Three cases of meningioma complicated by increased edema or intratumoral bleeding following embolization with N-butyl cyanoacrylate

Abstract

Objective: We report three cases of meningioma complicated by increased edema or intratumoral bleeding following embolization with N-butyl cyanoacrylate (NBCA).
Case presentation: Case 1 (a 36-year-old man) presented with a parasagittal meningioma. Both Cases 2 (an 83-year-old woman) and 3 (a 63-year-old woman) presented with large convexity meningiomas. All three meningiomas were large tumors with prominent tumor staining and arteriovenous (AV) shunts. Because of the AV shunt, NBCA used for the preoperative embolization of the middle meningeal arteries flowed into the drainage vein. Patients in Cases 1 and 2 had progression of hemiparesis 2 days after embolization. Drainage vessel occlusion was presumably the cause of increased edema because Case 1 presented venous infarction on magnetic resonance imaging. The patient in Case 3 complained of headache after embolization; CT performed 1 day after embolization demonstrated intratumoral bleeding. However, CT immediately after embolization showed no clear bleeding due to the contrast and NBCA artifacts. Fortunately, an intravenous drip of steroids and osmotic diuretics prevented those symptoms from worsening. All patients underwent scheduled surgery. Although large cerebral infarctions were observed around the tumor resection sites in all cases postoperatively, the cause was not obviously venous infarction due to drainage occlusion. Patients recovered during a 3-month rehabilitation period and improved to modified Rankin Scale 1–3.
Conclusion: NBCA, a liquid embolic material, can easily infiltrate the tumor capillary bed, especially for tumors with the AV shunt. Physicians should pay close attention to injection speed and NBCA viscosity because of the risk of drainage vein occlusion.