Abstract
Background and purpose: Radiology has an important role before the operation of a patient with a cerebral meningeoma. The radiologic management of cerebral meningiomas at Ullevål Sykehus were investigated. We wanted to compare this with guidelines in litterature. Methods: All patients operated for cerebral meningioma in the years 2003 and 2004 were identified, in total 61 patients, 38 ladies and 23 men. Their radiologic journals were searched through and compared with guidelines for radiological management in litterature. (Pubmed) Results: Mean age at the operation time was 60.4 years. 49 of the patients had been to CT scan, and 55 had been to MR scan. Mean largest diameter at the time of operation was 4,1 cm (in the 46 patients where the size had been meazured.) 17 patients (27.8%) had been to cerebral angiography and 8 (13.1%) patients had gone throug a preoperative embolization. Mean largest diameter of these 8 embolized meningeomas were 6,1 cm. The konvexity was the most common location for embolization, with 4 of 8 patients. Also 2 falx and 2 skull base meningeomas where embolized. 10 pasients were operated for second time or more, and the skull base was the most common location for residiv of meningioma, with 6 of 10 operations.
Conclusion: The advant of MR has improved the diagnostic quality of meningeomas dramatically. We should therefore increase the MR frequency, from 90% in our findings, to 100% for optimal preoperative planning. Some controversy exist about the benefit of preoperative embolization. According to the litterature it seems to have most value in locations where blood supply not can be interupted at the time of surgery. Our material Is rather small. But maybe one could be at least more careful in performing cerebral angiography and preoperative embolization to skullbase meningeomas, and perhaps to large konvexity meningeomas. Non-invasive MR/CT angio could possibly replace a few of the cerebral angigraphys done in our material. Anyhow the risk and benefit of preoperative embolization should be waighed carefully in each case, by both the radiologist and the surgeon.