[Efficiency of Embosphere in the Pre-Operative Embolization of Meningioma:Clinical Experience].

Embosphere® was approved in Japan for embolizing intracranial arteries for the reduction of intraoperative bleeding in January 2014. Until August 2015, we performed embolization for four meningiomas using Embosphere®. We performed an initial evaluation of all the cases, including evaluation of the clinical courses, change in the maximum tumor diameters and volumes, alteration in the appearance on magnetic resonance imaging(MRI), amount of intraoperative bleeding, complications, and histopathological findings. After embolization, the maximum tumor diameters and volumes slightly decreased on MRI, whereas the signal change on diffusion-weighted imaging(DWI)or fluid-attenuated inversion recovery(FLAIR)varied in each case. One case demonstrated a partial signal change on DWI one day after the initial procedure, and another case demonstrated a decrease in perifocal edema on FLAIR. Among our patients, least bleeding was recorded at 6 days after the embolization. Histopathological analysis revealed coagulative necrotic lesions in two cases. The von Kossa stain was used to distinguish Embosphere® from the psammoma body. One case involved a thromboembolic complication of the retinocentral artery caused by an Embosphere® of 100-300 µm. Our early-stage experience suggests that an Embosphere® of 300-500 µm should be used for safe embolization before resection to avoid thromboembolic complications because an Embosphere® of 100-300 µm can pass through the dangerous anastomosis. Our present strategy was to resect the tumor approximately seven days after the embolization using Embosphere®. However, further studies and discussion on the size of Embosphere®, and the interval between pre-operative embolization and surgical removal are needed.

[The role of endovascular treatment for multiple intracranial aneurysms with subarachnoid hemorrhage].

In consideration of the treatment for multiple cerebral aneurysms occurring in association with subarachnoid hemorrhage, it is sometimes difficult to determine which therapeutic strategy should be used when it is difficult to detect the ruptured aneurysm by CT or angiography and difficult to clip all the aneurysms using one approach. This study was conducted to examine indications and problems of coil embolization in the acute stage in such a situation, based on our experience in 9 patients. The patients were aged between 29 to 91 years (mean 61.6 years), and the severity on admission was recorded according to the World Federation of Neurosurgical Societies (WFNS) Grade I in 6 patients, Grade II in 2 patients, and grade IV in 1 patient. The number of aneurysms was 2 in 5 patients, 3 in 3 patients, and 4 in 1 patient. Four patients underwent embolization for all the aneurysms simultaneously, 3 patients underwent embolization for a single aneurysm and then underwent clipping of other aneurysms, and 2 patients were considered to be eligible for surgery and underwent clipping, but since no rupture was detected, they underwent embolization for all the remaining aneurysms. Seven patients made satisfactory progress, but 1 patient developed an embolic complication. Another patient developed recurrent hemorrhage from the untreated aneurysm, so additional clipping was performed. Coil embolization is beneficial in that treatment is completed simultaneously, but has problems in that it cannot be determined whether or not the embolized aneurysm is the ruptured one, embolic complications may occur, and long-term prognosis is unknown.