The role of preoperative embolization for intracranial meningiomas

A review

Restricted access

Object

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.

Methods

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.

Results

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).

Conclusions

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: RKomotar@med.miami.edu.

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.

Headings

Figures

  • View in gallery

    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.

  • View in gallery

    PRISMA flow chart for systematic reviews.

References

1

Abe TMatsumoto KHomma HKawamura NIwata TNemoto S: Dorsum sellae meningioma mimicking pituitary macroadenoma: case report. Surg Neurol 51:5435471999

2

Anderson DKhalil M: Meningioma and the ophthalmologist. A review of 80 cases. Ophthalmology 88:100410091981

3

Bendszus MKlein RBurger RWarmuth-Metz MHofmann ESolymosi L: Efficacy of trisacryl gelatin microspheres versus polyvinyl alcohol particles in the preoperative embolization of meningiomas. AJNR Am J Neuroradiol 21:2552612000

4

Bendszus MMonoranu CMSchütz ANölte IVince GHSolymosi L: Neurologic complications after particle embolization of intracranial meningiomas. AJNR Am J Neuroradiol 26:141314192005

5

Bendszus MRao GBurger RSchaller CScheinemann KWarmuth-Metz M: Is there a benefit of preoperative meningioma embolization?. Neurosurgery 47:130613122000

6

Boulos PTDumont ASMandell JWJane JA Sr: Meningiomas of the orbit: contemporary considerations. Neurosurg Focus 10:5E52001

7

Burkhardt JKZinn POGraenicher MSantillan ABozinov OKasper EM: Predicting postoperative hydrocephalus in 227 patients with skull base meningioma. Neurosurg Focus 30:5E92011

8

Carli DFSluzewski MBeute GNvan Rooij WJ: Complications of particle embolization of meningiomas: frequency, risk factors, and outcome. AJNR Am J Neuroradiol 31:1521542010

9

Celedin SRabitsch EHausegger KARichling B: Accidental transtumoral microparticle embolization of eloquent brain areas in a case of large temporofrontal meningioma. Interv Neuroradiol 14:3393432008

10

Chun JYMcDermott MWLamborn KRWilson CBHigashida RBerger MS: Delayed surgical resection reduces intraoperative blood loss for embolized meningiomas. Neurosurgery 50:123112372002

11

Chung YGLee KCLee ISLee NJ: Profound hypothermia and cardiopulmonary bypass in the treatment of recurrent giant angioblastic meningioma case report. J Korean Med Sci 11:4494531996

12

Dean BLFlom RAWallace RCKhayata MHObuchowski NAHodak JA: Efficacy of endovascular treatment of meningiomas: evaluation with matched samples. AJNR Am J Neuroradiol 15:167516801994

13

Dowd CFHalbach VVHigashida RT: Meningiomas: the role of preoperative angiography and embolization. Neurosurg Focus 15:1E102003

14

Hamada JUshio YKazekawa KTsukahara THashimoto NIwata H: Embolization with cellulose porous beads, I: An experimental study. AJNR Am J Neuroradiol 17:189518991996

15

Hart JLDavagnanam IChandrashekar HSBrew S: Angiography and selective microcatheter embolization of a falcine meningioma supplied by the artery of Davidoff and Schechter. Case report. J Neurosurg 114:7107132011

16

Hirai TKorogi YOno KUemura SYamashita Y: Preoperative embolization for meningeal tumors: evaluation of vascular supply with angio-CT. AJNR Am J Neuroradiol 25:74762004

17

Hirohata MAbe TMorimitsu HFujimura NShigemori MNorbash AM: Preoperative selective internal carotid artery dural branch embolisation for petroclival meningiomas. Neuroradiology 45:6566602003

18

Javadpour MKhan ADJenkinson MDFoy PMNahser HC: Cerebral aneurysm associated with an intracranial tumour: staged endovascular and surgical treatment in two cases. Br J Neurosurg 18:2802842004

19

Kai YHamada JIMorioka MYano SNakamura HMakino K: Clinical evaluation of cellulose porous beads for the therapeutic embolization of meningiomas. AJNR Am J Neuroradiol 27:114611502006

20

Kaji THama YIwasaki YKyoto YKusano S: Preoperative embolization of meningiomas with pial supply: successful treatment of two cases. Surg Neurol 52:2702731999

21

Kallmes DFEvans AJKaptain GJMathis JMJensen MEJane JA: Hemorrhagic complications in embolization of a meningioma: case report and review of the literature. Neuroradiology 39:8778801997

22

Kantrowitz ABSpallone ATaylor WChi TLStrack MFeghali JG: Erythropoietin-augmented isovolemic hemodilution in skull-base surgery. Case report. J Neurosurg 80:7407441994

23

Kasuya HShimizu TSasahara ATakakura K: Phenytoin as a liquid material for embolisation of tumours. Neuroradiology 41:3203231999

24

Kubo MKuwayama NHirashima YTakaku AOgawa TEndo S: Hydroxyapatite ceramics as a particulate embolic material: report of the clinical experience. AJNR Am J Neuroradiol 24:154515472003

