Catheter embolization of the feeding vessels in six cases of intracranial meningiomas (author's transl)

Abstract

Meningiomas are known for their propensity to hemorrhage during surgery. When massive hemorrhaging occurs, exision of the tumor occasionally becomes difficult or incomplete. For this reason, it appeared to us that preoperative gelfoam embolization of the feeding vessels of meningiomas should facilitate surgery by abolishing or diminishing the risk of hemorrhage. The authors have undertaken embolization of 6 intracranial meningiomas which possessed predominant or exclusive external carotid vascularization. The cases included 2 male and 4 female patients. The age of the youngest was 42, and the oldest 64 yrs. The distribution of tumor sites was as follows: 2 in the convexity, 2 in the parasagittal region, 1 in the middle cranial fossa, and 1 in the tentoriurn. Histological examinations of the resected tumors revealed 5 to be meningothelial and 1 angioblastic. Cerebral catheterization by the retrograde transfemoral route was performed. The embolization in all 6 cases was effected with gelfoam, cut into fine strips. The delay between embolization and craniotomy varied between 1 day and 7 days, with a mean of 5.5 days. The results of embolization were evaluated on the basis of operative findings and the postoperative sequelae. In 2 cases (the 2 convexity meningiomas), the surgery (bone flap, section of the dural attachment and excision of the meningioma itself) was bloodless. In one of these convexity meningiomas, histological examinations of surgical specimens revealed fragments of gelfoam in the fine vessels within the capsule as well as the tumor tissue. In 2 cases (1 tentorial and 1 parasagittal), the surgery was minimally hemorrhagic, considering the volume and site of the tumor. In 1 case (the middle cranial fossa meningioma), preoperative embolization of the external carotid branches appeared to have a little effect. In this case, hemostasis of the dural attachment at the base of the middle cranial fossa was extremely difficult to maintain. This patient died 4 days after the operation. Complications related to the embolization were seen in 2 cases with transient pain in the temporal scalp region, and in 1 case with ischemic scalp complications. The findings of repeated CT scan after the embolization were useful for detecting possible changes within the tumor tissue itself. When performed as an integral part of the preoperative angiographic evaluation in case of meningiomas, careful embolization of the feeding vessels causes little increase in danger to the patient, while it clearly facilitates surgery by reducing the high risk of hemorrhage during the operative procedure.