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Han S, Yang Y, Yang Z, Liu N, Qi X, Yan C, Yu C. Continuous progression of hemorrhage of sphenoid ridge meningioma causing cerebral hernia: A case report and literature review. Oncol Lett 2020; 20:785-793. [PMID: 32566005 PMCID: PMC7285884 DOI: 10.3892/ol.2020.11590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/05/2020] [Indexed: 01/14/2023] Open
Abstract
The aim of the present study was to explore the clinical characteristics of repeated hemorrhages of meningioma and analyze the causes of hemorrhage. Meningiomas are mostly benign tumors that rarely manifest hemorrhagic strokes. In the present study, a case of sphenoid ridge meningioma with repeated hemorrhages is reported. Internal hemorrhage was first observed, which, on further aggravation, formed a hematoma in the brain parenchyma and finally led to the development of a hernia. No neurological deficit was present after surgery and rehabilitation. A postoperative pathological examination showed increased levels of Ki-67, abnormal blood vessels in the tumors and the presence of progesterone, which indicate possible causes of the hemorrhage. A review of associated previous studies revealed that hemorrhages originate mainly from inside the meningioma. Two cases of meningiomas with repeated hemorrhages have been reported; one in the foramen magnum region and the other in the pineal gland area. The foramen magnum tumor had an interval of 1.33 months between two hemorrhagic episodes. Collecting relevant data from the latter case was not possible. In the present case report, the interval between two bleeding episodes was 3 days. The literature review also revealed that the average age of onset of meningioma is relatively young at only 28.00±6.24 years. In conclusion, repeated hemorrhages in meningiomas are extremely rare and the causes have not yet been identified. Increased Ki-67 and abnormally proliferating blood vessels may be potential causes of hemorrhage. Early diagnosis and rapid surgical intervention are essential to prevent further episodes of bleeding, which may otherwise have fatal consequences for the patients.
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Affiliation(s)
- Song Han
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Yakun Yang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Zuocheng Yang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Ning Liu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Xueling Qi
- Department of Pathology, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Changxiang Yan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Chunjiang Yu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
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Dubel GJ, Ahn SH, Soares GM. Contemporary endovascular embolotherapy for meningioma. Semin Intervent Radiol 2014; 30:263-77. [PMID: 24436548 DOI: 10.1055/s-0033-1353479] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Preoperative endovascular tumor embolization has been used for 40 years. Meningiomas are the most common benign intracranial tumor in which preoperative embolization has been most extensively described in the literature. Advocates of embolization report that it reduces operative blood-loss, and softens the tumor, thus making surgery safer and easier. Opponents suggest that it adds additional risk and cost for patients without controlled studies showing conclusive benefit. The literature suggests a 3 to 6% neurological complication rate related to embolization. The combined external and internal carotid artery blood supply and complex anastomoses of the meninges can make embolization challenging. Positive outcomes require thorough knowledge of the pertinent vascular anatomy, familiarity with the neurovascular equipment and embolics, and meticulous technique. There remains debate on several aspects of embolization, including tumors most appropriate for embolization, embolic agent of choice, ideal size of embolic, and the choice of vessel(s) to embolize. This detailed review of pertinent vascular anatomy, embolization technique, results, and complications should allow practitioners to maximize treatment outcomes in this setting.
