American Journal of Neuroradiology, Vol 14, Issue 3 571-582, Copyright © 1993 by American Society of Neuroradiology
ARTICLES |
Extended preoperative polyvinyl alcohol microembolization of intracranial meningiomas: assessment of two embolization techniques
AK Wakhloo, FD Juengling, V Van Velthoven, M Schumacher, J Hennig and K Schwechheimer
Department of Neuroradiology, University of Freiburg, Federal Republic of Germany.
PURPOSE: To evaluate the efficacy of preoperative meningioma devascularization with small polyvinyl alcohol (PVA) particles. METHODS: In 34 patients with intracranial meningiomas, CT, MR, 1H MR spectroscopy, MR volumetric measurements, intraoperative ultrasound, and histopathologic findings were used to compare the efficacy of two embolization techniques: 1) administration of 150- to 300-microns PVA particles in the usual suspension, and 2) administration of 50- to 150- microns PVA particles in a highly diluted suspension. RESULTS: Angiography after embolization demonstrated the total elimination of tumor blush in all patients. Contrast-enhanced MR after the administration of 150- to 300-microns PVA particles revealed a reduction of tumor enhancement in only two out of 14 patients. Only after the use of small particles could significant tumor necrosis be depicted on MR and confirmed histopathologically after surgery. In 12 of 20 patients, 30% to 95% of the whole tumor was necrotic with 17% to 20% reduction of tumor volume in four cases, leading to recovery from the initial neurologic deficits. In three of 20 patients without sufficient steroid medication before the treatment, tumor swelling occurred. Postembolization MR disclosed a tumor volume increase of 10% to 20% in these patients. 1H MR spectroscopy of the tumors showed an increase of lactate and aliphatic lipid compounds after embolization, indicating tumor infarction. Surgical removal of effectively embolized meningiomas without significant blood loss was possible. The appearance of the tumor at operation, ultrasound examination, and the histopathologic examination of different parts of the tumor confirmed the preoperative MR findings suggesting necrosis. CONCLUSION: Extended microembolization with 50- to 150-microns PVA particles improves the surgical treatment of meningiomas, as compared with larger particle embolization. It may also be the only treatment required in older or high-risk patients. The protective effect of steroid medication before the endovascular treatment of meningiomas is suggested by our study.
This article has been cited by other articles:
 |
|
 |
|
  D. Gandhi, J.J. Gemmete, S.A. Ansari, S.K. Gujar, and S.K. Mukherji Interventional Neuroradiology of the Head and Neck AJNR Am. J. Neuroradiol., November 1, 2008; 29(10): 1806 - 1815. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.-S. Yen, C.-c. Lin, C.-C. Lee, T. Harnod, T.-W. Loh, and Y.-H. Hsu CNS Clostridium perfringens Infection: A Rare Complication of Preoperative Embolization of Meningioma AJNR Am. J. Neuroradiol., June 1, 2006; 27(6): 1355 - 1356. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Kai, J.-I. Hamada, M. Morioka, S. Yano, H. Nakamura, K. Makino, T. Mizuno, H. Takeshima, and J.-I. Kuratsu Clinical evaluation of cellulose porous beads for the therapeutic embolization of meningiomas. AJNR Am. J. Neuroradiol., May 1, 2006; 27(5): 1146 - 1150. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Renowden Interventional neuroradiology J. Neurol. Neurosurg. Psychiatry, September 1, 2005; 76(suppl_3): iii48 - iii63. [Full Text] [PDF]
|
|
|
|
|
|
L. Feng, B. A. Kienitz, C. Matsumoto, J. Bruce, M. Sisti, H. Duong, and J. Pile-Spellman Feasibility of Using Hyperosmolar Mannitol as a Liquid Tumor Embolization Agent AJNR Am. J. Neuroradiol., June 1, 2005; 26(6): 1405 - 1412. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Bendszus, C. M. Monoranu, A. Schutz, I. Nolte, G. H. Vince, and L. Solymosi Neurologic Complications after Particle Embolization of Intracranial Meningiomas AJNR Am. J. Neuroradiol., June 1, 2005; 26(6): 1413 - 1419. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. C. H. Yu, R. Boet, G. K. C. Wong, W. W. M. Lam, and W. S. Poon Postembolization Hemorrhage of a Large and Necrotic Meningioma AJNR Am. J. Neuroradiol., March 1, 2004; 25(3): 506 - 508. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kubo, N. Kuwayama, Y. Hirashima, A. Takaku, T. Ogawa, and S. Endo Hydroxyapatite Ceramics As a Particulate Embolic Material: Report of the Physical Properties of the Hydroxyapatite Particles and the Animal Study AJNR Am. J. Neuroradiol., September 1, 2003; 24(8): 1540 - 1544. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kubo, N. Kuwayama, Y. Hirashima, A. Takaku, T. Ogawa, and S. Endo Hydroxyapatite Ceramics As a Particulate Embolic Material: Report of the Clinical Experience AJNR Am. J. Neuroradiol., September 1, 2003; 24(8): 1545 - 1547. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Turner, J. D. Trobe, and J. P. Deveikis Sequential Branch Retinal Artery Occlusions Following Embolization of an Intracranial Meningioma Arch Ophthalmol, June 1, 2002; 120(6): 857 - 860. [Full Text] [PDF]
|
|
|
|
|
|
Y. Kai, J.-i. Hamada, M. Morioka, T. Todaka, S. Hasegawa, and Y. Ushio The Utility of the Microcrystalline Cellulose Sphere as a Particulate Embolic Agent:An Experimental Study AJNR Am. J. Neuroradiol., June 1, 2000; 21(6): 1160 - 1163. [Abstract] [Full Text]
|
|
|
|
|
|
M. Bendszus, I. Martin-Schrader, M. Warmuth-Metz, E. Hofmann, and L. Solymosi MR imaging-and MR spectroscopy-revealed Changes in Meningiomas for which Embolization was Performed without Subsequent Surgery AJNR Am. J. Neuroradiol., April 1, 2000; 21(4): 666 - 669. [Abstract] [Full Text]
|
|
|
|
|
|
M. Bendszus, R. Klein, R. Burger, M. Warmuth-Metz, E. Hofmann, and L. Solymosi Efficacy of Trisacryl Gelatin Microspheres versus Polyvinyl Alcohol Particles in the Preoperative Embolization of Meningiomas AJNR Am. J. Neuroradiol., February 1, 2000; 21(2): 255 - 261. [Abstract] [Full Text]
|
|
|
|
|
|
E. N. Probst, U. Grzyska, M. Westphal, and H. Zeumer Preoperative Embolization of Intracranial Meningiomas with a Fibrin Glue Preparation AJNR Am. J. Neuroradiol., October 1, 1999; 20(9): 1695 - 1702. [Abstract] [Full Text]
|
|
|
|
 |
|
 Y. P. Gobin, Y. Murayama, K. Milanese, K. Chow, N. R. Gonzalez, G. R. Duckwiler, and F. Vinuela Head and Neck Hypervascular Lesions: Embolization with Ethylene Vinyl Alcohol Copolymer—Laboratory Evaluation in Swine and Clinical Evaluation in Humans Radiology, November 1, 2001; 221(2): 309 - 317. [Abstract] [Full Text] [PDF]
|
|