Pre-resection Meningioma Embolization Does Not Improve Time to Recurrence in a Heterogeneous Cohort: A Retrospective Propensity-Matched Cohort

Abstract

Introduction Meningiomas are the most common primary tumors of the central nervous system, and pre-resection meningioma embolization has been touted to reduce surgical blood loss; however, high-quality evidence supporting its routine employment is lacking. A recent study demonstrated that embolization benefited progression-free recurrence, so we aimed to evaluate the safety and efficacy of pre-resection meningioma embosurgery. Methods This retrospective cohort study examined adult patients who underwent intracranial meningioma resection from January 2014 to July 2019. One-to-one propensity score matching was applied. The association of embolization with operative time, estimated blood loss (EBL), hemoglobin drop, length of stay, need for blood transfusion, achievement of gross total resection, complication incidence, death within 90 days, tumor recurrence, and time to recurrence was analyzed. Results Of 116 patients meeting study criteria, 32 underwent embolization (28.6%). After excluding World Health Organization grade 2-3 meningiomas and propensity score matching, there were 28 patients in each of the embolization and non-embolization groups. Embolization was not associated with operative time, EBL, post-resection hemoglobin drop, perioperative transfusions, complications, or death. Embolization was associated with increased post-resection length of stay (9.9 + 1.3 days versus 6.6 + 1.3 days, P = 0.002). In survival analysis, embolization was not associated with improved recurrence-free survival. Conclusions While meningioma embolization appears safe, its long-term efficacy is unclear. Embosurgery was not associated with increased time to recurrence in this patient cohort, but the observed results may be due to differences in technique, tumor genomics, or patient selection. Prospective, randomized studies are warranted for further investigation.

Keywords: central nervous system neoplasms; embolization; endovascular procedures; meningioma; neurosurgery.

Figure 1. Flow diagram demonstrating the creation of the final study cohort.

Figure 2. Kaplan-Meier curves demonstrating rates of recurrence-free survival over time, stratified by embolization status of (A) only patients with World Health Organization grade 1 meningiomas and (B) all study patients.