Efficacy of Trisacryl Gelatin Microspheres versus Polyvinyl Alcohol Particles in the Preoperative Embolization of Meningiomas
Martin Bendszus
,a,
Rüdiger Kleina,
Ralf Burgera,
Monika Warmuth-Metza,
Erich Hofmanna and
Laszlo Solymosia
a From the Departments of Neuroradiology (M.B., M.W-M., E.H., L.S.), Neuropathology (R.K.), and Neurosurgery (R.B.), University of Würzburg, Germany.
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FIG 1. Extent of angiographic preoperative devascularization in groups 1 through 3 (proportional representation for every group). White bars indicate trisacryl gelatin microspheres; dark gray bars, PVA particles 45 to 150 µm; light gray bars, PVA particles 150 to 250 µm
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FIG 2. Mean intraoperative blood loss (mL) and mean number of blood units in groups 1 through 3. Shaded bars indicate blood loss; black line, blood units
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FIG 3. Most distal intravascular location of the embolic agent in groups 1 through 3 (proportional representation for every group). White bars indicate trisacryl gelatin microspheres; light gray bars, PVA particles, 45 to 150 µm; dark gray bars, PVA particles 150 to 250 µm
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FIG 4. A, Low-power magnification of large PVA particles (150–250 µm) seen in arterial vessels of a meningioma. Note the particles in a small arterial vessel and large extent of necrosis next to the embolized vessel (original magnification x60).
B, High-power view shows the irregularly shaped large PVA particles that obliterate the lumen and lead to additional thrombosis (original magnification x240).
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FIG 5. A, Small PVA particles (45–150 µm) are found in arterial vessel, in which they nearly completely obliterate the lumen, as well as in vessels in which they do not fully obliterate the lumen but lead to intravascular thrombosis (original magnification x60).
B, High-power view of small PVA particles in a precapillary vessel, with thrombosis surrounding the irregularly shaped PVA particle. A slight lymphocytic inflammatory reaction surrounds the vessel (original magnification x480).
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FIG 6. A, Embospheres (100–300 µm) form rolls and aggregations but do not lead to thrombosis in larger vessels (original magnification x60).
B, High-power view of a single trisacryl gelatin microsphere that completely obliterates a precapillary vessel. A small capillary without blood particles branches from this embolized vessel (original magnification x480).
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