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Affiliation(s)
- Gregory J Dubel
- Department of Diagnostic Imaging, Division of Interventional Radiology Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Sun Ho Ahn
- Department of Diagnostic Imaging, Division of Interventional Radiology Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Gregory M Soares
- Department of Diagnostic Imaging, Division of Interventional Radiology Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
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Gilad R, Fatterpekar GM, Gandhi CD, Winn HR, Johnson DM, Patel AB, Bederson JB, Naidich TP. Intracranial Tumors: Cisternal Angle as a Measure of Midbrain Compression for Assessing Risk of Postembolization Clinical Deterioration. Radiology 2009; 251:892-900. [DOI: 10.1148/radiol.2513081333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Celedin S, Rabitsch E, Hausegger KA, Richling B. Accidental transtumoral microparticle embolization of eloquent brain areas in a case of large temporofrontal meningioma. Interv Neuroradiol 2008; 14:339-43. [PMID: 20557734 DOI: 10.1177/159101990801400317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 04/28/2008] [Indexed: 11/15/2022] Open
Abstract
SUMMARY We report a case of transtumoral diapedesis of microparticles during preoperative embolization of a large symptomatic temporofrontal meningioma, resulting in severe neurological deficit. In retrospective analysis of angiographic images, the pattern of supply to the tumour was found to be predictive for wide anastomotic channels connecting the dural and pial supply, thereby increasing the risk of the procedure. Recognising this pattern can prevent this rare cause of complication in a still controversial procedure.
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Affiliation(s)
- S Celedin
- Institute for Diagnostic and Interventional Radiology, General Hospital Klagenfurt, St.Veiter Strasse 47, Klagenfurt, Austria
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5
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Kai Y, Hamada JI, Morioka M, Yano S, Nakamura H, Makino K, Mizuno T, Takeshima H, Kuratsu JI. Preoperative cellulose porous beads for therapeutic embolization of meningioma: provocation test and technical considerations. Neuroradiology 2007; 49:437-43. [PMID: 17318600 DOI: 10.1007/s00234-007-0218-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 01/22/2007] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cellulose porous beads (CPBs) are exceptionally uniform in size and nonabsorbable and they provide highly effective tumor devascularization. The risk of cranial nerve palsy must not be overlooked when embolization with CPBs is considered in meningioma patients. We attempted to identify patients at risk of cranial nerve palsy after meningioma embolization. METHODS Prior to preoperative superselective embolization with 200 mum diameter CPBs, 141 patients with meningioma underwent provocation test with lidocaine and amytal. They were divided into two groups on the basis of whether they were or were not considered eligible for embolization. We evaluated the differences between the two groups with respect to tumor anatomy, angiographic findings, and clinical presentation and recorded complications associated with the embolization of the meningioma. RESULTS Of the 141 patients, 128 underwent CPB embolization (group 2); 13 were not embolized because their provocation test results were positive (group 1, n = 11) or because they showed vasospasm (n = 2). Group 1 patients had meningioma in the cavernous sinus or petroclival region. Characteristically, the feeders were of middle meningeal artery origin and exhibited a posteromedial course toward the petrous apex or cavernous sinus. In group 2 patients the middle meningeal artery was the feeder, but it lacked branches coursing posteromedially. Three of these patients experienced complications which included intratumoral hemorrhage (n = 2) and post-embolization hearing disturbance (n = 1). CONCLUSION Patients with meningioma whose tumor-feeding arteries run posteromedially toward the petrous apex or cavernous sinus are at increased risk of post-embolization cranial nerve palsy. Appropriate protocols, including lidocaine and amytal provocation tests, may reduce the risk of complications after CPB embolization of the external carotid territory in this group of patients.
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Affiliation(s)
- Yutaka Kai
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto 860-8556, Japan.
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6
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Abstract
The technical skill set of peripheral interventional radiologists is well-suited to the performance of most transcatheter embolization procedures in the external carotid artery (ECA). These procedures center in large part on hypervascular tumors, epistaxis, and trauma. ECA embolization in the trauma patient is well-defined, albeit in small patient series. The transcatheter treatment of epistaxis is still mostly reserved for cases that are intractable to conservative therapy. Preoperative embolotherapy for vascular tumors remains popular, although it is somewhat controversial in terms of its risk-benefit ratio. The purpose of this review is to highlight pertinent anatomy, selected technical procedural aspects, and the available literature to better characterize the role of ECA embolization in the hands of the practicing peripheral interventionist.
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Affiliation(s)
- Tony P Smith
- Department of Radiology, Duke University Medical Center, Room 1502, Box 3808, Durham, North Carolina 27710, USA.
