Definitive embolization of meningiomas. A review

Abstract

This review examines the possible role for definitive embolization as a primary therapy for intracranial meningiomas. Surgery or radiosurgery are currently considered the standard of care for most benign meningiomas. However, each of these carries substantial risks. The perioperative mortality for surgical resection, as reported in large series, is between 3.7-9.4%; these studies report a similarly high rate of new neurological deficits following surgery. The rate of complications from radiosurgery is reported between 2-16% and it may take months to years before improvement in symptoms occurs following this therapy. There are a few reports of treating meningiomas by embolization without subsequent surgery. While these studies include small numbers of patients and have limited follow-up, the initial results are very promising. Given the risks and limitations of surgery and radiosurgery, prospective trials are now needed to determine the safety and efficacy of definitive embolization.

Figure 1

From Bendszus et Al:. The patient is a 70-year-old man with symptoms of lumbar stenosis who could not be operated upon because of co-morbid disease. (A) Contrast enhanced T1-weighted MRI prior to embolization. (B) Angiography showed that the tumor was supplied exclusively by the middle meningeal artery, which was completely embolized. (C) Contrast enhanced T1-weighted MRI one day after embolization. (D) Contrast enhanced T1-weighted MRI at 23 month follow-up showing marked reduction of the tumor with minimal mass effect. (Permission granted for use)