Preoperative Embolization of Meningiomas: Differences in Surgical Operability and Histopathologic Changes Between Embosphere and N-butyl 2-cyanoacrylate

Arai, Shintaro; Shimizu, Katsuyoshi; Yamochi, Toshiko; Mizutani, Tohru; Okumura, Hirotaka; Nakajo, Takato; Matsumoto, Masaki

doi:10.1016/j.wneu.2017.12.003

Cited by 6 publications

(3 citation statements)

References 11 publications

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“…Furthermore, NBCA spreads unevenly within a tumor, resulting in heterogeneity of the embolized area. 12 Additionally, liquid embolic materials carry a risk of migration to the intraparenchymal vessels through dangerous anastomoses or vasa nervous. In addition, it is technically difficult to use NBCA due to its adhesiveness.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Preoperative Embolization in Patients with Meningioma

et al. 2018

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Preoperative embolization for intracranial meningioma has remained controversial for several decades. In this study, we retrospectively reviewed our experience of embolization using particulate embolic material and coil to clarify the therapeutic efficacy, safety, and risk of complication. We reviewed 69 patients who underwent embolization with particulate embolic material followed by surgical resection. An additional 6 procedures were included for patients in whom recurrence was treated, for a total of 75 procedures of preoperative embolization. We analyzed the following clinical data: age, sex, tumor size pathology, complications related to embolization, and surgeon's opinion on the intraoperative ease of debulking and blood transfusion. Embolization was performed mainly from the branches of the external carotid artery. No allogenic blood transfusions were needed for any patients. The surgeon had the opinion that whitening and softening of the tumor allowed for easy debulking during decompression of the tumor in most of the patients. Hemorrhagic complications were seen in two patients after embolization. Emergency tumor removal was performed in both of those patients, and they were recovered well after surgery. Transient cranial nerve palsy was seen in one patient. One ischemic complication and one allergic complication occurred. Preoperative embolization could give us an advantage in surgery for meningioma. The procedure reduces intraoperative blood loss and operating time by softening the tumor consistency. However, we must pay attention to the possibility of embolic complications and keep the preparation of emergency craniotomy, particularly in patients with large meningiomas.

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Preoperative Embolization in Patients with Meningioma

et al. 2018

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“…Although there is no consensus on how to measure the efficacy of embolization, previous studies have frequently used operative duration, estimated blood loss (EBL), Simpson grade, prognosis, hardness of tumors. [5][6][7] In addition, studies have found that lack of contrast enhancement on postembolization MRI correlates with pathological findings of necrosis and can be used to assess efficacy 5,8) ; however, few studies have focused on the factors influence necrosis after preoperative embolization. Therefore, this study aimed to examine clinicopathologic factors associated with tumor necrosis in embolized meningiomas.…”

Section: Introductionmentioning

confidence: 99%

Clinicopathologic Factors Associated with Tumor Necrosis after Preoperative Embolization of Meningiomas

Fujimori

Okauchi

Toyota

et al. 2021

JNET

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Objective Preoperative embolization of meningiomas induces necrosis prior to surgery and facilitates resection. Lack of contrast enhancement on postembolization MRI correlates with pathological findings of necrosis and can be used to assess embolization efficacy. This study aimed to examine clinicopathologic factors associated with tumor necrosis after embolization. Methods A total of 119 patients with intracranial meningioma who underwent 145 surgical resections between 2010 and 2019 at our institute were reviewed. Inclusion criteria for the study were preoperative embolization with trisacryl gelatin microspheres (Embosphere) or absorbable gelatine sponge (Gelfoam). Postembolization Gd-enhanced T1-weighted and angiographic imaging, and histopathologic examination results were reviewed to evaluate the effectiveness of embolization. Results In all, 66 patients satisfied the inclusion criteria. In total, 36 patients were embolized with Embosphere and 30 patients were embolized with Gelfoam. Patients embolized with Embosphere had a significantly higher necrosis rate (NR) than patients with Gelfoam (21% vs. 7.1%, P <0.01). The 36 Embosphere patients were analyzed regarding clinicopathologic factors associated with NR. Tumors in 12 patients were located in the parasagittal/falx region; these patients had a significantly lower NR compared with tumors in other locations (10.6% vs. 26.2%, P = 0.016). In all, 13 patients had feeders arising from only the middle meningeal artery (MMA), which was associated with a significantly higher NR (29.3% vs. 14.4%, P = 0.015). In total, 11 patients had meningeal feeders arising from internal carotid artery (ICA), which was associated with a significantly lower NR (9.0% vs. 26.3%, P <0.01). Conclusion This study showed embolization agent, tumor location, and blood supply were important factors predicting necrosis after preoperative embolization.

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“…It seems to have the effect of reducing bleeding, softening of the tumor, and shortening of the operation time. 1 – 4) While the target of the surgery is primarily meningioma, it also applies to other tumors such as hemangioblastoma (HB). Although clear cell ependymoma (CCE) is a rare tumor, the tumor at cerebellums is often known to have both neuroimaging and histological similarities with HB.…”

Section: Introductionmentioning

confidence: 99%

Case of Clear Cell Ependymoma Successfully Treated with Preoperative Embolization

Haryu

Niizuma

Endo

et al. 2020

JNET

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Clear cell ependymoma (CCE) is known to be very similar to hemangioblastoma (HB) in regards to neuroimaging and histopathology. We report a rare case of CCE in which successfully underwent preoperative embolization with a prior diagnosis of HB. Case Presentation: A 58-year-old woman presented with vertigo for several months. MRI showed the right cerebellar tumor mimicking solid HB. DSA revealed the hypervascular tumor supplied by branches of the posterior inferior cerebellar artery (PICA). To reduce intraoperative bleeding, preoperative embolization was performed using n-butyl-2-cyanoacrylate (NBCA). A flow-guided microcatheter was guided to the proper feeders, and diluted NBCA was injected. Sufficient devascularization was achieved. The tumor was totally resected with minimal blood loss the next day. Postoperative pathological diagnosis was CCE. Conclusion: This is the first report that preoperative embolization was performed to CCE with careful techniques and recent advanced devices. Since CCE has a poorer prognosis, preoperative embolization for safety total resection may be more important. Keywords▶ clear cell ependymoma, intracranial tumor, hypervascular tumor, preoperative embolization, transarterial embolization This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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Preoperative Embolization of Meningiomas: Differences in Surgical Operability and Histopathologic Changes Between Embosphere and N-butyl 2-cyanoacrylate

Cited by 6 publications

References 11 publications

Safety and Efficacy of Preoperative Embolization in Patients with Meningioma

Safety and Efficacy of Preoperative Embolization in Patients with Meningioma

Clinicopathologic Factors Associated with Tumor Necrosis after Preoperative Embolization of Meningiomas

Case of Clear Cell Ependymoma Successfully Treated with Preoperative Embolization

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