Introduction: Presurgical embolization of meningiomas was first described in 1973 by Manelfe et al. There are great discrepancies in this respect and the current scientific evidence is poor.
Methods: We retrospectively reviewed supratentorial meningiomas greater than 4cm, intervened in our center between 2002-2015. We found 28 embolized meningiomas and 54 non-embolized meningiomas of similar size and location. All of them presented an irragation that depended on more than 50% of the external carotid artery.
Embolization was carried out by ultraselective catheterization with microspheres (500-700 µ) with the patient awake and surgery was performed 24-48 hours after.
Results: The mean age was lower in the embolized patients (E) compared to the non-embolized patients (E) (p = 0.027). We did not find statistically significant differences in terms of location, size (p = 0.065), preoperative neurological examination, degree of resection, mean stay or complications between both groups.
The surgical time was lower in the case of embolized meningiomas (p = 0.091). The percentage of embolized patients who needed positive ionotropic drugs during surgery was lower (p = 0.102) and the volume of transfusion was lower in the embolized cases, too (p = 0.471).
The difference between the scores on the Canadian scale between discharge and admission was higher in the case of embolized patients versus non-embolized patients (p = 0.003).
Conclusions: Pre-surgical embolization may be beneficial in certain supratentorial meningiomas larger than 4 centimeters.
Given the scarce scientific evidence and the possible complications of embolization, prospective randomized studies are necessary to determine the true benefit of preoperative embolization of meningiomas
Patient Care: Providing more clinical evidence
Learning Objectives: Indications and benefits of presurgical embolization of meningiomas