurysm in 20% of cases of subarachnoid hemorrhage. Basilar artery (BA) perforator aneurysm is rare and about 30–60% were not identified by initial angiography.Case presentation: A 71-year-old male was transferred with sudden onset of headache and loss of consciousness. Computed tomography demonstrated subarachnoid hemorrhage, but no ruptured aneurysm was detected. Repeat preoperative cerebral angiography indicated bifurcation aneurysm of the circumflex branch of the superior cerebellar artery perforator but microsurgical observation identified BA perforator aneurysm.Conclusions: If the location of the BA perforator aneurysm cannot be clearly identified, as in this case, repeat angiography should be considered, and the treatment strategy should be decided based on detailed consideration of the site of the aneurysm.