ORIGINAL ARTICLE Clinical features and surgical management of four peculiar cases of intracranial metastases from renal cell carcinoma Fuyou Guo • Junkuan Wang • Laijun Song • Hongwei Sun • Bo Yang • Xianzhi Liu • Shukai Wang Received: 30 July 2011 / Accepted: 9 January 2012 / Published online: 21 January 2012 Ó Springer-Verlag 2012 Abstract Intracranial metastasis from renal cell carci- noma is rare. In this study, four patients (age range 56–72 years) were treated for intracranial metastases from renal cell carcinoma. The metastasis was solitary in all four patients and was located in the temporoparietal region in two patients, cerebellum in one patient, and bilateral lateral ventricles in one patient. Preoperative magnetic resonance imaging showed hemorrhage and necrosis in the tumor in all four patients, and one patient had edema in the region of the tumor. All patients were treated with craniotomy for tumor resection, and histopathologic examination showed clear cell carcinoma. Marked bleeding occurred in all patients during the operation, but preoperative direct injection of ethanol into epidural metastases (2 patients) was effective in decreasing intraoperative blood loss. Prognosis was poor with limited survival time (range 2 weeks–45 months), but prognosis was best in the two patients who were treated with postoperative radiation therapy and chemotherapy (survival times 26 and 45 months). To our knowledge, this is the largest report of four uncommon intracranial metastases from RCC in Chinese patients. In summary, intracranial metastasis from renal cell carcinoma should be considered in the differen- tial diagnosis of intracranial tumor because of the high risk of bleeding and poor prognosis. Keywords Central nervous system Á Metastatic disease Á Kidney Á Cancer Á Treatment Introduction Intracranial metastasis is the most common intracranial tumor with major morbidity and mortality. The annual incidence of intracranial metastasis in the USA (37,000 cases) is more than double that of primary intracranial tumors (17,000 cases) [1, 2]. In Sweden, intracranial metastasis in women most frequently occurs from primary lung cancer (33%), breast cancer (33%), and colorectal cancer (7%) and in men from lung cancer (44%), malignant melanoma (12%), and colorectal cancer (9%) [3]. How- ever, the location of the primary tumor is unknown in 15% of patients with intracranial metastasis [1]. In China, intracranial metastasis most frequently occurs from pri- mary lung cancer (72%) and digestive tract cancers (5.6%), and the most common histologic type of metastasis is adenocarcinoma (52%) [4]. Renal cell carcinoma usually metastasizes to the lung, liver, and bone. Intracranial metastasis from renal cell carcinoma, especially to the lateral ventriclular mass or cerebellum, is uncommon. In a series of 254 Chinese patients with intracranial metastasis, only 3 patients had intracranial metastases from renal cell carcinoma [4]. Solitary intracranial metastasis from renal cell carcinoma has not been reported at intracranial special regions, such as lateral ventricle and cerebellum in Chinese patients. Furthermore, limited information is available about bleeding from intracranial metastases caused by renal cell carcinoma. We evaluated and treated four patients who had intra- cranial metastases from renal cell carcinoma. The purpose F. Guo (&) Á J. Wang Á L. Song Á H. Sun Á B. Yang Á X. Liu Á S. Wang Key Laboratory of Neurosurgical Diseases, Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, 40 Daxue Road, Zhengzhou 450052, Henan, China e-mail: guofuyou888@yahoo.com.cn 123 Neurol Sci (2013) 34:149–156 DOI 10.1007/s10072-012-0944-x