Preoperative Embolization of Intracranial Meningiomas with a Fibrin Glue Preparation
Eva Neumaier Probst
,a,
Ulrich Grzyskaa,
Manfred Westphala and
Hermann Zeumera
a From the Departments of Neuroradiology (E.N.P., U.G., H.Z.) and Neurosurgery (M.W.), University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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FIG 1. Preparation formula for the fibrin glue mixture. Final concentrations were as follows: 139 mg J, 62.5 IU thrombin, 33.25 mg fibrin glue, and 3.333 KIE Trasylol/mL
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FIG 2. Case 42: 40-year-old woman with sphenoid wing meningioma.
A and B, Lateral views of vascular arterial tumor supply show the main feeding artery to be the middle meningeal artery on the right side.
C and D, Capillary phase (lateral view) shows progression of embolization with fibrin glue.
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FIG 3. A–D, CT scans of same patient as in figure 2 after embolization of the tumor core fed by the middle meningeal artery. Considerable hyperdensity, caused by fibrin glue, is dispersed homogeneously in this supply area. Less hyperdensity, from contrast medium alone, is seen within the nonembolized areas
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FIG 4. Histologic specimen shows the clear-cut borderline between necrotic meningeal (lower right ) and vital arachnoidal (upper left ) supply areas after embolization (hematoxylin-eosin, original magnification x40)
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FIG 5. T1-weighted axial MR images of a clivus meningioma obtained after administration of contrast material.
Top row, Images obtained before embolization show the tumor displacing the pons and compressing the fourth ventricle on the right side.
Middle row, 4 days after embolization of the meningioma, extensive necrotic areas are visible, especially in the rostral and dorsal parts of the tumor.
Bottom row, 5 months later, tumor is significantly reduced in size. The necrotic areas are resorbed and the compression of the pons and the fourth ventricle is barely detectable.
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FIG 6. Coronal T1-weighted MR images of the same patient as in figure 2 after administration of contrast material show reduction in tumor size.
Top row, 4 days after embolization, the meningioma shows extensive necrotic areas.
Bottom row, 5 months later, there is resorbtion of the necrotic areas and a reduction in tumor size.
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AJNR - American Journal of Neuroradiology