Preoperative Transarterial Embolization of a Large Petrotentorial Angiomatous Meningioma Using Combination of Liquid Embolic Materials: A Case Report

Abstract

Intracranial angiomatous meningiomas are a rare WHO grade I histological variant of meningioma whose vascular component exceeds 50% of the total tumor area. Preoperative embolization of angiomatous meningiomas has rarely been reported previously. A 58-year-old woman was referred to our institute for a large petrotentorial hypervascular tumor presented with progressively worsening right facial paralysis and hearing loss for 6 months. Cranial computed tomography scan and magnetic resonance imaging revealed a large homogenously enhancing multilobulated mass involving middle and posterior cranial fossae with marked brainstem compression. The tumor extended into a right internal auditory canal and labyrinthine structures with destructive changes of bony structures. Magnetic resonance angiography showed hypervascularity in the tumor. Preoperative transarterial embolization using liquid embolic materials was successfully performed with resulting in almost complete devascularization of the tumor. Adequate hemostasis was achieved following gross total resection of the tumor (Simpson grade II). A histopathological examination confirmed the diagnosis of an angiomatous meningioma. Preoperative transarterial embolization of angiomatous meningioma with liquid embolic material was safe and effective in reducing perioperative blood loss and facilitating total tumor resection.

Scalp necrosis following preoperative endovascular embolisation of the superficial temporal artery for meningioma

“…Embolisation methods and materials vary, such as particulate or liquid embolic agents for embolisation. Liquid embolic agents (sclerosing agents, lipiodol cyanoacrylate glue and Onyx) are permanent, penetrate deeper into tumour vasculature and are currently the preferred embolysate 11. Onyx-18 is an ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide (DMSO), popular for its successful use with arteriovenous malformations and fistulas.…”

Spontaneous complete regression of malignant cavernous sinus dural arteriovenous fistula following partial transarterial embolization with liquid embolic material: Report of two cases

“…[ 8 , 14 , 23 ] At present, ethylene-vinyl alcohol (EVOH) copolymer-based liquid embolic agent, such as Onyx, has widely been used for intracranial DAVFs or hypervascular lesions due to slow polymerization and nonadhesive properties providing reduced risk of microcatheter entrapment than NBCA and prolonged embolization time during the embolization resulting in the more controlled injection of the agent. [ 6 , 12 , 14 ] We preferred EVOH as the first choice of liquid embolic material for CSDAVFs. In our first case, we used NBCA due to no EVOH available at that time.…”