25

Kubo MKuwayama NHirashima YTakaku AOgawa TEndo S: Hydroxyapatite ceramics as a particulate embolic material: report of the physical properties of the hydroxyapatite particles and the animal study. AJNR Am J Neuroradiol 24:154015442003

26

Kunikata HTamai M: Cilioretinal artery occlusions following embolization of an artery to an intracranial meningioma. Graefes Arch Clin Exp Ophthalmol 244:4014032006

27

Lefkowitz MGiannotta SLHieshima GHigashida RHalbach VDowd C: Embolization of neurosurgical lesions involving the ophthalmic artery. Neurosurgery 43:129813031998

28

Lieu ASHowng SL: Intracranial meningiomas and epilepsy: incidence, prognosis and influencing factors. Epilepsy Res 38:45522000

29

Maekawa HTanaka MHadeishi H: Middle meningeal artery aneurysm associated with meningioma. Acta Neurochir (Wien) 151:116711682009

30

Manelfe CGuiraud BDavid JEymeri JCTremoulet MEspagno J: [Embolization by catheterization of intracranial meningiomas.]. Rev Neurol (Paris) 128:3393511973. (Fr)

31

Nakamura MRoser FBundschuh OVorkapic PSamii M: Intraventricular meningiomas: a review of 16 cases with reference to the literature. Surg Neurol 59:4915042003

32

Nakamura MRoser FMichel JJacobs CSamii M: The natural history of incidental meningiomas. Neurosurgery 53:62712003

33

Nozaki KNagata IYoshida KKikuchi H: Intrasellar meningioma: case report and review of the literature. Surg Neurol 47:4474541997

34

O'Neill ORBarnwell SLSilver DJ: Middle meningeal artery aneurysm associated with meningioma: case report. Neurosurgery 36:3963981995

35

Oka HKurata AKawano NSaegusa HKobayashi IOhmomo T: Preoperative superselective embolization of skull-base meningiomas: indications and limitations. J Neurooncol 40:67711998

36

Quinones-Hinojosa AChang EFMcDermott MW: Falcotentorial meningiomas: clinical, neuroimaging, and surgical features in six patients. Neurosurg Focus 14:6e112003

37

Quiñones-Hinojosa AKaprealian TChaichana KLSanai NParsa ATBerger MS: Pre-operative factors affecting resectability of giant intracranial meningiomas. Can J Neurol Sci 36:6236302009

38

Rosen CLAmmerman JMSekhar LNBank WO: Outcome analysis of preoperative embolization in cranial base surgery. Acta Neurochir (Wien) 144:115711642002

39

Sagoh MOnozuka SMurakami HHirose Y: Successful removal of meningioma of the pineal region after embolization. Neurol Med Chir (Tokyo) 37:8528551997

40

Shi ZSFeng LJiang XBHuang QYang ZHuang ZS: Therapeutic embolization of meningiomas with Onyx for delayed surgical resection. Surg Neurol 70:4784812008

41

Sorimachi TMaruya JMizusawa YIto YTakeuchi S: Glaucoma as a complication of superselective ophthalmic angiography. AJNR Am J Neuroradiol 24:155215532003

42

Suzuki MMizoi KYoshimoto T: Should meningiomas involving the cavernous sinus be totally resected?. Surg Neurol 44:3131995

43

Tajima YTakagi RKominato YKuwayama N: A case of iatrogenic cerebral infarction demonstrated by postmortem cerebral angiography. Leg Med (Tokyo) 9:3263292007

44

Terada TKinoshita YYokote HTsuura MItakura TKomai N: Preoperative embolization of meningiomas fed by ophthalmic branch arteries. Surg Neurol 45:1611661996

45

Tymianski MWillinsky RATator CHMikulis DTerBrugge KGMarkson L: Embolization with temporary balloon occlusion of the internal carotid artery and in vivo proton spectroscopy improves radical removal of petrous-tentorial meningioma. Neurosurgery 35:9749771994

46

Velez AMFriedman WA: Disseminated intravascular coagulation during resection of a meningioma: case report. Neurosurgery 68:E1165E11692011

47

Wakhloo AKJuengling FDVan Velthoven VSchumacher MHennig JSchwechheimer K: Extended preoperative polyvinyl alcohol microembolization of intracranial meningiomas: assessment of two embolization techniques. AJNR Am J Neuroradiol 14:5715821993

48

Waldron JSSughrue MEHetts SWWilson SPMills SAMcDermott MW: Embolization of skull base meningiomas and feeding vessels arising from the internal carotid circulation. Neurosurgery 68:1621692011

49

Yano SKuratsu J: Indications for surgery in patients with asymptomatic meningiomas based on an extensive experience. J Neurosurg 105:5385432006

50

Yasui KShoda YSuyama TNuma YAmanouchi YYKawamoto K: Preoperative embolization for meningioma using lipiodol. Interv Neuroradiol 4:Suppl 163661998

51

Yen PSLin CCLee CCHarnod TLoh TWHsu YH: CNS Clostridium perfringens infection: a rare complication of preoperative embolization of meningioma. AJNR Am J Neuroradiol 27:135513562006

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 81 81 22
Full Text Views 269 269 56
PDF Downloads 150 150 10
EPUB Downloads 0 0 0

PubMed

Google Scholar