Bilateral Middle Meningeal Artery Embolization and Resection of a Large Parafalcine Meningioma: a Case Study
Melinda Arthur1, Samuel Lee1, Rosemary Gomes1, Hope Okpokam1, Adesh Tandon2, Jonathon Lebovitz3, Wright Paul1
1Division of Neurology, 2Division of Neurosurgery, 3Division of Neurointerventional Radiology, Nuvance Health
Objective:
Parafalcine meningiomas are located in the central longitudinal sulcus and difficult to access intraoperatively. Endovacular embolization reduces surgical complications and blood loss in highly vascular meningiomas and when blood supply is out of surgical visualization. We present a case of successful middle meningeal artery (MMA) embolization and resection of a large bifontral lobe parafalcine meningioma.
Design/Methods:
A 51-year-old male with a history of bipolar disorder, thyroid papillary carcinoma, childhood leukemia status post radiation presented with several syncopal episodes. CT head showed a large extra-axial hyperintense mass. MRI of the brain with contrast revealed a 4.1 x 7.9 x 5.2 cm enhancing midline bifrontal parafalcine extra-axial mass compatible with a meningioma. MR Venogram showed severe narrowing of the middle third of the superior sagittal sinus. Due to highly the vascular nature of the tumor, a decision was made for endovascular embolization. Right and left MMA were selected for embolization and Cook PVA 200 particles were used for successful embolization. The next day, a bicoronal craniotomy with the use of frameless neuronavigation was performed. Tissue was sent to pathology and was defined as WHO Grade 1 meningioma.
Results:
Bilateral MMA embolization and craniotomy of a large bifrontal parafalcine meningioma was performed successfully without complications.
Conclusions:
Endovascular embolization is optimal in reducing surgical complications and blood loss in highly vascular parafalcine meningiomas.