Pre-surgical embolization of intracranial meningioma with Onyx: A safety and efficacy study

Friconnet, Guillaume; Espíndola, Víctor Hugo; Lemnos, Leslie; Saleme, Suzana; Duchesne, Mathilde; Salle, Henri; Caire, François; Mounayer, Charbel; Rouchaud, Aymeric

doi:10.1016/j.neurad.2019.05.012

Cited by 14 publications

(6 citation statements)

References 19 publications

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“…Onyx-18 is an ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide (DMSO), popular for its successful use with arteriovenous malformations and fistulas. It enables more rapid and visible embolisation than particulates and is less technically demanding than traditional liquid embolic agents 12. The procedure is performed slowly through a microcatheter with the intent of preserving antegrade flow for as long as possible until there is loss of tumour’s blush, demonstrating decreased blood flow towards the tumour.…”

Section: Discussionmentioning

confidence: 99%

Scalp necrosis following preoperative endovascular embolisation of the superficial temporal artery for meningioma

Panesar,

Hatazaki,

Shekhtman

2024

BMJ Case Rep

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A woman in her late 50s with a left frontal lobe convexity meningioma underwent an elective endovascular embolisation of the left middle meningeal artery and distal branches of the left superficial temporal artery prior to surgical resection of the tumour. On postoperative day 46, she developed scalp necrosis, leading to poor wound healing requiring wound debridement and a complex plastic surgery reconstruction with a rotational flap. Endovascular embolisation of vascular tumours prior to surgical resection does not come without risks. The lack of consistency in the literature regarding indication, technique and outcomes makes it difficult to define the exact role of preoperative meningioma embolisation.

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Section: Discussionmentioning

confidence: 99%

Scalp necrosis following preoperative endovascular embolisation of the superficial temporal artery for meningioma

Panesar,

Hatazaki,

Shekhtman

2024

BMJ Case Rep

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“…In some centers, meningiomas are embolized preoperatively in order to reduce blood loss and to reduce the complexity of surgery [ 27 ]. We hypothesize that due to reduced blood flow to tumors or necrosis of tumor tissue, drug delivery to the tumor would be impaired.…”

Section: Discussionmentioning

confidence: 99%

The NXDC-MEN-301 Study on 5-ALA for Meningiomas Surgery: An Innovative Study Design for the Assessing the Benefit of Intra-Operative Fluorescence Imaging

et al. 2022

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Background: 5-aminolevulinic acid (5-ALA; GleolanTM, NX Development Corps., Lexington, USA) is approved for fluorescence-guided resections of suspected malignant gliomas. Experience has demonstrated that meningiomas also show fluorescence, which may be a useful surgical adjunct. We present an innovative design for a multi-center, prospective study to determine the clinical safety and potential benefit of fluorescence-guided resection of meningiomas with utmost bias reduction. Methods: All patients with suspected meningioma (all grades) receive GleolanTM 20 mg/kg 2–4 h prior to surgery supported by fluorescence excitation from a blue light source (Blue400, Zeiss Meditech, Oberkochen, Germany; FL400, Leica Microsystems, Heerbrugg, Switzerland). Surgeons are asked whether a residual tumor can be observed to fluoresce under blue light (BL) after the tumor is no longer recognizable using conventional illumination at the end of surgery. In addition, when faced with tissues of uncertain tissue type (so-called “indeterminate” tissue), this study records how often surgeons make a correct decision based on fluorescence and how this influences surgical strategy. The primary endpoint is the percentage of patients in whom one of these two benefits are observed. Other endpoints include the diagnostic accuracy of fluorescence compared to white light (WL) versus correlative histology. For bias reduction, pertinent data are derived from surgical videos reviewed by independent reviewers blinded to surgeons’ assessments of tissue type and fluorescence status. Data will be included from approximately 100 study participants completing the study at approximately 15 centers in the United States, Germany, and Austria. Results: As of May 2022, 88 patients have completed the study. No adverse safety signal has been detected. Conclusions: Preliminary data confirm the feasibility of our study design. Accrual is targeted for completion in the third quarter of 2022.

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“…Diversos agentes embólicos são utilizados para embolização pré-cirúrgica, no entanto, independente do agente embólico utilizado, a embolização pré-operatória ainda apresenta alguns riscos em potencial, incluindo acidente vascular cerebral devido à migração irregular em outras artérias cerebrais 8 , cegueira, hemorragia e paralisia dos nervos cranianos 9 . As complicações não neurológicas relacionadas ao tratamento endovascular também podem ocorrer e incluem hematoma na virilha, pseudoaneurisma femoral e fístula arteriovenosa 10 .…”

Section: Comentáriosunclassified

Embolização pré-cirúrgica de meningioma intracraniano

Péres

Junior²,

Vasconcelos³

et al. 2022

Anais FMO

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Introdução: Os meningiomas são tumores altamente vascularizados cujo tratamento de escolha é a ressec-ção cirúrgica. Contudo, a embolização pré-operatória do meningioma tem sido estabelecida para facilitar a ressecção cirúrgica, uma vez que pode reduzir a perda sanguínea intraoperatória e o tempo cirúrgico. Relatodo caso: Paciente sexo feminino, 45 anos, com história de cefaleia recorrente há seis meses, que não cedeuaos analgésicos e apresentando déficit visual, com perda de campo visual principalmente à esquerda há trêsmeses. Foi submetida à ressonância magnética do encéfalo e a angiorressonância magnética com contraste, na qual foi evidenciada processo expansivo sólido extra-axial vascularizado na fossa craniana anterior, sen-do a principal hipótese, lesão de linhagem meningotelial (entre elas o meningioma). Em seguida, realizada uma embolização pré-operatória da vascularização tumoral e, no dia seguinte, a neurocirurgia de ressecçãotumoral. No pós-operatório a paciente cursou sem déficit visual, consciente e orientada. Comentários: Aembolização pré-operatória pode nos dar uma vantagem na cirurgia para meningioma. O procedimento reduz a perda sanguínea intraoperatória e o tempo de operação, suavizando a consistência do tumor. No entanto, devemos prestar atenção à possibilidade de complicações embólicas e manter o preparo da craniotomia de emergência, principalmente em pacientes com grandes meningiomas.

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Pre-surgical embolization of intracranial meningioma with Onyx: A safety and efficacy study

Cited by 14 publications

References 19 publications

Scalp necrosis following preoperative endovascular embolisation of the superficial temporal artery for meningioma

Scalp necrosis following preoperative endovascular embolisation of the superficial temporal artery for meningioma

The NXDC-MEN-301 Study on 5-ALA for Meningiomas Surgery: An Innovative Study Design for the Assessing the Benefit of Intra-Operative Fluorescence Imaging

Embolização pré-cirúrgica de meningioma intracraniano

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