2021 Volume 6 Issue 4 Pages 181-188
Objective: Few reports have described embolization prior to extraction of an intra-ventricular meningioma as this involves a rare site of origin. Embolization of the feeding arteries in such cases is difficult as the tumor is supplied by tiny branches of the cortical and choroidal arteries. Here, we discuss the embolization strategy adopted in treating a hypervascular meningioma at the trigone of the lateral ventricle in a pediatric patient.
Case Presentation: The patient was a 13-year-old girl presenting with the chief complaint of headaches and left-side hemiparesis. Magnetic resonance imaging (MRI) revealed a large meningioma and several flow void signals at the trigone of the right lateral ventricle. The maximum diameter of the meningioma was approximately 8 cm. During initial surgery without embolization, very little of the tumor could be removed due to massive bleeding. Proximal occlusion of the main feeders with 10% Eudragit E through the cortical branch of the posterior cerebral artery in a second procedure allowed the posterior two thirds to be removed. Two years later, the patient presented again, however, complaining of hemianopsia, and subsequent MRI revealed a residual tumor. In a subsequent third procedure, additional embolization through the posterior choroidal artery allowed complete removal of the residual tumor. She showed hemianopsia prior to being discharged.
Conclusion: We presented a case where, due to the vascular architecture, proximal occlusion by a simple push technique rather than intentional penetrating injection with liquid embolic materials was safe and effective in embolizing a meningioma at the trigone of the lateral ventricle before removal.
