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Tumor Volume Decrease via Feeder Occlusion for Treating a Large, Firm Trigone Meningioma.
Takuma Nakashima1, Norikazu Hatano2, Fumiaki Kanamori3
1Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Large trigone meningiomas pose surgical challenges. Initial microsurgical feeder occlusion followed by staged surgery effectively treated a large, hard trigone meningioma by inducing necrosis and softening.
Area of Science:
- Neurosurgery
- Oncology
Background:
- Trigone meningiomas are challenging due to their size and vascularity.
- Surgical treatment of large, firm trigone meningiomas requires innovative approaches.
Observation:
- A 19-year-old woman presented with a large, firm left ventricular trigone meningioma.
- Initial transsylvian surgery involved microsurgical occlusion of choroidal artery feeders.
- Tumor firmness limited initial resection, but feeder occlusion caused necrosis and volume reduction.
Findings:
- Initial feeder occlusion led to a 20% tumor diameter decrease and mass effect alleviation within a year.
- Ischemia-induced tumor softening facilitated complete resection in staged procedures.
- This staged approach proved safe and effective for managing a large, hard trigone meningioma.
Implications:
- Microsurgical feeder occlusion is a viable strategy for large, firm trigone meningiomas.
- Staged surgical excision following feeder occlusion can improve resectability and patient outcomes.
- This technique offers a potential solution for complex meningioma cases.

