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  • The Meningioma Vascular Index: A Volumetric Analysis of Flow Voids Predicts Successful Embolization

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    Carlito Lagman MD; Vera Ong; Thien Phuc Nguyen BS; Yasmine Alkhalid BS; John Patrick Sheppard; Prasanth Romiyo BA, BS; Daniel Azzam; Giyarpuram Prashant MD; Joel S Beckett MD; MHS; Isaac Yang MD

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    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting - Late Breaking Science

    Introduction: Meningiomas that appear hypervascular on neuroimaging may be amenable to preoperative embolization. However, methods for measuring hypervascularity have not been described nor has the predictive value of hypervascularity been assessed.

    Methods: We performed volumetric analysis of 51 intracranial meningiomas (21 preoperatively embolized) resected at our institution. Through the use of an image segmentation software and voxel-based segmentation method, we measured volumes of flow voids on T2-weighted magnetic resonance images. We named this novel volumetric the meningioma vascular index (MVI). The primary outcome was a successful embolization procedure. We also analyzed operative time, intraoperative blood loss, Simpson grade, and the need for blood transfusion.

    Results: The MVI was correlated with successful embolization (rpb = 0.35, P = .01), intraoperative blood loss (r = 0.29, P = .04), and postoperative blood transfusion (rpb = 0.36, P = .009). An MVI greater than or equal to 2.5 cc was a significant predictor of successful embolization (odds ratio [OR] 4.00, 95% confidence interval [CI] 1.01-15.78), subtotal resection (OR 7.64, 95% CI 1.74-33.58), and blood transfusion (OR 9.25, 95% CI 1.44-59.51).

    Conclusions: We report a method of predicting the success of preoperative embolization using volumetric analysis of flow voids on standard magnetic resonance imaging sequences. This information could help neurosurgeons and neurointerventionalists better understand the chance of a successful embolization procedure and could be useful when counseling patients.

    Patient Care: This research will help in predicting the success of preoperative embolization using diagnostic cerebral angiogram.

    Learning Objectives: To investigate flow void volume as a predictor of a successful embolization.


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