Contrast-enhanced CT scan at the level of the lateral ventricles
Contrast-enhanced CT (Fig. 1) and T1-weighted MRI (Fig. 2) scans showed the typical appearances of a partially cystic convexity meningioma in a left fronto-temporo-parietal location. The neurological deficits were slightly improved with intravenous corticosteroid therapy (12 mg dexamethasone/24 hours). Since the patient was willing to undergo surgical treatment, preoperative embolisation was recommended.
After embolisation, the tumour blush disappeared completely (Fig. 4) and during surgery the typical yellow-coloured surface of a devascularised meningioma could be seen (Fig. 5). The tumour was completely removed without related haemorrhage.
Although there are conflicting opinions concerning the value of preoperative embolisation of meningiomas among neurosurgeons, it is now a standard procedure for reducing blood loss during surgery. At histological examination, the first manifestations of necrosis are apparent the day after embolisation, so surgical removal should not be performed before.
It is most important to achieve a distal embolisation of the tumour's vascular bed, which is provided by the use of small particles (150-250µm) and superselective catheterisation, and furthermore, to avoid any complications due to vasospasm, rupture, external-internal anastomoses or retrograde embolisation.
In our opinion devascularisation of supplying vessels within the internal carotid artery territory should not be performed, because its risk-to-benefit ratio is too high for a benign disease like a meningioma.
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