Predictors of preoperative endovascular embolization of meningiomas: subanalysis of anatomic location and arterial supply

Abstract

IntroductionEndovascular embolization of intracranial meningiomas is commonly used as an adjunct to surgical resection. We sought to describe the anatomic locations and vascular supplies of meningiomas to identify characteristics predictive of successful preoperative endovascular embolization.MethodsWe conducted a retrospective review of 139 meningioma cases receiving cerebral angiograms for possible preoperative endovascular embolization at our institution between December 2000 and March 2017. The extent of embolization, arterial supply, anatomic location, and procedural complications were recorded for each case. Univariate and multivariate analyses were performed to identify tumor characteristics that predicted successful embolization.ResultsOf the total meningioma patients undergoing preoperative angiography, 78% (108/139) were successfully embolized, with a 2.8% periprocedural complication rate (3/108). Within the subset of patients with successful embolization, 31% (33/108) achieved complete angiographic embolization. Significant multivariate predictors of embolization (either partial or complete) were convexity/parasagittal locations (OR 5.15, 95% CI 0.93 to 28.54, p=0.060), meningohypophyseal trunk (MHT, OR 4.65, 95% CI 1.63 to 13.23, p=0.004), middle meningeal artery (MMA, OR 10.89, 95% CI 3.43 to 34.64, p<0.001), and ascending pharyngeal artery supply (APA, OR 9.96, 95% CI 1.88 to 52.73, p=0.007). Significant predictors for complete embolization were convexity/parasagittal locations (OR 4.79, 95% CI 1.66 to 13.84, p=0.004) and embolized APA supply (OR 6.94, 95% CI 1.90 to 25.39, p=0.003). Multiple arterial supply was a negative predictor of complete embolization (OR 0.38, 95% CI 0.15 to 0.98, p=0.05).ConclusionsTumor characteristics can be used to predict the likelihood of preoperative meningioma embolization. Parasagittal and convexity meningiomas, and those with APA supply, are most likely to achieve complete angiographic embolization.

The Preferred Locations of Meningioma According to Different Biological Characteristics Based on Voxel-Wise Analysis

“…The high incidence rates and surgical difficulties for uneasily accessible locations of meningioma challenge the clinicians despite the benign nature of this tumor. As symptoms and treatment strategies largely depend on the location, it is indispensable to analyze the role of lesion location in clinical investigation of meningiomas (19,20). A visual-perceivable graphic pattern is required for identifying and visualizing tumor locations rather than complicated table analyses.…”

Operative Technique: Angiomatoid Fibrous Histiocytoma—Unique Case and Management

“…A prior study has shown high rates of success for embolization of the APA. 25 It was decided that the patient should undergo a preoperative embolization to aid in surgical resection. Our case is unique in that our treatment management included the preoperative use of endovascular arterial embolization followed by surgical resection.…”

Signo de oscurecimiento tumoral: hallazgo imagenológico que puede corresponder a una embolización pre-quirúrgica exitosa en meningiomas

“…Algunas de las recomendaciones para la embolización preoperatoria de los meningiomas, incluyen el tamaño (> 4 cm de diámetro), irrigación proveniente de la carótida externa (al menos en 50% por el fácil acceso), tumores hipervascularizados, situados en áreas elocuentes y no calcificados 6 . Otros estudios demuestran que la embolización completa de estos tumores es mayor en aquellos meningiomas localizados a nivel parasagital, en la convexidad, o con irrigación proveniente de la arteria faríngea ascendente 7 .…”