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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 T2-weighted (a) brain magnetic resonance imaging (MRI) showing a giant parieto-temporal meningioma enhancing after Gadolinium administration (c). Sagittal MRI venous angiography (b) evidenced an abnormal superior sagittal sinus drainage. Preoperative angiography with embolization of the lesion (d). During venous phase of angiography, the abnormal drainage of superior sagittal sinus like “sinus pericranii” was clearly confirmed (e, red arrow)
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Figure 2: Axial T2-weighted (a) brain magnetic resonance imaging (MRI) showing a giant parieto-temporal meningioma enhancing after Gadolinium administration (c). Sagittal MRI venous angiography (b) evidenced an abnormal superior sagittal sinus drainage. Preoperative angiography with embolization of the lesion (d). During venous phase of angiography, the abnormal drainage of superior sagittal sinus like “sinus pericranii” was clearly confirmed (e, red arrow)

Mentions: A 50-year-old female was admitted to Emergency Department because of the onset of status epilepticus requiring intubation. Brain MRI with venous angiography showed a parietotemporal enhancing giant mass extending toward pineal region determining mass effect on brain parenchyma, compression of the ventricular system and midline shift with an abnormal vascular drainage of superior sagittal sinus [Figure 2a–c]. After starting antiepileptic therapy, the status epilepticus resolved and the patient was extubated. Neurological examination showed only a left homonymous hemianopsia. She was then submitted to DSA to better understand the vascular anatomy and embolizate the lesion. During the procedure, only the embolization of the left occipital artery using Contour particle (150–200 micron) was possible due to the deviousness of posterior and middle meningeal artery feeders; moreover, during venous phase of angiography, the abnormal drainage of superior sagittal sinus like “sinus pericranii” was clearly confirmed [Figure 2d and e]. 2 days later, she was submitted to parieto-occipital craniotomy. During the approach, great care was made to avoid a skin incision over the sinus pericranii in order to respect the venous drainage of superior sagittal sinus. Complete tumor removal was obtained. Histological diagnosis was meningioma (WHO I). Postoperative course was uneventful. She is in good neurological and general conditions at 2-year follow-up.


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 T2-weighted (a) brain magnetic resonance imaging (MRI) showing a giant parieto-temporal meningioma enhancing after Gadolinium administration (c). Sagittal MRI venous angiography (b) evidenced an abnormal superior sagittal sinus drainage. Preoperative angiography with embolization of the lesion (d). During venous phase of angiography, the abnormal drainage of superior sagittal sinus like “sinus pericranii” was clearly confirmed (e, red arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Axial T2-weighted (a) brain magnetic resonance imaging (MRI) showing a giant parieto-temporal meningioma enhancing after Gadolinium administration (c). Sagittal MRI venous angiography (b) evidenced an abnormal superior sagittal sinus drainage. Preoperative angiography with embolization of the lesion (d). During venous phase of angiography, the abnormal drainage of superior sagittal sinus like “sinus pericranii” was clearly confirmed (e, red arrow)
Mentions: A 50-year-old female was admitted to Emergency Department because of the onset of status epilepticus requiring intubation. Brain MRI with venous angiography showed a parietotemporal enhancing giant mass extending toward pineal region determining mass effect on brain parenchyma, compression of the ventricular system and midline shift with an abnormal vascular drainage of superior sagittal sinus [Figure 2a–c]. After starting antiepileptic therapy, the status epilepticus resolved and the patient was extubated. Neurological examination showed only a left homonymous hemianopsia. She was then submitted to DSA to better understand the vascular anatomy and embolizate the lesion. During the procedure, only the embolization of the left occipital artery using Contour particle (150–200 micron) was possible due to the deviousness of posterior and middle meningeal artery feeders; moreover, during venous phase of angiography, the abnormal drainage of superior sagittal sinus like “sinus pericranii” was clearly confirmed [Figure 2d and e]. 2 days later, she was submitted to parieto-occipital craniotomy. During the approach, great care was made to avoid a skin incision over the sinus pericranii in order to respect the venous drainage of superior sagittal sinus. Complete tumor removal was obtained. Histological diagnosis was meningioma (WHO I). Postoperative course was uneventful. She is in good neurological and general conditions at 2-year follow-up.

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