Longitudinal Imaging of Tumor Volume, Diffusivity, and Perfusion After Preoperative Endovascular Embolization in Supratentorial Hemispheric Meningiomas

Gruber, Philipp; Schwyzer, Lucia; Klinger, Elisabeth; Burn, Felice; Diepers, Michael; Añon, Javier; Fathi, Ali-Reza; Fandiño, Javier; Remonda, Luca; Roelcke, Ulrich; Berberat, Jatta

doi:10.1016/j.wneu.2018.08.078

Cited by 10 publications

(6 citation statements)

References 21 publications

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“…The extent of angiographic devascularization or radiographic ischemia on MRI did not correlate with subsequent intraoperative blood loss, degree of surgical resection, or patient functional outcome at follow-up in their study. These authors suggested meningiomas with dominant dural arterial supply are most amenable to safe and effective embolization, similar to our study results 22. Of note, aside from the use of diagnostic cerebral angiography and MRI in an attempt to assess embolization efficacy in both a qualitative and quantitative fashion, more recent efforts by Wen et al have proposed the use of semiquantitative analysis by flat-detector CT imaging to assess for degree of tumor embolization 23…”

Section: Discussionsupporting

confidence: 87%

“…Bendszus et al and Borg et al found a reduction in estimated blood loss when comparing extensively embolized (>90%) to only partially embolized tumors 11 12. Other studies have failed to demonstrate significant correlation between degree of preoperative embolization and blood loss or extent of resection 10 13 22 24. A recent study of 28 patients with skull base meningioma did not find any association between arterial supply or anatomic location and degree of devascularization 20.…”

Section: Discussionmentioning

confidence: 97%

“…A study by Gruber et al reviewed 14 patients and demonstrated radiographic evidence of tumor devascularization using MRI at 6 hours and 48 hours post-embolization using sodium polymethacrylate particulate agent 22. Apparent diffusion coefficient, relative cerebral blood flow, and relative cerebral blood volume MRI sequences all showed significant reduction at 6 hours post-embolization, with no significant progression after 48 hours.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of preoperative endovascular embolization of meningiomas: subanalysis of anatomic location and arterial supply

Barros

Feroze

Sen

et al. 2019

J NeuroIntervent Surg

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IntroductionEndovascular embolization of intracranial meningiomas is commonly used as an adjunct to surgical resection. We sought to describe the anatomic locations and vascular supplies of meningiomas to identify characteristics predictive of successful preoperative endovascular embolization.MethodsWe conducted a retrospective review of 139 meningioma cases receiving cerebral angiograms for possible preoperative endovascular embolization at our institution between December 2000 and March 2017. The extent of embolization, arterial supply, anatomic location, and procedural complications were recorded for each case. Univariate and multivariate analyses were performed to identify tumor characteristics that predicted successful embolization.ResultsOf the total meningioma patients undergoing preoperative angiography, 78% (108/139) were successfully embolized, with a 2.8% periprocedural complication rate (3/108). Within the subset of patients with successful embolization, 31% (33/108) achieved complete angiographic embolization. Significant multivariate predictors of embolization (either partial or complete) were convexity/parasagittal locations (OR 5.15, 95% CI 0.93 to 28.54, p=0.060), meningohypophyseal trunk (MHT, OR 4.65, 95% CI 1.63 to 13.23, p=0.004), middle meningeal artery (MMA, OR 10.89, 95% CI 3.43 to 34.64, p<0.001), and ascending pharyngeal artery supply (APA, OR 9.96, 95% CI 1.88 to 52.73, p=0.007). Significant predictors for complete embolization were convexity/parasagittal locations (OR 4.79, 95% CI 1.66 to 13.84, p=0.004) and embolized APA supply (OR 6.94, 95% CI 1.90 to 25.39, p=0.003). Multiple arterial supply was a negative predictor of complete embolization (OR 0.38, 95% CI 0.15 to 0.98, p=0.05).ConclusionsTumor characteristics can be used to predict the likelihood of preoperative meningioma embolization. Parasagittal and convexity meningiomas, and those with APA supply, are most likely to achieve complete angiographic embolization.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Predictors of preoperative endovascular embolization of meningiomas: subanalysis of anatomic location and arterial supply

