Abstract
ObjectiveThe potential benefits of preoperative embolization for intracranial meningiomas are still under debate. We aimed to investigate whether preoperative embolization can improve surgical and functional outcomes, based on controlling patient- and tumor-related confounding factors.MethodsWe reviewed all meningioma cases in our department from January 2016 to May 2021. Cases in the nonembolization cohort were matched to the embolization cohort by 1:1 ratio propensity score matching, through controlling patient- and tumor-related confounds. Surgical outcomes, complications, and functional outcomes were retrospectively compared between these two groups.ResultsSixty-six cases in each group were included in our study after being matched. We did not find any significant differences of estimated blood loss (600.00 (400) vs. 500.00 (500.00) ml, p = 0.31), decrease of HGB level (30.81 ± 15.82 vs. 26.59 ± 12.90 g/L, p = 0.09), gross total resection rate (74.24% vs. 77.27%, p = 0.68), surgical time (302.50 (136) vs. 300.00 (72) min, p = 0.48), blood transfusion rates (53.03% vs. 42.42%, p = 0.35), blood transfusion volume [650.00 (657.50) vs. 535.00 (875.00) ml, p = 0.63] between the embolization group and nonembolization group. The number of patients who experience postsurgery complications were significantly higher in the nonembolization group (39.39% vs. 21.21%, p = 0.02). Patients in the nonembolization group were more likely to have a higher rate of mRS decline postsurgery (31.82% vs. 15.15%, p = 0.04).ConclusionOur study showed significant lower rates of surgical complications and long-term disabilities of meningioma patients treated with preoperative embolization. There were no significant differences in estimated blood loss, surgical time, and blood transfusion volume between embolization and nonembolization groups.
Highlights
Meningiomas are the most common type of primary brain tumors, accounting for one-third of all central nervous system (CNS) tumors [1]
As only WHO grade I meningiomas, which are generally less aggressive and complicated than WHO grades II and III meningiomas, are enrolled in this study, that limits generalizability of interpretation. Their results demonstrate that embolization is found to lead to a greater chance of clinical improvement [12]. This cohort-matching study retrospectively was performed with reviewing data of patients with meningioma who underwent with/without preoperative embolization at the Department of Neurosurgery of the Southwest Hospital Affiliated to Army Medical University from January 2016 to May 2021
Sixty-six patients from the nonembolization group (n = 267) were matched to the preoperative embolization patient’s cohort and enrolled in the nonembolization group, with algorithm parameters described in the Materials and Methods section
Summary
Meningiomas are the most common type of primary brain tumors, accounting for one-third of all central nervous system (CNS) tumors [1]. Meningiomas always tend to be rich in vascularity, which complicates surgical resection due to substantial intraoperative blood loss. Devascularization of meningioma by preoperative endovascular embolization of feeding vessels was firstly introduced by Manelfe et al [2]. The intentions of such adjunctive therapy are to reduce surgical blood loss, soften tumor, and shorten the surgical time [3–6]. Discrepancies are found between results reported by different groups [7–9]. Recent updated meta-analysis study indicates no clear benefit is observed in operative and postoperative outcomes of embolization [10], which is inconsistent with findings in an earlier meta-analysis [11]
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