Stent Retriever and Aspiration Catheter Biopsy of an Intraluminal Transverse Sinus Meningioma: Case Report.

BACKGROUND AND IMPORTANCE: Intracranial intraluminal mass lesions are rare and challenging to biopsy using noninvasive methods. Obtaining tissue for diagnosis is critical for guiding treatment, yet traditional approaches such as craniotomy pose significant risks. In this case report, we describe the first use of an aspiration catheter and stent retrieval system to safely and successfully perform an endovascular biopsy in a patient with an exclusively intraluminal meningioma.

CLINICAL PRESENTATION: The patient had a history of medulloblastoma, which was resected and treated with craniospinal radiation. During routine surveillance MRI, an incidental filling defect was identified in the superior sagittal sinus, suspected to be either thrombus or intraluminal meningioma. The lesion demonstrated rapid growth despite anticoagulation therapy, prompting the decision to pursue tissue sampling to guide further treatment. A combined approach using a large-bore suction thrombectomy catheter and a 6-mm Solitaire X stentriever was used through a transvenous femoral approach. Although no tissue was obtained from the suction effluent, sufficient tissue fragments were captured on the stentriever to diagnose meningioma. The patient tolerated the procedure well, with no periprocedural complications.

CONCLUSION: Obtaining intravascular tissue with a stent retrieval system, particularly for firmer sinus wall lesions such as a meningioma may offer a safe alternative technique to craniotomy for intraluminal sinus tissue diagnosis.