[Cystic meningioma associated with intratumor and subarachnoid hemorrhage during embolization--a case report]

We present a case of a cystic meningioma accompanied with hemorrhage in a cyst and adjacent subarachnoid space that occurred while preoperative embolization in feeders for the tumor was being applied. A 73-year-old male patient was admitted for a complaint of convulsion. Under CT examination, a tumor was observed at the left frontal convexity and found to be fed by the middle cerebral artery shown in the left cerebral angiograms. The tumor was diagnosed meningioma. After removing the tumor, we conducted histological study. Gross findings of its cross section had an atypical bleeding pattern which was resulted from the ruptures of the criss-crossing internal and external carotid arteries in the tumor. The findings indicated that the tumor was an angiomatous meningioma and contained meningotheliomatous components. The hemorrhage was occurred in the portion of the angiomatous meningioma. The possible reason for the hemorrhage was thought that sudden dynamic changes in blood flow which were triggered by the embolization. The sudden changes could have caused multiple ruptures on pathologic small vessels. Therefore, we strongly recommend that preoperative embolization should be proceeded with caution for exercising a cyst meningioma, since it could increase the possibility of bleeding from pathologic weak vessels.