Preoperative Gelfoam embolization of supratentorial meningiomas

Intracranial meningiomas are often highly vascular and a successful outcome depends upon surgical resection. Preoperative embolization of supratentorial meningiomas, which have a major blood supply from the external carotid artery, has been advocated to reduce intraoperative bleeding and thus facilitate surgical extirpation. The authors carried out transfemoral, Gelfoam embolization preoperatively in eight patients with supratentorial meningiomas. In seven of the cases, post-embolization, contrast-enhanced, computerized tomography was carried out. Areas of low-density tumour necrosis were identified in five. In three of the eight patients, post-embolization angiography demonstrated elimination of the tumour blush and in the other five, the blush was reduced in intensity. Histologic evidence of tumour embolization was identified in each case to a varying degree. Preoperative embolization resulted in an identifiable radiologic change in the majority of these tumours, but the authors could not determine, in this small series, whether intraoperative bleeding was reduced.