Successful removal of a giant skull base metastasis from hepatocellular carcinoma after direct ethanol injection: Case report

Skull metastases from hepatocellular carcinoma (HCC) are extremely rich in vascularity, which sometimes makes surgery dangerous. For minimally invasiv e surgery, it is very important to diminish the intratumoral vascular flow preoperatively. We report the case of a 69-year-old man with a giant skull base metastasis from HCC that was successfully removed after two sessions o f direct ethanol injection into the tumor as a preoperative treatment to di minish the intratumoral vascular flow. Direct ethanol injection is a modifi cation of percutaneous ethanol injection therapy, which is widely used in t he treatment of primary HCC. In this article, we describe in detail the pra ctical procedures and the usefulness of this treatment for a giant skull ba se metastasis from HCC.