Meningiomas : Figure 1

39 year old man with Neurofibromatosis Type II, a condition that often results in early development of multiple brain tumors presented with hearing loss and seizures. In addition to small bilateral tumors of the vestibular nerves (not shown), the patient had developed a large extra-axial mass most compatible with a meningioma, a benign tumor that arises from the dura mater or brain covering (upper left image, white arrow). Meningiomas are often highly vascular tumors. Prior to surgical removal of the tumor, the patient underwent cerebral arteriography which demonstrated that blood supply to the tumor arose from branches of the middle meningeal artery (upper right image, white arrow). With the patient awake and in a painless manner, a tiny microcatheter was advanced into the branches of the middle meningeal artery supplying the tumor (lower left image, black arrow), and the tumor was embolized. Arteriography after embolization demonstrates that there is no longer any blood flowing to the tumor (lower right image, white circle) indicating that the tumor could now be surgically resected with minimal blood loss.