Preoperative embolization (POE) of meningioma is a widely adopted adjunctive procedure in favor of decrease of the intraoperative bleeding, softening of the tumor and shortening of the operative time. It is indicated not only for large and/or hypervascular meningiomas, but also for those located at the skull base; however, the evidence of its usefulness has not been established, although its favorable effects have been shown on contrast-enhanced or arterial spin labeling MRI.
To date, different embolic materials have been used, such as particles, liquid and metallic coils, which should be selected after careful assessment of the feeding arteries, considering the features of each embolic material. On histopathological diagnosis, POE frequently induces necrosis, regenerative atypia and compensatory proliferative activity in the tumor, which may have the potential for overgrading inherently benign meningiomas (WHO grade I) as atypical (WHO grade II). This concern has influenced the definition of atypical meningioma in the WHO classifications. This review describes the current status of POE of meningioma and the pathological considerations in the diagnosis of embolized meningiomas.
We report a rare case of cerebral amyloid angiopathy-related inflammation. A 75-year-old man presented with sudden-onset of headache, left hemiplegia and sensory disturbance, followed by left hemispatial neglect, pseudopsia, behavior disorder, and seizure. Magnetic resonance imaging showed leptomeningeal enhancement along the parietal and occipital sulci without cortical-subcortical microhemorrhage. Examination of the cerebrospinal fluid revealed highly elevatedprotein with only a slightly increased cell count. Brain biopsy of the lesion showed vascular amyloid deposition in the leptomeningeal and parenchymal vessels with perivascular inflammation and abundant multi-nuclear giant cells, which suggested a diagnosis of cerebral amyloid angiopathy-related inflammation. The effect of pulse steroid therapy was equivocal and the clinical and radiological findings remainedunchanged, consistent with subacute leukoencephalopathy.