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Lee SSW, Chan KY, Pang KH, Datta N, Poon YF, Aung TH, Kwok J. Effect of preoperative embolization on resection of intracranial meningioma: Local experience. SURGICAL PRACTICE 2006. [DOI: 10.1111/j.1744-1633.2006.00309.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Deshmukh VR, Fiorella DJ, McDougall CG, Spetzler RF, Albuquerque FC. Preoperative embolization of central nervous system tumors. Neurosurg Clin N Am 2005; 16:411-32, xi. [PMID: 15694171 DOI: 10.1016/j.nec.2004.08.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Vivek R Deshmukh
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA
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Levy EI, Kim SH, Bendok BR, Boulos AS, Xavier AR, Yahia AM, Qureshi AI, Guterman LR, Hopkins LN. Interventional Neuroradiologic Therapy. Stroke 2004. [DOI: 10.1016/b0-44-306600-0/50087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Perry A, Chicoine MR, Filiput E, Miller JP, Cross DT. Clinicopathologic assessment and grading of embolized meningiomas: a correlative study of 64 patients. Cancer 2001; 92:701-11. [PMID: 11505418 DOI: 10.1002/1097-0142(20010801)92:3<701::aid-cncr1373>3.0.co;2-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Preoperative embolization of meningiomas is commonly performed to minimize intraoperative bleeding, thereby facilitating surgery and reducing the necessity for transfusion. However, the resulting necrosis and compensatory proliferation reportedly have hampered subsequent histologic grading. METHODS The clinicopathologic features of 64 meningiomas embolized between 1989 and 1997 were assessed. Tumors were graded according to recently published criteria. RESULTS A good embolization result (> 75% reduction in angiographic blush) was achieved in 52%. Histologically, embolized meningiomas showed higher frequencies of necrosis (89%), nuclear atypia (72%), macronucleoli (58%), sheeting (31%), high mitotic index (30%), and brain invasion (14%) when compared with nonembolized counterparts. Median mitotic and MIB-1 indices were slightly elevated (1.5 of 10 high-power fields and 1.6%, respectively). A significant degree of necrosis (> 10%) was found in 43% and was only roughly correlated with extent of angiographic blush reduction or embolization particle size. Histologic grade was benign in 57.8%, atypical in 40.6%, and anaplastic in 1.6%. At last follow-up, there were 13 recurrences, 11 in the atypical/anaplastic (41%) versus 2 in the benign (5%) subsets (P = 0.001). CONCLUSIONS The authors conclude that 1) their grading scheme accurately stratifies embolized meningiomas, 2) extent of necrosis is difficult to predict using standard clinical parameters, and 3) their high incidence of atypical meningioma more likely reflects patient selection biases rather than artifacts induced by the embolization procedure.
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Affiliation(s)
- A Perry
- Department of Pathology and Immunology, Division of Neuropathology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO 63110-1093, USA.
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Kurata A, Miyasaka Y, Tanaka C, Tokiwa K, Saegusa H, Fujii K, Kan S. Prevention of Complications during Endovascular Surgery on the External Carotid Arteries, with Special Reference to Use of Nitropaste and the Lidocaine test. Interv Neuroradiol 2001; 2:193-200. [PMID: 20682096 DOI: 10.1177/159101999600200304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/1996] [Accepted: 07/25/1996] [Indexed: 11/15/2022] Open
Abstract
SUMMARY PURPOSE To examine all complications of endovascular procedures on the external carotid arteries and to ascertain how to reduce their number. METHODS In 93 consecutive patients, 137 endovascular procedures on the external carotid arteries were performed during the last 6 years. RESULTS We encountered no neurologic complications in these patients. In eight (9%) of the 93 patients who underwent lidocaine tests of the external carotid branches, nine transient cranial nerve palsies occured, seven of 67 vessels (10%) involving the middle meningeal artery and two of 18 vessels (11%) the ascending pharyngeal artery. However, they soon disappeared and successful embolisations were achieved. Vasospasm that prevented endovascular procedures occurred in only two cases of this series as a result of the application of isosorbide dinitrate. CONCLUSIONS The lidocaine test effectively provoked cranial nerve palsies without false negatives. The complication rate of endovascular surgery will decrease as long as awareness of complications such as cranial nerve palsy is maintained.
