Shojima K, Hayashi T, Higashihara H, Utsunomiya H, Moritaka K, Honda E
No Shinkei Geka. 1986 Jun;14(7):919-24.
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.
我们报告一例囊性脑膜瘤病例，该肿瘤在对其供血动脉进行术前栓塞时，囊肿及邻近蛛网膜下腔出现出血。一名73岁男性患者因惊厥主诉入院。CT检查发现左额叶凸面有一肿瘤，左脑血管造影显示该肿瘤由大脑中动脉供血。该肿瘤被诊断为脑膜瘤。切除肿瘤后，我们进行了组织学研究。其横断面大体所见有非典型出血模式，这是由肿瘤内纵横交错的颈内动脉和颈外动脉破裂所致。结果表明该肿瘤为血管瘤型脑膜瘤，含有脑膜上皮成分。出血发生在血管瘤型脑膜瘤部分。出血的可能原因被认为是栓塞引发的血流突然动态变化。这种突然变化可能导致病理性小血管多处破裂。因此，我们强烈建议对囊性脑膜瘤进行术前栓塞时应谨慎操作，因为这可能增加病理性薄弱血管出血的可能性。
