Preoperative embolization of meningioma with ultra-low concentration n-butyl 2-cyanoacrylate

Abstract

• Abstract • Objective: We report the utility of low-concentration n-butyl 2-cyanoacrylate (NBCA) for preoperative embolization of meningioma. Methods: Twelve patients who were preoperatively diagnosed with meningioma were included in the study. Preoperative meningioma embolization with NBCA at 10-20% concentration was performed for 22 feeding vessels in 12 patients. We assessed the extent of intratumoral embolization and its effect on tumor removal. Results: Intratumoral embolization was possible in 17 feeding vessels (77.3%). In particular, 10-12.5% warmed NBCA effectively penetrated the tumor. The effect on tumor removal was good or excellent in 58.3% of patients. Conclusion: Preoperative embolization of meningioma with ultra-low concentrations of NBCA was useful. Understanding the relationship between the adhesion, the viscosity and the concentration of NBCA is essential for effective preoperative embolization.•

Angiogenesis in the Septum and Inner Membrane of Refractory Chronic Subdural Hematomas: Consideration of Findings after Middle Meningeal Artery Embolization with Low-concentration <i>n</i>-butyl-2-cyanoacrylate

“…As a result of reducing the concentration, adhesion to the catheter decreases and polymerization time is prolonged, thereby enabling infusion for a long period of time. 32,33) On the other hand, the viscosity of Lipiodol is 27–54 mm 2 /s at 20°C, which is more than 10 times higher than that of non-ionic contrast medium used for cerebral angiography. 34) Thus, simply decreasing the NBCA concentration reduces the viscosity, and even if NBCA is injected for a long time, the cast often does not flow significantly into the periphery.…”

“…In the past, the use of low-concentration NBCA in the preoperative embolization of meningioma was also reported to allow NBCA to reach the peripheral vascular bed in the tumor. 32) Based on the hypothesis that the formation of neovascular vessels in the inner membrane of hematomas is a cause of CSDH re-enlargement, we believe penetrating the periphery with low-concentration NBCA mixed with warm Lipiodol is effective for treatment. Moreover, NBCA is reported to present no difference in its effects for vascular occlusion at different concentrations; 35) thus, if NBCA can reach more peripheral neovascular vessels, potential blocking of the blood flow from the collateral circulation can be expected.…”

“…In addition, when removing a cast of low-concentration NBCA, one should pay attention to the scattering of NBCA to proximal vessels due to the softness of the cast. 36) To reduce these risks, Fukuda et al 32) reported the importance of using a 4-Fr intermediate catheter and slowly removing a catheter after NBCA injection. No complications resulting from the use of low-concentration NBCA for recurrent CSDH has been reported in any study, 16,18),20) including ours.…”

Usefulness of Oily Iodine Contrast Medium for Embolization of Meningioma

“…Kominami et al reported safety of embolization mainly with NBCA compared with embolization with particles, although embolization remained in the proximal portion in some cases. 5) Fukuda et al reported the usefulness of low concentration NBCA diluted warmed lipiodol, which enabled embolization of the tumor vascular bed, 6) but it makes the preparation complex. Aggravation of cerebral edema and intratumor hemorrhage due to obstruction of the outflow vein in cases with an arteriovenous shunt has been reported.…”