What’s the diagnosis?
Note the prominent flow voids, or vessels, along the periphery of the tumor
Distal right middle cerebral artery branches provide arterial inflow into the tumor. Note the vascular tumor blush that lasts late into the venous phase on these angiographic runs.
Middle meningeal and superficial temporal arteries provide arterial inflow into the tumor.
An hypertrophied left middle meningeal artery crosses over to the contralateral side to provide arterial inflow into the tumor.
- Patients with large intracranial lesions that cause mass effect on the normal brain may benefit from steroids, which → ↓ vasogenic edema.
- Patients with a newly identified brain tumor who have a seizure should be started on anti-epileptic medications to prevent further seizures.
- Blood supply to extra-axial brain tumors typically arises from external carotid artery branches and from dural branches of the internal carotid arteries. However, highly vascular tumors can recruit substantial arterial inflow from the internal carotid artery and also from trans-osseous scalp arteries that travel through the bony skull to feed the tumor.
What's your treatment plan?
In this case, the patient underwent adjunctive endovascular embolization of right external carotid feeding arteries with microsphere particles and coils. The next day a right-sided craniotomy was performed with resection of the tumor and excision of the involved dura mater. Final tissue diagnosis was meningioma (World Health Organization Grade 1).
A microcatheter was advanced as distally as possible into the middle meningeal artery branches that were providing arterial inflow into the tumor. Microspheres were slowly injected until flow stagnation or any reflux along the microcatheter were noted.
Once the distal middle meningeal artery feeders were satisfactorily embolized, coils were used to embolize the more proximal middle meningeal artery trunk.