Abstract
Background
Preoperative embolization of radiographically suspected meningiomas is often performed to facilitate subsequent tumor resection. Its effects on the post-operative course of operated meningiomas have not been studied in detail and randomized trials are lacking. The objective of this study was to explore associations of preoperative meningioma embolization with postoperative outcome.
Patients and Methods
Patients undergoing resection of an intracranial meningioma at a single tertiary center 2000–2013 (N=741) were reviewed for the inclusion of pre-operative embolization in the management strategy. Annotations included demographics, radiographic, surgical, histological and hematological parameters, cardiovascular risk factors, pre- and postoperative neurological function and gene methylation-based classification. Binary regression and Cox proportional hazards models were applied to determine factors associated with outcome.
Results
Pre-operative embolization was performed in 337 patients (42%). Cardiovascular events after surgery comprised mostly deep vein thrombosis (N=39) and pulmonary embolisms (N=64). On multivariate analyses of post-operative cardiovascular adverse events controlling for established risk factors, there were associations with embolization (OR 2.38, 95% CI 1.37–4.00), and with female gender (OR 2.18, 95% CI 1.17–4.08). Recurrence-free survival (RFS) of embolized patients was less favorable among patients with WHO grade II or grade III meningiomas (median RFS: 4.3 versus 7.0 years, P=.029) or in patients with intermediate or malignant gene methylation subtype meningiomas (median RFS: 2.0 versus 8.2 years, P=.005), including in a multivariate Cox regression model that controlled for established risk factors.
Conclusion
Pre-operative meningioma embolization may cause adverse surgical outcomes. Randomized trials to determine benefit-risk ratios are warranted to clarify the role of pre-operative embolization for meningioma surgery.