Safety and Efficacy of Preoperative Embolization of Meningioma in Patients with Preoperative Peritumoral Edema

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. Peritumoral edema is often present in meningioma patients and has been known to contribute to difficulty in visualizing safe resection intraoperatively, postoperative surgical complications, and worse long-term outcomes including recurrence. Here, we analyze the safety and efficacy of preoperative embolization in meningioma patients with preoperative peritumoral edema.

Materials/Methods: A retrospective chart review of a total of 26 patients with both supratentorial and skull base meningiomas was performed from July 2015 to February 2020. All embolization procedures were performed within our institution. Peritumoral edema, edema index (ratio of preoperative peritumoral edema to tumor volume), and tumor volume were calculated using a semiautomatic image-processing software.

Results: The mean age of patients was 61.4 years. The mean BMI was 26.4 kg/m². Eighteen (69.2%) patients were female and eight (30.8%) were male. Twenty-one (80.8%) tumors were skull base. The most common artery supplying a tumor was the middle meningeal artery (80.8%). Nineteen (73.1%) received gross total resection. Mean length-of-stay was 7.2 days. Nine patients (34.6%) were WHO grade-II tumors. Mean tumor volume was 60.6cm³. Mean edema index was 0.69 with a range of 0.01 to 3.71. One patient (4%) had a stroke as an immediate/next-day postembolization complication. Five patients (19.2%) required postoperative radiation and five patients (19.2%) had tumor recurrence. Mean blood loss was 538 mL.

Conclusion: In our case series, surgical planning for meningioma resection utilizing preoperative embolization carries minimal risk to the patient. The most common artery supplying meningiomas was the middle meningeal artery. We conclude that preoperative embolization in patients with peritumoral edema is safe and effective.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021