Preoperative Embolization of Intracranial Meningiomas: Efficacy, Technical Considerations, and Complications

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
Fig 1.
Right frontal meningioma, pre- and postembolization and resection. Pre-embolization right ECA injection demonstrates tumor blush from the middle meningeal artery (A, lateral view; B, frontal view). Embolization was achieved with 150- to 250-μm PVA particles. Postembolization right ECA injection reveals complete obliteration of tumor blush (C, lateral view; D, frontal view). T1-weighted MR imaging with gadolinium before embolization (E, axial view; F, coronal view). T1-weighted MR imaging with gadolinium postresection (G, axial view; H, coronal view).

Table 1:

Patient and tumor characteristics

	Total Cohort	Embo	No Embo	P Value
Total patients	470	174	307	–
Total treated meningiomas	504	177	327	–
Mean age (range) (yr)	57 (17–90)	56 (17–82)	58 (18–90)	.2988
Female (%)	336 (71.5)	116 (66.7)	223 (72.6)	.185
Tumor location				<.001^{^a}
Olfactory groove (%)	27 (5.5)	5 (2.9)	22 (6.9)
Planum sphenoidale/tuberculum (%)	42 (8.6)	5 (2.9)	37 (11.6)
Cavernous sinus (%)	5 (1.0)	0	5 (1.6)
Sphenoid wing (%)	66 (13.5)	31 (18.0)	35 (11.0)
Suprasellar (%)	2 (0.4)	0	2 (0.6)
Convexity (%)	187 (38.2)	65 (37.8)	122 (38.2)
Parasagittal (%)	88 (18.0)	41 (23.8)	47 (14.7)
Middle cranial fossa (%)	12 (2.4)	2 (1.2)	10 (3.1)
Posterior fossa (%)	41 (8.4)	18 (10.5)	24 (7.5)
Intraosseous (%)	1 (0.2)	1 (0.6)	0
Intraventricular (%)	9 (1.8)	0	9 (2.8)
Cerebellopontine angle (%)	10 (2.0)	4 (2.3)	6 (1.9)
Skull base location (%)	164 (33.4)	47 (27.3)	117 (36.7)	.036^{^a}
Max. tumor diameter (mm) (range)	38.7 (5–89)	45.6 (16–89)	34.9 (5–89)	<.001^{^a}
Prior resection (%)	59 (11.9)	11 (6.4)	48 (15.0)	.005^{^a}
Prior radiosurgery (%)	35 (7.0)	11 (6.3)	24 (7.5)	.626
Prior radiotherapy (%)	12 (2.4)	5 (2.9)	7 (2.2)	.633
WHO grade				.807
I	344 (74.8)	121 (75.2)	223 (74.6)
II	98 (21.3)	35 (21.7)	63 (21.1)
III	18 (3.9)	5 (3.1)	13 (4.3)
Brain invasion	108 (21.4)	42 (23.7)	56 (17.1)	.773

Note:—Embo indicates embolized group; –, not significant; No Embo, non-embolized group; Max., maximum; WHO, World Health Organization.
↵a Significant difference.

Table 2:

Embolization characteristics

	No.
Referred for embolization	224
Successful embolization (%)	177 (79.0)
Method of embolization
PVA (%)	67 (39.0)
PVA and Gelfoam (%)	75 (43.6)
PVA and coil (%)	26 (15.1)
Coil (%)	3 (1.7)
PVA and Gelfoam and coil (%)	1 (0.6)
Embolized vessel
Middle meningeal	157 (67.4)
Occipital	21 (9.0)
Internal maxillary	14 (6.0)
Superficial temporal	14 (6.0)
Deep temporal branch	13 (5.6)
Ascending pharyngeal	6 (2.6)
Posterior auricular	1 (0.4)
Sphenopalatine	3 (1.3)
Meningohypophyseal trunk	1 (0.4)
Anterior cerebral artery branch	1 (0.4)
Middle cerebral artery branch	1 (0.4)
Vertebral artery branch	1 (0.4)
Tumor devascularization
>75%	107 (68.6)
50%–74%	27 (17.3)
25%–49%	12 (7.7)
<25%	10 (6.4)
Mean time from embolization to surgery (days) (range)	1.6 (0–31)
Complications
Dissection	2 (1.1)
Facial nerve palsy	1 (0.6)
Stroke	1 (0.6)
Scalp infarction	1 (0.6)
Iodine allergy	1 (0.6)

Table 3:

Operative outcomes

	Embolized	Nonembolized	P Value
Operative time (min)	3:53 (0:55–10:39)	3:39 (0:37–13:35)	.2348
Estimated blood loss (mL)	410 (0–2700)	315 (0–2200)	.0074^{^a}
Extent of resection			.249
Gross total	116 (69.5)	228 (75.2)
Subtotal	33 (19.8)	42 (13.8)
Partial	18 (10.8)	33 (10.9)
Operative complications
Subdural hematoma	3 (1.7)	4 (1.2)	.6455
Cerebral infarction	3 (1.7)	3 (0.9)	.4274
ICH/IVH	0	5 (1.5)	.1015
CSF leak	1 (0.6)	3 (0.9)	.7173
Pseudomeningocele	2 (1.1)	1 (0.3)	.2593
Hydrocephalus	1 (0.6)	1 (0.3)	.6129
Seizure	0	6 (1.8)	.0726
Infection	4 (2.2)	6 (1.8)	.7560
Cranial nerve deficit	2 (1.1)	4 (1.2)	.9204
DVT/PE	4 (2.2)	6 (1.8)	.7560
Perioperative mortality	2 (1.1)	2 (0.6)	.5413
Other	1 (0.5)	1 (0.3)	.7242
Total complications	23 (12.9)	43 (13.1)	.960
Postoperative radiotherapy (%)	8 (4.8)	20 (6.3)	.500
Postoperative radiosurgery (%)	23 (14.1)	27 (8.6)	.042^{^a}

Note:—ICH/IVH indicates intracerebral hemorrhage/intraventricular hemorrhage; DVT/PE, deep vein thrombosis/pulmonary embolism.
↵a Significant difference.