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Affiliation(s)
- A Kurata
- Department of Neurosurgery, Kitasato University School of Medicine; Sagamihara, Kanagawa, Japan
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13
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Abstract
Although embolization of meningiomas has been performed for many years as a preoperative adjunct to reduce tumor vascularity and facilitate surgical excision, little has been written about the features of the histological artefacts introduced by the process. In particular, the fact that it may produce tumor necrosis may potentially cause confusion with atypical or malignant meningiomas. In this study, 25 meningeal tumors of different histological subtypes, all of which had been previously embolized, were reviewed histologically as well as with immunostaining for the MIBI antigen and proliferating cell nuclear antigen (PCNA). Necrosis, in the form of confluent necrosis as well as micronecrosis, was the most common feature (48%). Other characteristic features included florid ischemic changes (16%), intravascular Ivalon particles (24%), and fibrinoid necrosis of vascular walls (12%). Histological changes showed no obvious relationship with the interval between embolization and surgery. There was an increase in MIB1 and PCNA labelling indices in those tumor exhibiting necrotic foci, but it did not seem to have any prognostic significance. We believe pathologists should be familiar with the histological changes induced by embolization in meningiomas so that an erroneous diagnosis of a high-grade lesion will not be made.
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Affiliation(s)
- H K Ng
- Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Shatin, Hong Kong
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15
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Embolization with Temporary Balloon Occlusion of the Internal Carotid Artery and In Vivo Proton Spectroscopy Improves Radical Removal of Petrous-tentorial Meningioma. Neurosurgery 1994. [DOI: 10.1097/00006123-199411000-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Tymianski M, Willinsky RA, Tator CH, Mikulis D, TerBrugge KG, Markson L. Embolization with temporary balloon occlusion of the internal carotid artery and in vivo proton spectroscopy improves radical removal of petrous-tentorial meningioma. Neurosurgery 1994; 35:974-7; discussion 977. [PMID: 7838353 DOI: 10.1227/00006123-199411000-00028] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A highly vascular petroclival meningioma supplied by tentorial branches of the internal carotid artery was embolized by temporary balloon occlusion of the parent vessel distal to the tumor, followed by obliteration of the tumor vascularity with polyvinyl alcohol particles. Subsequently, in vivo proton spectroscopy showed necrosis of a large portion of the tumor and helped determine the timing of surgery. Both innovative techniques considerably facilitated the subsequent radical excision of the tumor with no neurological morbidity.
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Affiliation(s)
- M Tymianski
- Division of Neurosurgery, Toronto Hospital, University of Toronto, Ontario, Canada
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Nelson PK, Setton A, Choi IS, Ransohoff J, Berenstein A. Current Status of Interventional Neuroradiology in the Management of Meningiomas. Neurosurg Clin N Am 1994. [DOI: 10.1016/s1042-3680(18)30529-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hemangiopericytoma of the Temporal Bone Presenting as a Retroauricular Mass. Neurosurgery 1993. [DOI: 10.1097/00006123-199310000-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Chin LS, Rabb CH, Hinton DR, Apuzzo ML. Hemangiopericytoma of the temporal bone presenting as a retroauricular mass. Neurosurgery 1993; 33:728-31; discussion 731-2. [PMID: 8232815 DOI: 10.1227/00006123-199310000-00025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
An unusual case of a hemangiopericytoma arising from the temporal bone is presented. The patient was noted to have a postauricular mass and was neurologically asymptomatic. A preoperative magnetic resonance image and an angiogram revealed the tumor to be highly vascular. Preoperative embolization facilitated the surgical removal of the tumor by rendering it avascular. Current therapy consists of radical resection of the tumor with postoperative radiation therapy. Patients must be monitored carefully for local recurrence and systemic metastasis.
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Affiliation(s)
- L S Chin
- Department of Neurological Surgery, University of Southern California School of Medicine, Los Angeles
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