Barros

Feroze

Sen

et al. 2019

J NeuroIntervent Surg

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“…Los estudios histopatológicos realizados en los meningiomas resecados, que fueron llevados previamente a embolización demuestran cambios celulares isquémicos y necrosis fibrinoide vascular, que en la Resonancia Magnética se traducen en una disminución significativa en la señal del coeficiente de difusión aparente (ADC), volumen sanguíneo cerebral relativo (rCBV) y flujo sanguíneo cerebral relativo (rCBF) que con frecuencia se encontrarán presentes desde las 6 horas a las 48 horas post-embolización 14 .…”

Section: Discussionunclassified

Signo de oscurecimiento tumoral: hallazgo imagenológico que puede corresponder a una embolización pre-quirúrgica exitosa en meningiomas

Hernández

Robles

Pardo³

et al. 2022

revchilneurocir

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Objetivo: El presente trabajo busca describir el cambio en las características imagenológicas en resonancia magnética cerebral en estudios pre y post-embolización de meningiomas en plan de ser llevados a resección quirúrgica. Justificación: La embolización pre-quirúrgica de los meningiomas intracraneales ha mostrado beneficios relacionados principalmente a un menor sangrado intra-operatorio y duración de estancia hospitalaria, así como mayor facilidad técnica en su resección debido a los cambios por necrosis licuefactiva que sufre el tumor. Métodos: Se presenta un caso representativo con estudios imagenológicos pre y post-embolización realizados a un paciente que posteriormente fue llevado a resección quirúrgica de un meningioma del tercio posterior de la hoz, en el que se aprecia una marcada disminución en la intensidad de la señal en estudio de resonancia magnética cerebral, especialmente en las imágenes con información en T1 y secuencia con medio de contraste, posiblemente relacionado a la obstrucción vascular y microvascular que se logra posterior a la embolización de las arterias aferentes del tumor. Conclusión: La perdida de realce posterior a la administración de medio de contraste (Gadolinio) en las imágenes por resonancia magnética cerebral con información en T1 post-embolización, ponen en evidencia la lesión vascular y microvascular posterior a la administración de material de embolización, lo cual se convierte en un signo imagenológico de embolización exitosa o satisfactoria previa a la resección quirúrgica.

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“…Other findings that can be found in Magnetic Resonance after meningioma embolization that indicate tumor necrosis are tumor size increase, Copyright © Robles Robles Vanesa TNN.MS.ID.000595. 4(4).2021 associated edema and of course decrease in enhancement with the contrast medium, even being less than 90% (mild, moderate, or extensive) also has an important effect in reducing bleeding during surgical resection [13].…”

Section: Discussionmentioning

confidence: 99%

Tumor Darkening Sign: Image Finding that May Correspond to a Successful Pre-Surgical Embolization in Meningiom

Vanesa

2021

TNN

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Objective: The present work seeks to describe the change in imaging characteristics in brain magnetic resonance in pre-and post-embolization studies in meningiomas in the plan of being taken to surgical resection. Justification:The pre-surgical embolization of intracranial meningiomas has shown benefits related mainly to less intra-operative bleeding and length of hospital stay, as well as greater technical ease in resection due to changes due to liquefactive necrosis suffered by the tumor. Method:A representative case is presented with pre-and post-embolization imaging studies performed on a patient who was subsequently taken to surgical resection of a meningioma of the posterior third of the sickle, in which there is a marked decrease in signal intensity in MRI study, especially in images with information in T1, sequence with contrast medium, possibly related to vascular and microvascular obstruction that is achieved after embolization of the arteries afferent to the lesion. Conclusion:The loss of enhancement after the administration of contrast medium (Gadolinium) in the images by cerebral magnetic resonance with information in post-embolization T1, evidences the vascular and microvascular lesion that is sought with the administration of embolization material, which serves as an imaging sign of successful or satisfactory embolization prior to being taken to surgery.

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Longitudinal Imaging of Tumor Volume, Diffusivity, and Perfusion After Preoperative Endovascular Embolization in Supratentorial Hemispheric Meningiomas

Cited by 10 publications

References 21 publications

Predictors of preoperative endovascular embolization of meningiomas: subanalysis of anatomic location and arterial supply

Predictors of preoperative endovascular embolization of meningiomas: subanalysis of anatomic location and arterial supply

Signo de oscurecimiento tumoral: hallazgo imagenológico que puede corresponder a una embolización pre-quirúrgica exitosa en meningiomas

Tumor Darkening Sign: Image Finding that May Correspond to a Successful Pre-Surgical Embolization in Meningiom

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