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Preoperative Particle and Glue Embolization of Meningiomas: Indications, Results, and Lessons Learned from 117 Consecutive Patients

Borg, Anouk MD, MRCS(Edin), MSc*; Ekanayake, Jinendra MBBS, BSc, MRCS(Edin)*; Mair, Richard MBChB, MRCS(Eng)*; Smedley, Thomas MA, MBBS*; Brew, Stefan MD; Kitchen, Neil MD, FRCS(SN)*; Samandouras, George MD, FRCS(SN)*,§; Robertson, Fergus MD, MRCP, FRCR

doi: 10.1227/NEU.0000000000000187
Technique Assessment

BACKGROUND: Preoperative embolization of meningiomas remains contentious, with persisting uncertainty over the safety and efficacy of this adjunctive technique.

OBJECTIVE: To evaluate the safety of presurgical embolization of meningiomas and its impact on subsequent transfusion requirement with respect to the extent of embolization and technique used.

METHODS: One hundred seventeen consecutive patients between 2001 and 2010 were referred for embolization of presumed intracranial meningioma before surgical resection. Glue and/or particles were used to devascularize the tumor in 107 patients, all of whom went on to operative resection. The extent and nature of embolization-related complications, degree of angiographic devascularization, and the intraoperative blood transfusion requirements were analyzed.

RESULTS: Mean blood transfusion requirement during surgery was 0.8 units per case (range, 1-14 units). Blood transfusion was significantly lower in patients whose meningiomas were completely, angiographically devascularized (P = .035). Four patients had complications as a direct result of the embolization procedure. These included intratumoral hemorrhage in 2, sixth cranial nerve palsy in 1, and scalp necrosis requiring reconstructive surgery in 1 patient.

CONCLUSION: The complication rate was 3.7%. No relationship between the embolic agent and the degree of devascularization was observed. Achieving a complete devascularization resulted in a lower blood transfusion requirement, considered an indirect measure of operative blood loss. This series demonstrates that preoperative meningioma embolization is safe and may reduce operative blood loss. We present distal intratumoral injection of liquid embolic as a safe and effective alternative to more established particle embolization techniques.

*Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom

Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom

§Lila Weston Research Laboratories, Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom

Correspondence: Anouk Borg, MD, MRCS(Edin), MSc, Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 6th Floor, Queen Mary Wing, Queen Square, London, WC1 N 3BG United Kingdom. E-mail:

Received May 21, 2012

Accepted February 19, 2013

Copyright © by the Congress of Neurological Surgeons