Introduction: Preoperative embolization for intracranial meningiomas offers potential advantages for safer and more effective subsequent resection. However, this treatment strategy has not been examined in a large contemporary series.
Methods: Retrospective review of patients undergoing intracranial meningioma resection at UVA Hospital 01/2009-12/2012. Comparisons were made for embolized vs non-embolized patients, including method of embolization, complications, operative blood loss, and tumor characteristics. Statistical analysis was performed using chi-square and Fisher’s exact tests.
Results: 145 patients were included. Average age was 56.2, and 28% of patients were male. The mean maximal tumor diameter was 3.74 cm. Patients were referred for preoperative embolization in 47% of cases, and full embolization was achieved in 76.5% (in 22% embolization was not possible; partial embolization was achieved in 1.5%). 97% of embolized patients experienced no complications; there were one case of stroke (1.6%) and one episode of iodine allergy (1.6%). Embolization was achieved using PVA particles in 47%, PVA + gelfoam in 26%, and PVA + coils in 21%. The vessel embolized was most commonly the middle meningeal (70%), followed by occipital artery (8.6%). 33% of patients had more than one vessel embolized and 17% had bilateral embolizations.
Among patients who were embolized, average EBL at surgery was 356 mL (range: 50-2250). The rates of GTR, STR and partial resection were 72%, 16% and 12% respectively. Among patients who did not receive embolization, average EBL was 277 mL (range: 50-1300). The rates of GTR, STR and partial resection were 81%, 11% and 8% respectively. There were no statistically significant differences in EBL or rate of GTR between patients who were or were not embolized.
Conclusions: Preoperative embolization is a safe option for some intracranial meningiomas. Although embolization may make a subjective difference during operative resection, there was no difference in EBL or ability to achieve GTR in the present study. Embolization should be considered on a case-by-case basis depending on imaging characteristics, anatomical location and patient-specific factors.
Patient Care: Characterize the risks and benefits of preoperative embolization for meningiomas.
Learning Objectives: Understand the advantages and limitations of preoperative embolization for intracranial meningiomas