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Does preoperative embolization improve outcomes of meningioma resection? A systematic review and meta-analysis

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Abstract

Current evidence regarding the benefit of preoperative embolization (POE) of meningiomas is inconclusive. This systematic review and meta-analysis aims to evaluate the safety profile of the procedure and to compare outcomes in embolized versus non-embolized meningiomas. PubMed was queried for studies after January 1990 reporting outcomes of POE. Pertinent variables were extracted and synthesized from eligible articles. Heterogeneity was assessed using I2, and random-effects model was employed to calculate pooled 95% CI effect sizes. Publication bias was assessed using funnel plots and Harbord’s and Begg’s tests. Meta-analyses were used to assess estimated blood loss and operative duration (mean difference; MD), gross-total resection (odds ratio; OR), and postsurgical complications and postsurgical mortality (risk difference; RD). Thirty-four studies encompassing 1782 preoperatively embolized meningiomas were captured. The pooled immediate complication rate following embolization was 4.3% (34 studies, n = 1782). Although heterogeneity was moderate to high (I2 = 35-86%), meta-analyses showed no statistically significant differences in estimated blood loss (8 studies, n = 1050, MD = 13.9 cc, 95% CI = −101.3 to 129.1), operative duration (11 studies, n = 1887, MD = 2.4 min, 95% CI = −35.5 to 30.8), gross-total resection (6 studies, n = 1608, OR = 1.07, 95% CI = 0.8–1.5), postsurgical complications (12 studies, n = 2060, RD = 0.01, 95% CI = −0.04 to 0.07), and postsurgical mortality (12 studies, n = 2060, RD = 0.01, 95% CI = 0–0.01). Although POE is relatively safe, no clear benefit was observed in operative and postoperative outcomes. However, results must be interpreted with caution due to heterogeneity and selection bias between studies. Well-controlled future investigations are needed to define the patient population most likely to benefit from the procedure.

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Data Availability

Data used for this meta-analysis is available in the manuscript and supplementary material.

References

  1. Ali R, Khan M, Chang V, Narang J, Jain R, Marin H, Rock J, Kole M (2016) MRI pre-and post-embolization enhancement patterns predict surgical outcomes in intracranial meningiomas. J Neuroimaging 26:130–135

    Article  Google Scholar 

  2. Bendszus M, Monoranu CM, Schütz A, Nölte I, Vince GH, Solymosi L (2005) Neurologic complications after particle embolization of intracranial meningiomas. Am J Neuroradiol 26:1413–1419

    PubMed  PubMed Central  Google Scholar 

  3. Bendszus M, Rao G, Burger R, Schaller C, Scheinemann K, Warmuth-Metz M, Hofmann E, Schramm J, Roosen K, Solymosi L (2000) Is there a benefit of preoperative meningioma embolization? Neurosurgery 47:1306–1312

    Article  CAS  Google Scholar 

  4. Borg A, Ekanayake J, Mair R, Smedley T, Brew S, Kitchen N, Samandouras G, Robertson F (2013) Preoperative particle and glue embolization of meningiomas: indications, results, and lessons learned from 117 consecutive patients. Oper Neurosurg 73:ons244–ons252

    Article  Google Scholar 

  5. Chen L, D-h L, Lu Y-h, Hao B, Y-q C (2019) Preoperative embolization versus direct surgery of meningiomas: a meta-analysis. World Neurosurg 128:62–68

    Article  Google Scholar 

  6. Chun JY, McDermott MW, Lamborn KR, Wilson CB, Higashida R, Berger MS (2002) Delayed surgical resection reduces intraoperative blood loss for embolized meningiomas. Neurosurgery 50:1231–1237

    PubMed  Google Scholar 

  7. Dean BL, Flom RA, Wallace RC, Khayata MH, Obuchowski NA, Hodak JA, Zabramski JM, Spetzler RF (1994) Efficacy of endovascular treatment of meningiomas: evaluation with matched samples. Am J Neuroradiol 15:1675–1680

    PubMed  PubMed Central  CAS  Google Scholar 

  8. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  Google Scholar 

  9. Fang Q-R, He X-Y, Li X-F, Zhang X, Chen M, Li H, Li W, Wang Z-Q, Duan C-Z (2016) Comparative efficacy of Glubran and polyvinyl-alcohol particles in the embolization of meningiomas. Int J Neurosci 126:1112–1119

    Article  CAS  Google Scholar 

  10. Grand C, Bank WO, Balériaux D, Matos C, Dewitte O, Brotchi J, Delcour C (1993) Gadolinium-enhanced MR in the evaluation of preoperative meningioma embolization. Am J Neuroradiol 14:563–569

    PubMed  PubMed Central  CAS  Google Scholar 

  11. Gruber A, Killer M, Mazal P, Bavinzski G, Richling B (2000) Preoperative embolization of intracranial meningiomas: a 17-years single center experience. min-Minimally Invasive. Neurosurgery 43:18–29

