American Board of Internal Medicine (ABIM) Certification Practice Exam

In the management of meningiomas, which intervention is sometimes used to shrink large tumors before resection?

1. Whole-brain radiation

2. Chemotherapy

3. Arterial embolization

4. Immunotherapy

The correct answer is: Arterial embolization

In the management of meningiomas, arterial embolization is sometimes employed as a preoperative intervention to reduce the size of large tumors before surgical resection. This technique involves selectively blocking the blood supply to the tumor, which can lead to tumor shrinkage, making it easier and safer to remove during surgery. By diminishing the vascularity of the meningioma, arterial embolization can help minimize intraoperative bleeding and potentially enhance the effectiveness of the surgical intervention. Other interventions, such as whole-brain radiation, chemotherapy, and immunotherapy, are generally not prioritized for the initial management of meningiomas. Whole-brain radiation is typically used for neuroectodermal tumors or in cases of multiple meningiomas, but it does not serve to shrink tumors directly prior to surgical intervention. Chemotherapy is not a standard treatment for meningiomas due to their variable response, and immunotherapy is still considered experimental in this context. Thus, arterial embolization stands out as a practical approach specifically aimed at reducing the size of meningiomas before surgery.