Safety and Efficacy of Preoperative Embolization of Meningioma

Introduction: Preoperative embolization of tumor feeders arising from the intracranial circulation is a therapy for highly vascularized tumors. Highly vascularized tumors can result in large magnitudes of intraoperative blood loss and preoperative embolization is believed to allow for resections with fewer intraoperative complications. Here, we analyze the safety and efficacy of preoperative embolization in meningioma patients that received total embolization and subtotal embolization.

Materials/Methods: A retrospective chart review of a total of 30 patients with both supratentorial and skull base meningiomas was performed from July 2015 to February 2020. All embolization procedures were performed within our institution. Total embolization was defined as successful embolization of all supplying arteries contributing to significant tumor blush. Subtotal embolization was defined as embolization of some supplying arteries but not all arteries identified as contributing significant tumor blush. Comparisons were made between the total embolization and subtotal embolization groups.

Results: The mean age of patients was 60.6 years. The mean BMI was 26.2. Twenty-one (70%) of patients were female and 9 (30%) were male. Thirteen patients (43.33%) had total embolization identified by complete embolization of all vessels supplying significant tumor blush. Twenty-one (70%) of tumors were skull base. The most common artery supplying a tumor was the middle meningeal artery (83.3%). Twenty-one patients (70%) received gross total resection. Mean length-of-stay was 8.35 days. Nine patients (32.1%) were WHO grade II tumors. Mean tumor volume was 53.2 cm³ with a mean edema index (ratio of preoperative peritumoral edema to tumor volume) of 0.63. One patient (3.4%) had a stroke as an immediate/next-day postembolization complication. Six patients (20.69%) required postoperative radiation and five patients (17.24%) had tumor recurrence. Mean blood loss was 535 mL. There was no difference in estimated blood loss between the two groups. There was no significant difference in postoperative surgical complications between the two groups.

Conclusion: In our case series, surgical planning for meningioma resection utilizing pre-operative embolization carries minimal risk to the patient. The most common artery supplying meningiomas was the middle meningeal artery. There was no difference in postoperative complications and outcomes based on extent of embolization.

Publication History

Article published online:
12 February 2021