Is There a Benefit of Preoperative Meningioma Embolization?

Bendszus, Martin; Rao, Gerad; Burger, Ralf; Schaller, Carlo; Scheinemann, Katrin; Warmuth‐Metz, Monika; Hofmann, Erich; Schramm, Johannes; Roosen, K.; Solymosi, L.

doi:10.1093/neurosurgery/47.6.1306

Cited by 15 publications

(12 citation statements)

References 3 publications

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“…Although many reports have suggested usefulness of preoperative embolization for intracranial tumors focusing on reducing intraoperative blood loss, 1–6,10,11) a certain number of procedure-related complications has also been reported in the literatures. 10–12) There is a critical paper which has demonstrated that preoperative meningioma embolization did not result in better clinical outcome or significant reduction of blood loss. 12) Raper et al 13) also reported that preoperative embolization did not alter the operative duration, complication, or degree of resection from their analysis of 224 patients with meningioma.…”

Section: Discussionmentioning

confidence: 99%

“…10–12) There is a critical paper which has demonstrated that preoperative meningioma embolization did not result in better clinical outcome or significant reduction of blood loss. 12) Raper et al 13) also reported that preoperative embolization did not alter the operative duration, complication, or degree of resection from their analysis of 224 patients with meningioma. Latchaw 14) advocated technical considerations affecting the risk-to-benefit ratio of preoperative intracranial meningioma embolization.…”

Section: Discussionmentioning

confidence: 99%

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Treatment Outcome of Intracranial Tumor Embolization in Japan: Japanese Registry of NeuroEndovascular Therapy 3 (JR-NET3)

Sugiu

Hishikawa

Murai

et al. 2019

Neurol. Med. Chir.(Tokyo)

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Embolization for intracranial tumor is performed as a standard endovascular treatment. A retrospective, multicenter, observational study was conducted to clarify the nature, frequency, and risk factors of complications in intracranial tumor embolization. Patients were derived from the Japanese Registry of NeuroEndovascular Therapy (JR-NET3) using data taken from January 2010 through December 2014 in Japan. A total of 40,169 patients were enrolled in JR-NET3, of which, 1,545 patients (3.85%) with intracranial tumors underwent embolization. The primary end point was the proportion of patients with a modified Rankin scale (mRS) score of 0–2 (independency) at 30 days after embolization. The secondary end point was the occurrence of complications related to the procedures. The risk factors of the development of complications were analyzed. The proportion of patients with mRS scores ≤2 at 30 days after procedure was 89.5%. Complications occurred in 57 of the 1544 patients (3.7%). Multivariate analysis showed that target vessels other than external carotid artery (ECA) (OR, 3.56; 95% CI, 2.03–6.25; P <0.001) and use of liquid material (OR, 2.65; 95% CI, 1.50–4.68; P <0.001) were significantly associated with the development of complications. In JR-NET3, the primary end point was 89.5%, and the procedure-related complication rate was 3.7%. Embolization from other than ECA was significant risk factor of the complications. In addition, increasing usage of liquid embolic material worsened the risk of complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment Outcome of Intracranial Tumor Embolization in Japan: Japanese Registry of NeuroEndovascular Therapy 3 (JR-NET3)

Sugiu

Hishikawa

Murai

et al. 2019

Neurol. Med. Chir.(Tokyo)

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“…However, it must be total to decrease operative blood loss; and an aggressive embolization can generate permanent postprocedural neurological deficits. [ 3 21 27 ]…”

Section: Discussionmentioning

confidence: 99%

Transzygomatic approach plus mini-peeling of middle fossa for devascularization of sphenoid wing meningiomas. Technical note

Campero¹,

Villalonga

López-Elizalde

et al. 2018

Surg Neurol Int

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Background:Sphenoid wing meningiomas account for 20% of supratentorial meningiomas. The main supply of these tumors is provided by branches of the middle and accessory meningeal arteries. Surgical resection of meningiomas requires early tumor devascularization. Our objective is to present the role of transzygomatic approach plus mini-peeling of the anterior third of the middle fossa in the extradural identification and coagulation of branches of middle and accessory meningeal arteries involved in tumor supply.Methods:Ten formalin-fixed, silicone-injected cadaveric heads were used. On each side a transzygomatic approach plus mini-peeling of the anterior third of the middle fossa was performed. Between 2005 and 2017, the authors applied this technique for the resection of sphenoid wing meningiomas in 28 patients.Results:The mean age of patients was 54 years. Thirteen tumors could be classified as medial-third type, 6 as middle-third type, and 4 tumors were lateral-third type. Five tumors represented combined types. Of these, 3 tumors involved the medial and middle-third of the sphenoid wing and 2 involved the entire wing. Surgical resection was classified as Simpson I/II in 24 patients (86%). There were no permanent deficits or postoperative mortality.Conclusions:The transzygomatic approach combined with mini-peeling of the anterior third of the middle fossa is effective in allowing early devascularization of sphenoid wing meningiomas. These maneuvers are particularly important during resection of large tumors.

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“…If delayed beyond this time frame, swelling of the tumor may occur along with neovascularization [ 7 8 ]. While embosurgery may overall facilitate the operative tumoral resection, and may diminish the complications while improving outcomes when compared to resection alone, the application of embolization is subject to debate, requiring balanced consideration of its pros and cons in given the particularities of each case [ 1 9 ]. Key components of a successful embosurgery include a comprehensive and thorough knowledge of the patient's unique neurovascular anatomy, venous outflow patterns, dural sinus involvement, anatomical variation, and regional anastomoses to avoid devastating unintended embolization of critical non-tumoral cerebrovascular territories [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Improving Forward Infusion Pressure during Brain Tumor Embolization with the Double Catheter and Coil Technique

Dayawansa

Konda²,

Lesley

et al. 2017

Neurointervention

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Endovascular embolization or embosurgery of brain tumors can be used to reduce neoplasm vascularity prior to surgical resection. Two challenges with embosurgery relate to insufficient perfusion pressure into the tumor and inadvertent escape of infused agents into parenchymal branches of the adjacent brain. This report describes a multi-catheter and coil technique to improve tumor perfusion and prevent reflux into normal branches.

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Is There a Benefit of Preoperative Meningioma Embolization?

Abstract: In this preliminary study, only complete embolization had an effect on blood loss. The value of preoperative embolization for all meningiomas must be reconsidered, especially in view of the high costs and risks of embolization.

Cited by 15 publications

References 3 publications

Treatment Outcome of Intracranial Tumor Embolization in Japan: Japanese Registry of NeuroEndovascular Therapy 3 (JR-NET3)

Treatment Outcome of Intracranial Tumor Embolization in Japan: Japanese Registry of NeuroEndovascular Therapy 3 (JR-NET3)

Transzygomatic approach plus mini-peeling of middle fossa for devascularization of sphenoid wing meningiomas. Technical note

Improving Forward Infusion Pressure during Brain Tumor Embolization with the Double Catheter and Coil Technique

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