The role of preoperative embolization for intracranial meningiomas

A review

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As endovascular techniques have become more advanced, preoperative embolization has become an increasingly used intervention in the management of meningiomas. To date, however, no consensus has been reached on the use of this technique. To clarify the role of preoperative embolization in the management of meningiomas, the authors conducted a systematic review of case reports, case series, and prospective studies to increase the current understanding of the management options for these common lesions and complications associated with preoperative embolization.


A PubMed search was performed to include all relevant studies in which the management of intracranial meningiomas with preoperative embolization was reported. Immediate complications of embolization were reported as major (sustained) or minor (transient) deficits, death, or no neurological deficits.


A total of 36 studies comprising 459 patients were included in the review. Among patients receiving preoperative embolization for meningiomas, 4.6% (n = 21) sustained complications as a direct result of embolization. Of the 21 patients with embolization-induced complications, the incidence of major complications was 4.8% (n = 1) and the mortality rate was 9.5% (n = 2).


Preoperative embolization is associated with an added risk for morbidity and mortality. Preoperative embolization may be associated with significant complications, but careful selection of ideal cases for embolization may help reduce any added morbidity with this procedure. Although not analyzed in the authors' study, embolization may still reduce rates of surgical morbidity and mortality and therefore may still have a potential benefit for selected patients. Future prospective studies involving the use of preoperative embolization in certain cases of meningiomas may further elucidate its potential benefit and risks.

Abbreviation used in this paper:PVA = polyvinyl alcohol.

Article Information

Address correspondence to: Ricardo J. Komotar, M.D., Department of Neurological Surgery, 1095 NW 14th Terrace, Room 2-06, University of Miami Hospital, West Building, Suite 306, Miami, Florida 33125. email:

Please include this information when citing this paper: published online April 12, 2013; DOI: 10.3171/2013.3.JNS121328.

© AANS, except where prohibited by US copyright law.



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    The successful resection of a highly vascular petrous meningioma following preoperative embolization. Large petrous meningioma with prominent intratumoral blood vessels well visualized on contrast-enhanced MRI (A). Left external carotid artery angiogram demonstrating hypervascular tumor blush supplied predominantly by the left ascending pharyngeal artery with a smaller contribution from the left middle meningeal artery (B). Left middle meningeal pedicle (C) and left ascending pharyngeal pedicle (D) were selectively catheterized for embolization with Onyx-18. Final left external carotid artery angiogram after embolization demonstrating near-complete devascularization of the tumor (E). Preoperative postembolization (F) and postoperative (G) MR images revealing successful resection of tumor.

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    PRISMA flow chart for systematic reviews.



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