Arterial embolization as a pre-operative strategy to reduce bleeding in giant meningioma resection

Alejandro Tenorio-Pacheco, Departamento de Neurocirugía, Instituto de Seguridad y Servicios Sociales de los Trabajadores al Servicio de los Poderes del Estado de Puebla (ISSSTEP), Puebla, Mexico
Pablo Ruíz-Flandes, Departamento de Neurocirugía, Instituto de Seguridad y Servicios Sociales de los Trabajadores al Servicio de los Poderes del Estado de Puebla (ISSSTEP), Puebla, Mexico
Talita B. Serrano-Hernández, Departamento de Neurocirugía, Instituto de Seguridad y Servicios Sociales de los Trabajadores al Servicio de los Poderes del Estado de Puebla (ISSSTEP), Puebla, Mexico

Meningiomas account for 39.7% of primary intracranial tumors, with atypical types comprising 17.7%. Here, we report a case of a 55-year-old woman with a giant right frontoparietal atypical meningioma, for which initial surgery was postponed due to excessive bleeding. Pre-operative endovascular embolization effectively reduced arterial flow to the tumor, allowing for successful complete resection. Histopathological analysis confirmed the atypical meningioma diagnosis according to the World Health Organization criteria. The post-operative course was favorable, with no complications or early recurrence. The objective of this article is to highlight the usefulness of pre-operative embolization in reducing intraoperative bleeding, which helps optimize complete resection, thereby lowering morbidity and the risk of recurrence, as demonstrated in this case.

Keywords: Meningioma. Neurosurgery. Embolization. Tumor. Endovascular.