Preoperative embolization of skull base meningiomas: Outcomes in the Onyx era.

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Preoperative embolization of skull base meningiomas: Outcomes in the Onyx era.

World Neurosurg. 2018 May 08;:

Authors: Przybylowski CJ, Baranoski JF, See AP, Flores BC, Almefty RO, Ding D, Chapple KM, Sanai N, Ducruet AF, Albuquerque FC

Abstract
OBJECTIVE: Preoperative embolization may facilitate skull base meningioma resection, but its safety and efficacy in the Onyx era have not been investigated. In this retrospective cohort study, we evaluated the outcomes of preoperative embolization of skull base meningiomas using Onyx as the primary embolysate.
METHODS: We queried an endovascular database for patients with skull base meningiomas who underwent preoperative embolization at our institution in 2007-2017. Patient, tumor, procedure, and outcome data were analyzed.
RESULTS: Twenty-eight patients (28 meningiomas) underwent successful preoperative meningioma embolization. The mean (±SD) patient age was 56 (±13) years, and 18 patients (64%) were women. The mean tumor size was 49 cm3. One, 2, or 3 arterial pedicles were embolized in 21 (75%), 6 (21%), and 1 (4%) case, respectively. The embolized pedicles included branches of the middle meningeal artery in 19 cases (68%), the internal maxillary artery in 8 (29%), the ascending pharyngeal artery in 2 (7%), and posterior auricular, ophthalmic, occipital, and anterior cerebral arteries in 1 each (4%). The embolysates used were Onyx alone in 20 cases (71%), NBCA alone in 3 (11%), coils+particles and Onyx/NBCA in 2 each (7%), and Onyx+coils in 1 (4%). The median degree of tumor devascularization was 60%. Significant neurological morbidity was incurred by 1 patient (4%) who developed symptomatic peritumoral edema after Onyx embolization.
CONCLUSION: For appropriately selected skull base meningiomas supplied by dura mater-based arterial pedicles without distal cranial nerve supply, preoperative embolization with current embolysate technology affords substantial tumor devascularization with a low complication rate.

PMID: 29751190 [PubMed - as supplied by publisher]

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