The safety and efficacy of preoperative embolization of meningioma with N-butyl cyanoacrylate

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Preoperative embolization of meningioma is commonly performed; however, there is no consensus on the best embolic material to reduce intraoperative blood loss and surgery time. </jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p> We retrospectively assessed the safety and efficacy of 56 cases of preoperative embolization of the middle meningeal artery with N-butyl cyanoacrylate (NBCA) in 105 cases of surgery for meningioma. We also defined a blood loss to tumor volume ratio to compensate for bias caused by tumor volume, and analyzed limited cases (the embolized group n = 52, the non-embolized group n = 21) of the convexity, the parasagittal region, the falx, and the sphenoidal ridge. </jats:p></jats:sec><jats:sec><jats:title>Result</jats:title><jats:p> The blood loss to tumor volume ratio was significantly less in the embolized group ( p &lt; 0.007). Preoperative embolization could be useful for cases with the external carotid artery as the dominant feeder vessel ( p &lt; 0.02); however, the efficacy decreased for cases with an internal carotid artery feeder. Transient complications occurred in four cases (hemiparesis secondary to edema: two cases; intratumoral bleeding: one case; trigeminal nerve disorder: one case). The cases that showed a postoperative increase in edema or intratumoral bleeding were large tumors with the early filling of veins. For such cases, surgeons should pay close attention to slow injection speed and higher NBCA viscosity, not to cause the occlusion of draining vessels. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Tumor embolization with NBCA can be safely performed, and the procedure significantly reduces intraoperative blood loss. </jats:p></jats:sec>

Preoperative Embolization for Skull Base Meningiomas

“…Embolization decreases bleeding and softens the tumor, and thus makes the surgery easier and safer to perform and reduces the surgical time. 2 However, embolization is useless when the risk of the proce-dure exceeds its potential beneficial effect because the final objective is excision. Negative opinions on preoperative embolization are occasionally reported.…”

“…When embolization is successful, bleeding obviously decreases. 2 When no bleeding occurs, and the tumor is softer, the surgery is much easier to perform. Dissection from the surrounding normal tissue becomes less complicated, and the procedure is performed in a visually dry field, thus improving the safety of the procedure.…”

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

“…51 The NBCA can enter feeding vessels simultaneously and can be administered with lower injection pressures, which may prevent intratumoral hemorrhage, a common complication of solid embolic materials. In a study of 56 patients, 26 only 4 (7.1%) patients treated with NBCA had transient complications, and only 1 was related to intratumoral hemorrhage. A newer supplementary technique involves the concurrent injection of 5% dextrose in water solution through the catheter to propel NBCA deeper into the target vessels.…”

“…44 One liquid glue, N-butyl cyanoacrylate (NBCA), was shown to have a lower risk of hemorrhage and ischemic complications compared with particle agents. 1,26,32,61 The NBCA can be delivered with a broader range of microcatheters, which allows for better distal navigation compared with particle agents. 51 The NBCA can enter feeding vessels simultaneously and can be administered with lower injection pressures, which may prevent intratumoral hemorrhage, a common complication of solid embolic materials.…”

“…Feeding vessels arose from the ECA in 26 patients (22%); the ICA in 30 (25%); a combination of ECA, ICA, and VA in 54 (45%); and the pial supply in 10 (8%). The most common locations were the sphenoid ridge (27 patients), anterior fossa (26), tentorium (15), and petrosal ridge/clivus (14). Total devascularization following embolization occurred in 6 of 64 patients (4 with ECA supply, 2 with ICA supply), and subtotal devascularization was seen in 58 of 64.…”