Preoperative embolization of intracranial meningiomas: efficacy, technical considerations, and complications

Abstract

Background and purpose: Preoperative embolization for intracranial meningiomas offers potential advantages for safer and more effective surgery. However, this treatment strategy has not been examined in a large comparative series. The purpose of this study was to review our experience using preoperative embolization to understand the efficacy, technical considerations and complications of this technique.

Materials and methods: We performed a retrospective review of patients undergoing intracranial meningioma resection at our institution (March 2001 to December 2012). Comparisons were made between embolized and nonembolized patients, including patient and tumor characteristics, embolization method, operative blood loss, complications, and extent of resection. Logistic regression analyses were used to identify factors predictive of operative blood loss and extent of resection.

Results: Preoperatively, 224 patients were referred for embolization, of which 177 received embolization. No complications were seen in 97.1%. There were no significant differences in operative duration, extent of resection, or complications. Estimated blood loss was higher in the embolized group (410 versus 315 mL, P=.0074), but history of embolization was not a predictor of blood loss in multivariate analysis. Independent predictors of blood loss included decreasing degree of tumor embolization (P=.037), skull base location (P=.005), and male sex (P=.034). Embolization was not an independent predictor of gross total resection.

Conclusions: Preoperative embolization is a safe option for selected meningiomas. In our series, embolization did not alter the operative duration, complications, or degree of resection, but the degree of embolization was an independent predictor of decreased operative blood loss.

Fig 1.

Right frontal meningioma, pre- and postembolization and resection. Pre-embolization right ECA injection demonstrates tumor blush from the middle meningeal artery (A, lateral view; B, frontal view). Embolization was achieved with 150- to 250-μm PVA particles. Postembolization right ECA injection reveals complete obliteration of tumor blush (C, lateral view; D, frontal view). T1-weighted MR imaging with gadolinium before embolization (E, axial view; F, coronal view). T1-weighted MR imaging with gadolinium postresection (G, axial view; H, coronal view).