Postembolization Hemorrhage of a Large and Necrotic Meningioma

Simon C. H. Yu, Ronald Boet, George K. C. Wong, Wynnie W. M. Lam, and Wai S. Poon

Abstract

Summary:
Microparticulate embolization of meningiomas is a useful preoperative measure, but the potential risk of hemorrhagic complications should be recognized and balanced against the benefits. We report a case of subarachnoid hemorrhage occurring immediately after the embolization of a meningioma. Techniques for early diagnosis, such as CT, and early surgical intervention are crucial to a promising outcome. Large-size and necrotic or cystic components of a meningioma are probable risk factors that demand special consideration.

Preoperative embolization of meningiomas is widely practiced, because the desired hemostasis and necrosis facilitate easier surgical manipulation and removal of the tumor as well as a reduction of blood loss during surgery. Such embolization procedures, however, are not without risk (1–3). We report a case of subarachnoid hemorrhage occurring immediately after the embolization of a large and necrotic falcine meningioma and propose a probable mechanism of such postembolization hemorrhage. Large and necrotic or cystic components of a meningioma are potential risk factors that should be recognized and considered when embolization of such tumors is contemplated.

Case Report
A 61-year-old woman presented with increasing headache and left lower limb weakness of 4-month duration. CT and MR imaging revealed a 7.3 x 5.2 x 6.6-cm falcine meningioma located in the right parietal lobe, with evidence of central tumor necrosis.

Full Publication: http://www.ajnr.org/content/25/3/506.full