    CAS  Google Scholar 

  12. Hirohata M, Abe T, Morimitsu H, Fujimura N, Shigemori M, Norbash A (2003) Preoperative selective internal carotid artery dural branch embolisation for petroclival meningiomas. Neuroradiology 45:656–660

    Article  CAS  Google Scholar 

  13. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13

    Article  Google Scholar 

  14. Iacobucci M, Danieli L, Visconti E, Maresca M, Anile C, Colosimo C, Pedicelli A (2017) Preoperative embolization of meningiomas with polyvinyl alcohol particles: the benefits are not outweighed by risks. Diagn Interv Imag 98:307–314

    Article  CAS  Google Scholar 

  15. Iampreechakul P, Tirakotai W, Lertbutsayanukul P, Siriwimonmas S, Liengudom A (2016) Pre-operative embolization of intracranial and extracranial tumors: a review of 37 cases. Journal of the Medical Association of Thailand=. Chotmaihet thangphaet 99:S91–S119

    PubMed  Google Scholar 

  16. Ilyas A, Przybylowski C, Chen C-J, Ding D, Foreman PM, Buell TJ, Taylor DG, Kalani MY, Park MS (2019) Preoperative embolization of skull base meningiomas: a systematic review. J Clin Neurosci 59:259–264

    Article  Google Scholar 

  17. Ishihara H, Ishihara S, Niimi J, Neki H, Kakehi Y, Uemiya N, Kohyama S, Yamane F, Kato H, Suzuki T (2015) The safety and efficacy of preoperative embolization of meningioma with N-butyl cyanoacrylate. Interv Neuroradiol 21:624–630

    Article  Google Scholar 

  18. Jiménez-Heffernan J, Corbacho C, Canizal J, Pérez-Campos A, Vicandi B, López-Ibor L, Viguer J (2012) Cytological changes induced by embolization in meningiomas. Cytopathology 23:57–60

    Article  Google Scholar 

  19. Kai Y, Hamada J-I, Morioka M, Yano S, Nakamura H, Makino K, Mizuno T, Takeshima H, Kuratsu J-I (2006) Clinical evaluation of cellulose porous beads for the therapeutic embolization of meningiomas. Am J Neuroradiol 27:1146–1150

    PubMed  PubMed Central  CAS  Google Scholar 

  20. Lee SSW, Chan KY, Pang KH, Datta N, Poon YF, Aung TH, Kwok J (2006) Effect of preoperative embolization on resection of intracranial meningioma: local experience. Surg Pract 10:106–110

    Article  Google Scholar 

  21. Manaka H, Sakata K, Tatezuki J, Shinohara T, Shimohigoshi W, Yamamoto T (2018) Safety and efficacy of preoperative embolization in patients with meningioma. J Neurol Surg B, Skull Base 79:S328–S333

    Article  Google Scholar 

  22. Manelfe C, Guiraud B, David J, Eymeri J, Tremoulet M, Espagno J, Rascol A, Geraud J (1973) Embolization by catheterization of intracranial meningiomas. Rev Neurol 128:339

    PubMed  CAS  Google Scholar 

  23. Medicine OCfE-B (2011) OCEBM Levels of Evidence Working Group. The Oxford 2011 levels of evidence.

  24. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097

    Article  Google Scholar 

  25. Nania A, Granata F, Vinci S, Pitrone A, Barresi V, Morabito R, Settineri N, Tomasello F, Alafaci C, Longo M (2014) Necrosis score, surgical time, and transfused blood volume in patients treated with preoperative embolization of intracranial meningiomas. Analysis of a single-centre experience and a review of literature. Clin Neuroradiol 24:29–36

    Article  CAS  Google Scholar 

  26. H-k N, W-s P, Goh K, Chan MS (1996) Histopathology of post-embolized meningiomas. Am J Surg Pathol 20:1224–1230

    Article  Google Scholar 

  27. Oka H, Kurata A, Kawano N, Saegusa H, Kobayashi I, Ohmomo T, Miyasaka Y, Fujii K (1998) Preoperative superselective embolization of skull-base meningiomas: indications and limitations. J Neuro-Oncol 40:67–71

    Article  CAS  Google Scholar 

  28. Przybylowski CJ, Zhao X, Baranoski JF, Moreira LB, Gandhi S, Chapple KM, Almefty KK, Sanai N, Ducruet AF, Albuquerque FC (2020) Preoperative embolization versus no embolization for WHO grade I intracranial meningioma: a retrospective matched cohort study. J Neurosurg 1:1–8

    Google Scholar 

  29. Raper D, Starke R, Henderson F, Ding D, Simon S, Evans A, Jane J, Liu K (2014) Preoperative embolization of intracranial meningiomas: efficacy, technical considerations, and complications. Am J Neuroradiol 35:1798–1804

    Article  CAS  Google Scholar 

  30. Shah AH, Patel N, Raper DM, Bregy A, Ashour R, Elhammady MS, Aziz-Sultan MA, Morcos JJ, Heros RC, Komotar RJ (2013) The role of preoperative embolization for intracranial meningiomas: a review. J Neurosurg 119:364–372

