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The role of preoperative angiography in the management of giant meningiomas associated to vascular malformation.

Papacci F, Pedicelli A, Montano N - Surg Neurol Int (2015)

Bottom Line: In the first case: A large right temporal meningioma with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit - a large pseudoaneurysm of right middle cerebral artery branch was found end embolized during DSA.Nonetheless, DSA remains a useful tool in giant meningiomas not only to embolizate the lesion but also to treat tumor associated vascular malformation and to achieve the full knowledge of vascular anatomy.We think that a wide communication between interventionalist and surgeon is essential for the optimal management of these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Institute of Neurosurgery, Catholic University, Rome, Italy.

ABSTRACT

Background: The role of preoperative digital subtraction angiography (DSA) in meningiomas is currently under discussion because of the introduction of noninvasive magnetic resonance imaging (MRI) angiography to study vascular anatomy associated to the tumor. Preoperative DSA is mainly performed to obtain embolization of the lesion, although a number of complications have been reported after this procedure. Nonetheless, the coexistence of meningiomas with vascular malformations has previously been reported and it has been evidenced that this event could be underestimated because of neglect of preoperative DSA. Here, we report on two challenging cases of giant meningiomas associated to vascular malformations and we discuss the pertinent literature.

Case descriptions: In the first case: A large right temporal meningioma with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit - a large pseudoaneurysm of right middle cerebral artery branch was found end embolized during DSA. In the second case: A giant parieto-temporal meningioma - DSA permitted the full visualization of an abnormal drainage of superior sagittal sinus like a "sinus pericranii" that was respected during the following surgery.

Conclusion: We think that MRI angiography is the exam of choice to study vascular anatomy in meningiomas. Nonetheless, DSA remains a useful tool in giant meningiomas not only to embolizate the lesion but also to treat tumor associated vascular malformation and to achieve the full knowledge of vascular anatomy. We think that a wide communication between interventionalist and surgeon is essential for the optimal management of these patients.

No MeSH data available.


Related in: MedlinePlus

Axial (a), coronal (b) and sagittal (c) T2-weighted brain magnetic resonance imaging showing a large right temporal meningioma with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit. The tumor shows wide enhancement after Gadolinium administration (d). A pseudo-aneurysm of right middle cerebral artery branch before (e and f; red arrow) and after (g and h) embolization with Glubran2 glue
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Figure 1: Axial (a), coronal (b) and sagittal (c) T2-weighted brain magnetic resonance imaging showing a large right temporal meningioma with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit. The tumor shows wide enhancement after Gadolinium administration (d). A pseudo-aneurysm of right middle cerebral artery branch before (e and f; red arrow) and after (g and h) embolization with Glubran2 glue

Mentions: A 44-year-old female was admitted to our department because of a 3-year history of headache and a progressive worsening of right exophthalmos with a brain MRI showing a giant enhancing right temporal mass with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit [Figure 1a–d]. Due to the large dimensions and the invasiveness of the lesion, the patient was submitted to brain DSA with embolization of external carotid artery feeders (middle meningeal artery, accessory meningeal artery, distal sphenopalatin branches) using contour particles (150–350 micron). During the procedure, a large pseudoaneurysm of right middle cerebral artery branch was evident and embolized using Glubran2 glue [Figure 1e–h].


The role of preoperative angiography in the management of giant meningiomas associated to vascular malformation.

Papacci F, Pedicelli A, Montano N - Surg Neurol Int (2015)

Axial (a), coronal (b) and sagittal (c) T2-weighted brain magnetic resonance imaging showing a large right temporal meningioma with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit. The tumor shows wide enhancement after Gadolinium administration (d). A pseudo-aneurysm of right middle cerebral artery branch before (e and f; red arrow) and after (g and h) embolization with Glubran2 glue
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496841&req=5

Figure 1: Axial (a), coronal (b) and sagittal (c) T2-weighted brain magnetic resonance imaging showing a large right temporal meningioma with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit. The tumor shows wide enhancement after Gadolinium administration (d). A pseudo-aneurysm of right middle cerebral artery branch before (e and f; red arrow) and after (g and h) embolization with Glubran2 glue
Mentions: A 44-year-old female was admitted to our department because of a 3-year history of headache and a progressive worsening of right exophthalmos with a brain MRI showing a giant enhancing right temporal mass with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit [Figure 1a–d]. Due to the large dimensions and the invasiveness of the lesion, the patient was submitted to brain DSA with embolization of external carotid artery feeders (middle meningeal artery, accessory meningeal artery, distal sphenopalatin branches) using contour particles (150–350 micron). During the procedure, a large pseudoaneurysm of right middle cerebral artery branch was evident and embolized using Glubran2 glue [Figure 1e–h].

Bottom Line: In the first case: A large right temporal meningioma with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit - a large pseudoaneurysm of right middle cerebral artery branch was found end embolized during DSA.Nonetheless, DSA remains a useful tool in giant meningiomas not only to embolizate the lesion but also to treat tumor associated vascular malformation and to achieve the full knowledge of vascular anatomy.We think that a wide communication between interventionalist and surgeon is essential for the optimal management of these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Institute of Neurosurgery, Catholic University, Rome, Italy.

ABSTRACT

Background: The role of preoperative digital subtraction angiography (DSA) in meningiomas is currently under discussion because of the introduction of noninvasive magnetic resonance imaging (MRI) angiography to study vascular anatomy associated to the tumor. Preoperative DSA is mainly performed to obtain embolization of the lesion, although a number of complications have been reported after this procedure. Nonetheless, the coexistence of meningiomas with vascular malformations has previously been reported and it has been evidenced that this event could be underestimated because of neglect of preoperative DSA. Here, we report on two challenging cases of giant meningiomas associated to vascular malformations and we discuss the pertinent literature.

Case descriptions: In the first case: A large right temporal meningioma with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit - a large pseudoaneurysm of right middle cerebral artery branch was found end embolized during DSA. In the second case: A giant parieto-temporal meningioma - DSA permitted the full visualization of an abnormal drainage of superior sagittal sinus like a "sinus pericranii" that was respected during the following surgery.

Conclusion: We think that MRI angiography is the exam of choice to study vascular anatomy in meningiomas. Nonetheless, DSA remains a useful tool in giant meningiomas not only to embolizate the lesion but also to treat tumor associated vascular malformation and to achieve the full knowledge of vascular anatomy. We think that a wide communication between interventionalist and surgeon is essential for the optimal management of these patients.

No MeSH data available.


Related in: MedlinePlus