Spinal dumbbell tumors are hourglass-shaped tumors that consist of intraspinal, foraminal, and/or extraforaminal portions. 1,2 Gross total resection of these tumors must be achieved to prevent recurrence. 3,4 Total facetectomy could be performed to remove the foraminal and extraforaminal portions of the tumor; however, this process destabilizes the cervical spine and requires screw fixation. To achieve gross total resection while preserving the facet joint, we performed laminoforaminotomy with a novel technique called the "3P method" along with open-door laminoplasty. The 3P method involved the following steps: (1) "P"ulling the tumor with a pituitary forceps through laminoforaminotomy, (2) "P"ushing the Gelfoams into the foramen, and (3) "P"ressure increase due to the Gelfoams facilitating the pulling of the tumor. We report the case of a 52-year-old woman who presented with a 6-month history of tingling sensations in her right arm and bilateral legs. Physical examination showed decreased motor power in the right arm (elbow flexion and extension grade 4, hand grasping grade 4). Magnetic resonance imaging (MRI) showed a homogenously enhanced dumbbell tumor of approximately 2.3 × 1.2 × 3.5 cm at the C2-3 level. The patient underwent an operation that used 2 techniques: laminoforaminotomy with the 3P method for the foraminal portion and open-door laminoplasty for the intradural portion. Open-door laminoplasty was performed to prevent postoperative deformity. 5 Gross total resection of the tumor was achieved, and postoperative MRI showed no residual tumor. Preoperative symptoms of tingling sensations were resolved. Informed consent was obtained from the patient before performing the operation.

Background Coil embolization is the mainstay treatment for carotid-cavernous fistulas (CCFs). However, few studies have reported entire occlusion of engorged veins to interrupt venous outflow. We report our experience with venous outflow-targeted coil embolization of direct CCFs. Methods We retrospectively reviewed all the patients diagnosed with direct CCFs treated with venous outflow-targeted coil embolization between November 2013 and February 2020. Venous outflow-targeted coil embolization of the CCFs was performed as follows. First, transarterial stent-assisted coil embolization of CCFs was performed. If the venous outflow to the engorged veins persisted after transarterial stent-assisted coil embolization, entire occlusion of the engorged veins and additional coil packing within the cavernous sinus were performed to interrupt the venous outflow. Results Ten patients had undergone venous outflow-targeted coil embolization, 6 women (60%) and 4 men (40%). Transfemoral cerebral angiography showed high-flow, direct CCFs in all the patients. Venous outflow occurred through the superior ophthalmic vein (SOV) in all the patients and was completely interrupted by the entire occlusion of the engorged veins with fibered coils. Three patients (30%) had undergone additional treatment in a supplementary manner because of recurrent symptoms (chemosis in 1 patient, faint tinnitus in 2 patients) in the early postprocedural period (1 to 4 weeks). All the symptoms were resolved on follow-up. No additional recurrence was found during follow-up (1–75 months). No peri-procedural complications were encountered. Conclusions Venous outflow-targeted coil embolization of CCFs would be a safe and effective treatment method.