Preoperative embolization of skull base meningiomas: current indications, techniques, and pearls for complication avoidance

Yoon, Nam; Shah, Aatman; Couldwell, William T.; Kalani, M. Yashar S.; Park, Min

doi:10.3171/2018.1.focus17686

Cited by 71 publications

(18 citation statements)

References 48 publications

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“…As embolysate technology has evolved over the last decade, several studies have been published on the safety and efficacy of preoperative meningioma embolization, 4,13,16,17,24,25 but none have adequately matched their patients to a nonembolization control group by controlling for detailed tumor-related parameters, which limits the interpretation of previously published findings. In this study, we controlled for important patient-and tumor-related variables between embolization and nonembolization cohorts to assess the effect of preoperative embolization on the surgical outcomes of patients with intracranial meningiomas.…”

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confidence: 99%

Preoperative embolization versus no embolization for WHO grade I intracranial meningioma: a retrospective matched cohort study

Przybylowski¹,

Zhao²,

Baranoski³

et al. 2021

Journal of Neurosurgery

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OBJECTIVEThe controversy continues over the clinical utility of preoperative embolization for reducing tumor vascularity of intracranial meningiomas prior to resection. Previous studies comparing embolization and nonembolization patients have not controlled for detailed tumor parameters before assessing outcomes.METHODSThe authors reviewed the cases of all patients who underwent resection of a WHO grade I intracranial meningioma at their institution from 2008 to 2016. Propensity score matching was used to generate embolization and nonembolization cohorts of 52 patients each, and a retrospective review of clinical and radiological outcomes was performed.RESULTSIn total, 52 consecutive patients who underwent embolization (mean follow-up 34.8 ± 31.5 months) were compared to 52 patients who did not undergo embolization (mean follow-up 32.8 ± 28.7 months; p = 0.63). Variables controlled for included patient age (p = 0.82), tumor laterality (p > 0.99), tumor location (p > 0.99), tumor diameter (p = 0.07), tumor invasion into a major dural sinus (p > 0.99), and tumor encasement around the internal carotid artery or middle cerebral artery (p > 0.99). The embolization and nonembolization cohorts did not differ in terms of estimated blood loss during surgery (660.4 ± 637.1 ml vs 509.2 ± 422.0 ml; p = 0.17), Simpson grade IV resection (32.7% vs 25.0%; p = 0.39), perioperative procedural complications (26.9% vs 19.2%; p = 0.35), development of permanent new neurological deficits (5.8% vs 7.7%; p = 0.70), or favorable modified Rankin Scale (mRS) score (a score of 0–2) at last follow-up (96.0% vs 92.3%; p = 0.43), respectively. When comparing the final mRS score to the preoperative mRS score, patients in the embolization group were more likely than patients in the nonembolization group to have an improvement in mRS score (50.0% vs 28.8%; p = 0.03).CONCLUSIONSAfter controlling for patient age, tumor size, tumor laterality, tumor location, tumor invasion into a major dural sinus, and tumor encasement of the internal carotid artery or middle cerebral artery, preoperative meningioma embolization intended to decrease tumor vascularity did not improve the surgical outcomes of patients with WHO grade I intracranial meningiomas, but it did lead to a greater chance of clinical improvement compared to patients not treated with embolization.

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confidence: 99%

Preoperative embolization versus no embolization for WHO grade I intracranial meningioma: a retrospective matched cohort study

Przybylowski¹,

Zhao²,

Baranoski³

et al. 2021

Journal of Neurosurgery

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“…Embolization of branches of the ICA is considered a risky procedure and can be complicated by embolic accidents such as blindness or ischemic stroke 12–14 . Nevertheless, many authors have reported the possibility of embolization of branches of the ICA for various indications, including skull base tumors 15–19 . However, to our knowledge, there is no report of superselective embolization of branches of the ICA in JNA; the possibility of nonselective embolization under ICA occlusion has been described in one case of JNA 20 .…”

Section: Discussionmentioning

confidence: 98%

Embolization of Internal Carotid Artery Branches in Juvenile Nasopharyngeal Angiofibroma

et al. 2020

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Objective Preoperative embolization of juvenile nasopharyngeal angiofibroma (JNA) is usually performed by the occlusion of branches of the external carotid artery (ECA). However, a significant proportion of JNAs also receive blood from the internal carotid artery (ICA). The objective of this study was to report on the feasibility and clinical impact of superselective embolization of ICA branches in complex cases of JNA. Methods This was a single‐center retrospective study of all patients operated on for JNA between 2000 and 2018. The patients treated with embolization of branches of the ICA were identified. The results in terms of complications, intraoperative blood loss, and rate of residual disease were analyzed and compared to those of a control group of patients treated only with embolization of ECA branches and matched by age, stage, angiographic pattern, surgical approach, and previous surgery. Results Ninety‐two patients were included. Embolization of branches of the ICA was attempted in 14 cases of advanced or recurrent tumors and was ultimately possible in nine cases. There were no complications after embolization. The mean intraoperative blood loss was 1428 mL. Residual disease was found in three cases (33%). There was no significant difference compared with the control group (mean intraoperative blood loss = 1355 mL, residual disease = 4 (44%); all P > .05). Conclusion In this retrospective study, we report the feasibility of superselective embolization of ICA branches in selected cases of JNA. There was no observed benefit of this technique in terms of intraoperative bleeding or decreased risk of residual disease. Level of Evidence 4 Laryngoscope, 131:E775–E780, 2021

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“…Studies have analyzed the safety and efficacy of different particulate and liquid embolic agents. Our center prefers PVA particles as the embolic agent, while others advocate Embospheres (trisacryl gelatin),18 liquid embolic agents such as Onyx (ethyl vinyl alcohol copolymer) or nBCA 19–21. Studies have not shown a significant correlation between different embolic agents and degree of angiographic devascularization 11.…”

Section: Discussionmentioning

confidence: 99%

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

Barros

Feroze

Sen

et al. 2019

J NeuroIntervent Surg

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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.

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Preoperative embolization of skull base meningiomas: current indications, techniques, and pearls for complication avoidance

Cited by 71 publications

References 48 publications

Preoperative embolization versus no embolization for WHO grade I intracranial meningioma: a retrospective matched cohort study

Preoperative embolization versus no embolization for WHO grade I intracranial meningioma: a retrospective matched cohort study

Embolization of Internal Carotid Artery Branches in Juvenile Nasopharyngeal Angiofibroma

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

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