Preoperative embolization of intracranial meningiomas with a fibrin glue preparation

BACKGROUND AND PURPOSE: Preoperative embolization expands the spectrum of m eningioma that can be operated on safely. Our goal was to achieve the dista lmost loading of the vascular bed and conflueut tumor necrosis with a fibri n glue preparation in the preoperative embolization of meningiomas. METHODS: Between 1992 and 1997, 80 patients with a meningioma had diagnosti c angiography with a standard transfemoral Seldinger technique, performed w ith a 6F guiding catheter and digital subtraction angiography, Preoperative embolization was carried out in the same session with an additional microc atheter system. Fibrin glue was the only component used. In all cases, CT w as performed immediately after embolization; in nine patients, MR imaging w as also performed. RESULTS: Angiography verified the elimination of tumor blush in all patient s. The high-density areas seen on postembolization CT scans, caused by the fibrin glue dispersed in the embolized supply area, were found to be necrot ic at surgery and were easily removed by suction. Two (2.5%) of the 80 pati ents had complications associated with embolization that resulted in neurol ogic deficits. CONCLUSION: The most effective preoperative embolization of tumors requires a distalmost loading of the vascular bed. Fibrin glue, which is easy to us e and safe to handle, causes confluent tumor necrosis within the injected v ascular territory.