Figure 1

Meningiomas refer to tumors that grow from the meninges, the membrane that covers and protects brain. Meningiomas are usually benign and slow to develop. However, as they grow, they may become large enough to apply pressure on the brain.

Symptoms may start to develop as this pressure develops. The type of symptoms one experiences will depend on the area of the brain that is affected by the meningioma. Possible symptoms may include headaches, visual problems, and changes in personality.

Meningiomas comprise about 20% of all brain tumors. They are more commonly found in women than in men and they are most likely to be diagnosed in middle-aged to elderly adults. The cause of meningiomas is currently unknown.

Multiple meningiomas can occur, and people with certain inherited diseases are particularly susceptible to them. Surgery is generally recommended for multiple meningiomas. However, when the tumors are very large, or have a large blood supply, surgery can be high-risk. In these instances, a procedure known as embolization is often recommended prior to surgery.

Embolization is similar to the procedure known as angiogram in that a catheter is inserted into the blood vessels supplying the tumor. Materials are then injected into the vessels to block off the blood supply to the tumor.

This type of procedure has been known to decrease the amount of blood lost during surgery and to also diminish the need for blood transfusion during surgery.1 Embolization usually takes place about a week prior to surgery for the removal of the meningioma.

The embolization procedure from start to finish
Prior to undergoing embolization, patients are expected to sign a consent form and will have the opportunity to have questions answered. The anesthesiologist will administer medications and fluids through the use of an intravenous line (IV) into a vein in the hand or arm. He or she will also administer general anesthesia so that the patient will be completely asleep for the procedure. Blood pressure will be monitored through an A-Line, a thin flexible tube or catheter placed in an artery in your wrist. An electrocardiogram (EKG) will monitor heart rate and rhythm as well as oxygen levels. A specific type of catheter known as a Foley will be placed in the bladder to allow urine to drain.

Once the procedure is complete, the patient will be transferred from the operating room to either the Surgical Intensive Care Unit (SICU) or the Post-Anesthesia Care Unit (PACU). Here, a heart monitor will closely monitor vital signs. This machine is very sensitive and often sounds inadvertently; this is not cause for alarm. The nursing staff will assist in changing positions, but bed rest is required. Eventually, the patient can look forward to a normal diet and transfer to a room on a surgical floor. The Foley catheter will also be removed prior to leaving the bed for the first time.

Patients are expected to keep the leg that underwent surgery straight for several hours and a tube may remain in place at the puncture sight for several days. Once it is removed, the physician will apply pressure for about 20 minutes to prevent bleeding, and a device may be used to seal the puncture.