Intra-operative N-butyl cyanoacrylate embolization arrest of uncontrollable hemorrhage during meningioma resection

• Presurgical embolization of meningiomas is controversial.
• NBCA embolization is effective in achieving rapid hemorrhage cessation.
• Uncontrolled hemorrhage during meningioma resection can be terminated with NBCA embolization.

During the surgical resection of a convexity meningioma in a 63-year-old woman, an uncontrollable active hemorrhage from the operative bed was arrested with microcatheter N-butyl cyanoacrylate (NBCA) embolization after superselective angiography. To date, an uncontrollable neurosurgical intraprocedural hemorrhage terminated by NBCA embolization has not been previously reported. The embolization risk relative to the benefit needs to be carefully considered prior to the surgical removal of a meningioma. This report emphasizes the potential value of embolization with NBCA for arresting active bleeding intraoperatively.