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Surg Neurol Int. 2013 Aug 8;4:102. doi: 10.4103/2152-7806.116307. eCollection 2013.

Is "en-bloc" excision, an option for select large vascular meningiomas?

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  • 1Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Abstract

BACKGROUND:

Large highly vascular meningiomas surgically challenging when preoperative embolization is not feasible.

CASE DESCRIPTION:

We present an illustrative case of 'en bloc' excision of a highly vascular giant lateral sphenoid wing meningioma using the technique of 4 D's. After ruling out neurovascular encasement and significant brain interposition, our technique consisted of devascularization, diminutive dural opening, early detachment, and progressively deeper circumferential dissection. "En bloc" delivery was aided by the underlying brain pulsations and edema with no retraction or manipulation. This was successfully employed in a series of seven more patients with large meningiomas with less blood loss. All the patients recovered well with no clinical or radiological sequelae.

CONCLUSION:

In select large vascular meningiomas, en bloc excision appears to be a simple, safe, and effective alternative to piecemeal excision, which can be performed in any set-up.

KEYWORDS:

Meningioma; blood loss; en bloc; excision; piecemeal

PMID:
24032077
[PubMed]
PMCID:
PMC3766328
Free PMC Article
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