PMC4496841_01
Axial (a), coronal (b) and sagittal (c) T2-weighted brain magnetic resonance imaging showing a large right temporal meningioma with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit. The tumor shows wide enhancement after Gadolinium administration (d). A pseudo-aneurysm of right middle cerebral artery branch before (e and f; red arrow) and after (g and h) embolization with Glubran2 glue
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F1
A 44-year-old female was admitted to our department because of a 3-year history of headache and a progressive worsening of right exophthalmos with a brain MRI showing a giant enhancing right temporal mass with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit [Figure 1a-d]. DSA with embolization of external carotid artery feeders (middle meningeal artery, accessory meningeal artery, distal sphenopalatin branches) using contour particles (150-350 micron). During the procedure, a large pseudoaneurysm of right middle cerebral artery branch was evident and embolized using Glubran2 glue [Figure 1e-h].
PMC4496841_02
Axial T2-weighted (a) brain magnetic resonance imaging (MRI) showing a giant parieto-temporal meningioma enhancing after Gadolinium administration (c). Sagittal MRI venous angiography (b) evidenced an abnormal superior sagittal sinus drainage. Preoperative angiography with embolization of the lesion (d). During venous phase of angiography, the abnormal drainage of superior sagittal sinus like "sinus pericranii" was clearly confirmed (e, red arrow)
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F2
Brain MRI with venous angiography showed a parietotemporal enhancing giant mass extending toward pineal region determining mass effect on brain parenchyma, compression of the ventricular system and midline shift with an abnormal vascular drainage of superior sagittal sinus [Figure 2a-c]. Contour particle (150-200 micron) was possible due to the deviousness of posterior and middle meningeal artery feeders; moreover, during venous phase of angiography, the abnormal drainage of superior sagittal sinus like "sinus pericranii" was clearly confirmed [Figure 2d and e]. 2 days later, she was submitted to parieto-occipital craniotomy. During the approach, great care was made to avoid a skin incision over the sinus pericranii in order to respect the venous drainage of superior sagittal sinus. Complete tumor removal was obtained.