title: The role of preoperative angiography in the management of giant meningiomas associated to vascular malformation.
abstract: BACKGROUND
  The role of preoperative digital subtraction angiography (DSA) in meningiomas is currently under discussion because of the introduction of noninvasive magnetic resonance imaging (MRI) angiography to study vascular anatomy associated to the tumor. Preoperative DSA is mainly performed to obtain embolization of the lesion, although a number of complications have been reported after this procedure. Nonetheless, the coexistence of meningiomas with vascular malformations has previously been reported and it has been evidenced that this event could be underestimated because of neglect of preoperative DSA. Here, we report on two challenging cases of giant meningiomas associated to vascular malformations and we discuss the pertinent literature.
  
  
  METHODS
  In the first case: A large right temporal meningioma with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit - a large pseudoaneurysm of right middle cerebral artery branch was found end embolized during DSA. In the second case: A giant parieto-temporal meningioma - DSA permitted the full visualization of an abnormal drainage of superior sagittal sinus like a "sinus pericranii" that was respected during the following surgery.
  
  
  CONCLUSIONS
  We think that MRI angiography is the exam of choice to study vascular anatomy in meningiomas. Nonetheless, DSA remains a useful tool in giant meningiomas not only to embolizate the lesion but also to treat tumor associated vascular malformation and to achieve the full knowledge of vascular anatomy. We think that a wide communication between interventionalist and surgeon is essential for the optimal management of these patients.
authors.affiliation: Department of Neurosurgery, Institute of Neurosurgery, Catholic University, Rome, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Papacci
authors.affiliation: Department of Interventional Radiology, Institute of Radiology, Catholic University, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pedicelli
authors.affiliation: Department of Neurosurgery, Institute of Neurosurgery, Catholic University, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Montano
keywords: Aneurysm; diagnosis; magnetic resonance imaging; meningioma; preoperative angiography; vascular malformations