    Article  Google Scholar 

  31. Singla A, Deshaies EM, Melnyk V, Toshkezi G, Swarnkar A, Choi H, Chin LS (2013) Controversies in the role of preoperative embolization in meningioma management. Neurosurg Focus 35:E17

    Article  Google Scholar 

  32. Sluzewski M, Van Rooij WJ, Lohle P, Beute G, Peluso J (2013) Embolization of meningiomas: comparison of safety between calibrated microspheres and polyvinyl-alcohol particles as embolic agents. Am J Neuroradiol 34:727–729

    Article  CAS  Google Scholar 

  33. Suzuki K, Nagaishi M, Matsumoto Y, Fujii Y, Inoue Y, Sugiura Y, Hirata K, Suzuki R, Kawamura Y, Nakae R (2017) Preoperative embolization for skull base meningiomas. J Neurol Surg B, Skull Base 78:308

    Article  Google Scholar 

  34. Wakhloo AK, Juengling FD, Van Velthoven V, Schumacher M, Hennig J, Schwechheimer K (1993) Extended preoperative polyvinyl alcohol microembolization of intracranial meningiomas: assessment of two embolization techniques. Am J Neuroradiol 14:571–582

    PubMed  PubMed Central  CAS  Google Scholar 

  35. Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135

    Article  Google Scholar 

  36. Wen L-L, Zhang X, Zhang Q-R, Wu Q, Chen S-J, Deng J-L, Huang K, Wang H-D (2017) Flat-detector computed tomography PBV map in the evaluation of presurgical embolization for hypervascular brain tumors. J Neurointerv Surg 9:1139–1144

    Article  Google Scholar 

  37. Wirsching H-G, Richter JK, Sahm F, Morel C, Krayenbuehl N, Rushing EJ, von Deimling A, Valavanis A, Weller M (2018) Post-operative cardiovascular complications and time to recurrence in meningioma patients treated with versus without pre-operative embolization: a retrospective cohort study of 741 patients. J Neuro-Oncol 140:659–667

    Article  CAS  Google Scholar 

  38. Wu Y-M, Wong H-F, CHen Y-L, Wong M-C, ToH C-H (2009) Preoperative embolization for parasagittal and convexity meningiomas: efficacy and safety. 中華放射線醫學雜誌 34:245–252

    Google Scholar 

  39. Yoon Y, Ahn J, Chang JH, Cho J, Suh S, Lee B, Lee K (2008) Pre-operative embolisation of internal carotid artery branches and pial vessels in hypervascular brain tumours. Acta Neurochir 150:447–452

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School & University Hospital, Rutgers-New Jersey Medical School, New Brunswick, NJ, USA

    Fareed Jumah, Bharath Raju, Vinayak Narayan, Hai Sun, Gaurav Gupta & Anil Nanda

  2. William J. von Liebig Center for Transplantation and Clinical Regeneration Mayo Clinic, Rochester, MN, USA

    Anan AbuRmilah & Suhaib Jaber

  3. Department of Neurosurgery, Ochsner-Louisiana State University Hospital, Shreveport, LA, USA

    Nimer Adeeb & Hugo Cuellar

  4. Department of Radiology, Ochsner-Louisiana State University Hospital, Shreveport, LA, USA

    Hugo Cuellar

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  1. Fareed Jumah
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Contributions

• Conception of design and work: Nimer Adeeb, Fareed Jumah, Bharath Raju, Anan Abu Rmilah.

• Data collection: Fareed Jumah, Anan AbuRmilah, Suhaib Jaber.

• Data analysis and interpretation: Fareed Jumah, Anan AbuRmilah.

• Drafting the article: Fareed Jumah, Anan AbuRmilah, Bharath Raju, Suhaib Jaber, Nimer Adeeb, Vinayak Narayan, Hai Sun, Hugo Cuellar, Gaurav Gupta, Anil Nanda.

• Critical revision of the article: Fareed Jumah, Anan AbuRmilah, Bharath Raju, Suhaib Jaber, Nimer Adeeb, Vinayak Narayan, Hai Sun, Hugo Cuellar, Gaurav Gupta, Anil Nanda.

• Final approval of the version to be published: Fareed Jumah, Anan AbuRmilah, Bharath Raju, Suhaib Jaber, Nimer Adeeb, Vinayak Narayan, Hai Sun, Hugo Cuellar, Gaurav Gupta, Anil Nanda.

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Correspondence to Anil Nanda.

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Jumah, F., AbuRmilah, A., Raju, B. et al. Does preoperative embolization improve outcomes of meningioma resection? A systematic review and meta-analysis. Neurosurg Rev 44, 3151–3163 (2021). https://doi.org/10.1007/s10143-021-01519-z

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  • DOI: https://doi.org/10.1007/s10143-021-01519-z

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