Benefits of preoperative embolization before resection of a giant convexity meningioma: a case report

Meningiomas are typically benign and asymptomatic, but complicated or symptomatic cases may necessitate immediate intervention. Specifically, a giant meningioma with high vascularization poses a surgical challenge due to increased risk. In this report, a case of a giant meningioma managed with preoperative embolization (POE) before surgery was presented. A 24-year-old woman presented with severe bilateral visual disturbances and chronic headaches. Upon examination, magnetic resonance imaging (MRI) showed a giant meningioma measuring 97 mm in maximum diameter. Subsequent angiography indicated a significant tumor blush, primarily supplied by the right anterior cerebral artery (RACA) and the right middle cerebral artery (RMCA), with additional dural supply from the distal branches of the right and left middle meningeal artery (R-L MMA). Following this, endovascular embolization was performed, achieving 75% occlusion of the MMA using polyvinyl alcohol (PVA). The tumor was subsequently resected, attaining Simpson grade 1 on the fifth day post-embolization. Theoretically, preoperative embolization offered several advantages, including tumor devascularization, reduced operative blood loss, improved tumor visualization, and potentially higher rates of achieving Simpson grades I or II resection. The MMA was frequently targeted for embolization in meningioma cases, with no additional neurological deficit observed afterward. The optimal timing for resection typically fell within 1-7 days after embolization. During surgery, the patient experienced 1000 ml of bleeding over a 7-hour duration. The results showed that preoperative embolization provided significant benefits in reducing bleeding, shortening operating time, and facilitating mass resection, thereby affecting long-term recurrence rates, reported at 9% over 10 years.