Endovascular treatment |
Embolization of a meningioma in the head or the spine with glue and/or particles
With this information we would like to clarify the treatment of a meningioma in the head and get you some guidelines and advice to heal faster.
A meningioma is a tumor that originates from the meninges. A meningioma can occur anywhere where meninges are present both in the head as in the spine. In principle, a meningioma is a benign tumor, which rarely can become malignant. Strictly, it is no brain tumor, but a tumor of the layer around the brain.
A meningioma is usually discovered in middle aged women but can occur at any age and also in men. It is a slow growing tumor and symptoms usually develop also slowly. Usually the meningioma not detected until it has grown large. The symptoms are due to pressure on the brain, causing headaches and sometimes nausea and vomiting. Depending on the place where it is located other (neurological) problems arise that are related with that part of the brain or spinal cord.
The diagnosis of meningioma is usually made on a CT or MRI examination . The treatment consists of removing the tumor. This is usually done with a surgical operation, sometimes with radiotherapy. Sometimes prior to surgery or radiation, an embolization of the meningioma is performed to reduce/occlude the blood supply to the tumor. This is called the meningioma embolization. The tumor itself is thus not removed, only the bllod supply.
Before the treatment
- It is important to inform the doctor or nurse on the following:
- Allergies, especially contrast allergy
- Medication use
- Use of medication should be consulted with your physician. Especially important to discuss is the use of blood thinners (aspirin, Ascal, Asaflow, Plavix, Clopidigrel, Ticlid, Marevan, Warfarin, fraxiparin, etc).
- If you are contrast allergic, you should be premedicated. Generally, you need to take a Medrol 35mg tablet the evening before the examination.
- You need to be sober for the treatment. This means that from midnight the day before the examination you should no longer eat or drink. On the day of the study, only take the necessary medication with a little water.
Illness or foreclosure
Ordinarily, your doctor or you yourself made an appointment for the examination. If due to any reason you are unable to pass the examination, kindly get in touch with the radiology department. This can be done via the telephone 03 821 3803. Please make a new appointment, if possible.
To have a safe treatment, you need to lie perfectly still with your head. Usually it is not necessary to be completely put to sleep (general anesthesia). The treatment is done through blood vessels on the outside of the skull and lasts about an hour. You do not need all that time to lie absolutely still. The interventional neuroradiologist will tell you what you can expect during the investigation and if you must not move your head.
You are 1 to 2 days (sometimes longer) in the hospital. This is usually on the ward A4 (4th floor) at the neurosurgery department. On the morning of the admittance you need to be sober (last meal taken before midnight). You check in at the central reception area of the hospital, then you will be referred to the ward. There, you will received by a nurse who can arrange all the practical issues. At the ward there is a attending physician present.
The embolization of a meningeoma is performed by specialized interventional neuroradiologists on the angiography room of the radiology department. Usually, the treatment is performed under local anesthesia. A thin catheter (small tube) is placed from the femoral artery (usually right) in one of the head and neck arteries. Through this catheter an even thinner tube (micro catheter) is then guided very carefully nearby or preferably in the meningeoma. Subsequently the bloodsupply to the meningeoma is gradually occluded with small particles under constant X-ray guidance until the bloodsupply is closed or partly closed. Sometimes glue is used to close the affected blood vessels.
After treatment, the catheters are removed and the hole in the femoral artery is closed with a special plug (Angioseal ®). This Angioseal® is naturally degraded by the body in about 2 to 3 months. During this period caution should be exercised with any re-puncture of the groin.
After the treatment
The patient has strict bed rest until the next day. To prevent a bleeding at the puncture site (groin) the patients has to keep his/her right leg immobile for at least 4 hours and needs to lie on his/her back. Try not to use the abdominal muscles (no coughing or sneezing, no toilet, …). Depending on the condition of the patient he/she stays for 1or 2 days in the hospital.
Frequently patients have headache. This can be treated with pain medication.
It is not allowed to drive a car the days after a treatment. Also, the patient needs to be cautious with sports, lifting and labour.
At hospital discharge you get instructions for medication and an appointment for a consultation at the neurovascular consultation (approximately 6 weeks after treatment).
Usually the meningeoma is resected by the neurosurgeon shortly after the embolization (next day or week).
Pain, discomfort and risks
During the treatment you will be under general anesthesia and feel nothing. You should inform the nurse or doctor if you have pain. Afterwards the puncture site in the groin can be sore. Seldom a bleeding can also occur in the groin at the puncture site. Rarely, allergic reactions (redness, rashes, swelling, hoarseness, chest tightness, ...) or adverse effects on the kidneys (especially in people with preexisting poorer kidney function) can occur because of the use of contrast and/or medication.
Sometimes serious complications of the embolization can occur due to glue deposition in normal instead of pathologic vessels or a bleeding caused by the DAVF. Sometimes an emergency operation by the neurosurgeon is necessary.
The specific (serious) risks of the treatment (thrombosis of brain vessels, bleeding) and possible consequences will be discussed before the procedure by the treating physicians.
Possible problems the first days…
Should one or more of the following symptoms occur the first days to weeks after the treatment, you immediately contact us: sudden onset headache (worse than before), progressive drowsiness, paralysis or other dysfunctions, bleeding in the groin. You call the general number of the hospital 03-8213000 and ask for one of the doctors of our team.
If you have any further questions, please feel free to contact your treating physician, neurosurgeon, specialist nurse or interventional neuroradiologist via the telephone number of the department of angiography of the UZA (03-821 3803).