Longitudinal Imaging of Tumor Perfusion After Preoperative Endovascular Embolization in Meningiomas: Surgical Time Window Selecting, Clinical Consideration, and Outcomes

Abstract

ObjectiveTo quantitatively investigate the longitudinal computed tomography perfusion (CTP) imaging in meningiomas preoperatively embolized using microcatheters. MethodsThis retrospective monocentric study included 27 patients with symptomatic supratentorial meningiomas. Quantitative CTP images before and post-embolization were evaluated and correlated with angiographic, immunohistochemical, and clinical data. ResultsThe mean age of the patients was 45±18 years, with a female-to-male ratio of 1.45:1. After embolization, both the embolized (Eb) and unembolized (UEb) regions showed hypoperfusion. A steady state was achieved on days 4-6 post-embolization, during which differences in regional cerebral blood volume (rCBV) (Eb 0.5±0.3 ml/100mg, UEb 3.3±1.4 ml/100mg; P<0.05), and mean transit time (MTT) (Eb 3.5 ±1.8 s, UEb 3.1±0.4 s) were observed. The cerebral blood flow (rCBF) and time to the peak (TTP) exhibited opposite patterns between Eb and UEb. A steady state was reached in rCBF (Eb 1.7± 1.2 ml/100 g/min, UEb 30± 5.4 ml/100 g/min; P<0.01), and TTP (Eb 5± 4.8 s, UEb 1.8± 1.5 s; P<0.01) within 4-6 days. Estimated blood loss (EBL) showed significant association with the surgical time interval among the three groups (p<0.05). Tissue necrosis predominated over 7 days post-embolization, indicating a correlation with the devascularization process. The overall incidence of post-embolized headache, seizures, extremity weakness/paralysis, and post-operational headache was 11.1%, 7.4%, 3.7%; and 7.4%, respectively. All symptoms resolved by the last follow-up (3 months). ConclusionPreoperative embolization of meningiomas using N-butyl cyanoacrylate effectively induced significant and sustained tissue transformation and decreased EBL over 7 days. Hemodynamic fluctuations tended to stabilize within 4-6 days.