Introduction: Meningiomas are benign, durally based cranial tumors. En bloc resection can be curative, although for very large tumors or those in the skull base, gross total resection can be difficult and bloody. Embolization prior to surgery has been previously described as an adjunct treatment for these tumors. However, controversy persists regarding the safety of pre-operative embolization especially given arterial supply to these tumors can occur from the internal carotid artery (ICA) or external carotid artery (ECA). Here we present our institutional experience with pre-resection embolization of meningiomas.
Methods: Retrospective review of cranial tumor embolization cases from 2012 to 2014 found 12 patients who underwent pre-resection embolization. All were performed by a single neuro-interventionalist.
Results: The mean age of patients was 56.5 years (range 39-75 years), 58% were female, 17% patients had WHO grade II tumors, 33% were located in the posterior fossa, and 66% underwent embolization of pedicles from the ICA. All cases used Onyx liquid embolic with 42% cases also using adjuvant aneurysm coils, 66% achieved complete embolization as seen on follow up angiography. All patients underwent open surgical resection within three days of embolization. The mean hematocrit change from pre to post-resection was 20% (range 0-33%), mean length of stay was 6 days, and no patients required follow up radiation. No patients had any direct complications from the embolization procedure.
Conclusions: Our case series indicates that in experienced hands, pre-resection embolization of meningiomas does not pose increased risk to the patient. Over half of our cases required embolization of tumor pedicles from the ICA directly and no patients suffered neurologic sequelae during embolization resulting from thromboembolic event or secondary to unintended Onyx penetration.
Patient Care: We hope oncologic neurosurgeons will consider pre-resection embolization in those patients with large or complex meningiomas as a way to help improve gross total resection, and minimize blood loss for patients.
Learning Objectives: 1) In experienced hands, embolization of even ICA feeders to meningiomas is a safe adjunct treatment to facilitate gross total resection during open surgery and minimize blood loss.