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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:1146-1150, May 2006
© 2006 American Society of Neuroradiology

INTERVENTIONAL

Clinical Evaluation of Cellulose Porous Beads for the Therapeutic Embolization of Meningiomas

Y. Kai^a, J.-I. Hamada^a, M. Morioka^a, S. Yano^a, H. Nakamura^a, K. Makino^a, T. Mizuno^a, H. Takeshima^a and J.-I. Kuratsu^b

^a Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
^b Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan

Address correspondence to Yutaka Kai, MD, Department of Neurosurgery, Graduate School of Medical Science, Kumamoto University, Honjo 1-1-1, Kumamoto 860-8556, Japan

BACKGROUND AND PURPOSE: Cellulose porous beads (CPBs) are a new, exceptionally uniformly sized, nonabsorbable embolic agent. We evaluated their efficacy in the preoperative embolization of meningiomas.

METHODS: In 141 consecutive patients, we used CPBs (200-µm diameter) for the preoperative embolization of meningiomas. We selected patients whose tumors were 4 cm with 50% of blood to the tumor supplied by the external carotid artery (ECA). All patients underwent a provocation test before embolization. The percentage of blood supplied to the tumor by the internal carotid artery and ECA was determined angiographically. Nonenhanced areas on postembolization MR imaging were calculated. Intraoperative blood loss, units of blood transfusion, and hemostasis at the time of surgery were recorded for each patient. The interval between embolization and surgery was intentionally longer than 7 days.

RESULTS: Of the 141 patients, 128 underwent CBP embolization. Eleven patients had positive provocation test results, and 2 had vasospasm; they were not CBP embolized. In 72% of the patients CBP embolization achieved reduction in the flow of the feeding artery by more than 50%. The nonenhanced area on MR imaging was not significantly correlated with the degree of ECA supply or devascularization. The interval between embolization and surgery was 8–26 days (mean, 9.9 days). The longer this interval, the greater was the tumor-softening effect and the rate of tumor removal.

CONCLUSIONS: CPBs may be useful for the preoperative embolization of meningiomas. To increase the efficacy of CPB embolization, the interval to surgery should be at least 7 days.