Preoperative embolization of meningiomas with N-butyl cyanoacrylate

Abstract

Meningiomas are often embolized before their surgical resection to reduce blood loss during surgery. Polyvinyl alcohol (PVA) particles have been the most frequently used material for embolization of meningiomas. We have used n-butyl cyanoacrylate (NBCA) as the first-choice material since 2001. Thirty-one meningiomas were embolized with NBCA. We report the result of embolization of meningiomas with NBCA in comparison with PVA particles.

Figure 1

Case 1. Contrast-enhanced T1-weighted image of MRI (A) shows a medial sphenoid ridge meningioma. Antero-posterior view of right internal carotid angiogram (B) and lateral view of external carotid angiogram (C) demonstrate tumor stain supplied from both internal and external carotid arteries. Injection of n-butyl cyanoacrylate in the tumor vessels through the microcatheter advanced via the middle meningeal artery (D) resulted in complete obliteration of tumor stain confirmed by internal carotid (E) and external carotid (F) injection of contrast after embolization.

Figure 2

Case 9. Embolization from bilateral middle meningeal artery. Contrast-enhanced T1-weighted image of MRI (A) shows a convexity meningioma on the left side. left external carotid angiogram (B) shows the tumor stain supplied from the left middle meningeal artery (MMA). Embolization with NBCA from the left MMA (C) ended up with proximal occlusion and right external carotid angiogram after the first embolization (D) demonstrates supply to the tumor from the contralateral MMA. Antero-posterior view of the injection of NBCA from the right MMA (E) penetrates not only into the tumor but also into the distal part of the falcine artery which is also feeding the tumor.

Figure 3

Case 12. Superselective embolization of a convexity meningioma. Contrast-enhanced T1-weighted image of MRI (A) shows a convexity meningioma. Antero-posterior view (B) and lateral view (C) of the right external angiogram shows two branches of the middle meningeal artery feeding the tumor. Superselective injections of NBCA through the two branches (D, E) penetrated into the tumor vessels.

Figure 4

Case 30. Embolization of contribution from pial vessel. Axial, coronal and sagittal images of contrast-enhanced T1-weighted images (A-C) show a convexity meningioma. Right internal carotid angiogram performed after embolization through the branches of bilateral middle meningeal artery (D) demonstrates pial contribution of the tumor from a branch of the anterior cerebral artery. This branch was catheterized with a flow-guided microcatheter and embolized with the same technique as that of arteriovenous malformation (E). Tumor stain from pial contribution disappeared after the embolization (F).

Figure 5

Case 31. Embolization of an infratentorial meningioma. Axial, coronal and sagittal images of contrast-enhanced T1-weighted images (A-C) show an infratentorial meningioma. Right external carotidogram (D) demonstrates feeders from the middle meningeal artery and the occipital artery. Use of a flow-guided microcatheter allowed superselective injections of NBCA through the middle meningeal artery (E) and through the transosseous branch of the occipital artery (F).