Meningioma with Intratumoral and Subdural Hemorrhage as an Immediate Complication of Therapeutic Embolization

A 63-year-old female with a large meningioma of the middle cranial fossa was admitted. The tumor was fed mainly by the hypertrophied middle meningeal artery. Immediately following a seemingly successful embolization of that artery with gelfoam powder, consciousness of the patient rapidly declined and anisocoria and decerebrate posturing developed. An intratumoral massive hemorrhage ruptured into and extended widely in the subdural space was confirmed by computed tomography scan. The hematoma was evacuated and the tumor was radically removed by emergency craniotomy, and the patient recovered. Therapeutic embolization for meningiomas and other highly vascular intracranial tumors has been established as a useful and relatively safe adjunctive preoperative measure, and an intratumoral massive hemorrhage in the period immediately following this procedure has seldom been reported in the literature. However, the present case shows that it is apparently a potential complication of this procedure. The possible mechanisms of an intratumoral hemorrhage following therapeutic embolization of the feeding arteries are briefly discussed.