eMedicine Specialties > Radiology > Brain/Spine

Meningioma, Brain: Follow-up

Author: German C Castillo, MD, FACR. FICS, Assistant Professor, Department of Diagnostic and Interventional Radiology, Harvard Clinic and Central University of Ecuador
Contributor Information and Disclosures

Updated: Apr 27, 2007

Intervention

The development of catheters and the continued refinement of embolic materials and radiographically controlled interventional procedures have contributed to improved treatment of patients with brain meningiomas. The clinician must be aware of the active participation of the neurosurgeon and neuroradiologist in the therapy of neurosurgical patients.

Currently, the best available treatment for benign meningiomas is complete surgical resection of the tumor. Nevertheless, interventional neuroradiologists should contribute in performing preoperative embolization to reduce the blood supply to the tumor. All meningiomas are benefited by embolization, but especially those with a complex presentation, giant meningiomas, meningiomas exhibiting malignant or angioblastic characteristics, or meningiomas involving the skull base, scalp, or critical vascular structures.The preoperative embolization of meningiomas is commonly used to facilitate surgery.

Embolization can be carried out at the same time as the diagnostic angiography session or may occur later if detailed procedural planning is required. Distal, homogeneous, and permanent occlusion of the vascular bed by injecting small particles (150-300 µ of polyvinyl alcohol) through microcatheters is the goal. Bilateral dural devascularization shortens the surgical resection time and permits total removal of the tumor. The procedure causes tumor necrosis, expanding the spectrum of meningiomas that can be safely resectioned during surgery.

Polyvinyl alcohol (PVA) particles size ranged from 100 to 2000 microns ( Biodyne, Ivalon, Contour Emboli) have been used, but the newer class of deformable particles (Embospheres (Microsphere) and Bead Block (Terumo) are more effective in distal embolotherapy to reach the capillary bed of the meningioma. Embospheres can be tagged with chemotherapeutic agents. Several meningiomas of the convexity have been embolized with Embospheres in our experience that will be soon reported.

Approximately 2% of patients have complications associated with embolization that result in neurologic deficits. At the theoretical level, embolization may reduce the likelihood of recurrence. Embolization also may be the only treatment required in older or high-risk patients (see Images 20-22 , 26-33).

Medicolegal Pitfalls

  • A growing number of lawsuits that name radiologists involve special procedures.
  • Good technique, good planning, and informed consent, which includes the involvement of the interventional neuroradiologist, can help physicians prevent most claims.

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References
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Further Reading

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Keywords

meningothelioma, leptomeningioma, mesothelioma of the dura mater

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Contributor Information and Disclosures

Author

German C Castillo, MD, FACR. FICS, Assistant Professor, Department of Diagnostic and Interventional Radiology, Harvard Clinic and Central University of Ecuador
German C Castillo, MD, FACR. FICS is a member of the following medical societies: American Roentgen Ray Society, International College of Surgeons, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey L Creasy, MD, Associate Professor, Associate Section Head, Division of Neuroradiology, Director, Neuroradiology Fellowship, Department of Radiology, Vanderbilt University
Jeffrey L Creasy, MD is a member of the following medical societies: American College of Radiology, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Carlos Lozada, 
Carlos Lozada is a member of the following medical societies: Society for Health and Human Values
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

James G Smirniotopoulos, MD, Professor of Radiology, Neurology, and Biomedical Informatics, Chairman, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences
James G Smirniotopoulos, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Head and Neck Radiology, American Society of Neuroradiology, American Society of Pediatric Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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