Introduction: Preoperative embolization for the treatment of intracranial meningiomas is controversial, and clinical benefit is difficult to demonstrate. We hypothesized that progression-free survival would be improved in the treatment of World Health Organization (WHO) grade 2 and 3 tumors which underwent significant (>75% reduction in angiographic tumor blush) preoperative embolization.
Methods: We reviewed all WHO grade II and III tumors treated with embolization and subsequent surgical resection between 2000-2010. Data regarding extent of embolization, extent of resection, recurrence rates, endovascular complications, and progression-free survival were analyzed.
Results: Overall, 43 high-grade intracranial meningiomas underwent preoperative embolization and were followed for a mean of 4.6 years. Gross total resection was achieved in 62.7%, and postoperative radiotherapy was performed in 47.6% of patients. Pathology revealed necrosis in 61% of specimens. The overall progression-free survival was 35.9 months. Endovascular complications were seen in 3% of patients.
The mean progression-free survival for tumors that were significantly embolized was greater than that of tumors that had less successful embolization (38.6 months vs. 28.5 months, p<.05).
Conclusions: Preoperative embolization of WHO grade 2 and 3 meningiomas confers a significant progression-free survival benefit in patients in whom a substantial (>75%) embolization can be obtained. Further study is needed to determine what role, if any, suboptimal embolization plays in the treatment of these challenging tumors.
Patient Care: High grade meningiomas remain a challenging neuro-oncological problem, and recurrence rates remain high despite maximal multimodality therapy. Embolization appears to improve the outcome in these tumors.
Learning Objectives: Understand the role of preoperative embolization in the treatment of high-grade intracranial meningiomas.