Outcomes of Preoperative Transophthalmic Artery Embolization of Meningiomas: A Systematic Review with a Focus on Embolization Agent.

Abstract

Transophthalmic artery embolization of intracranial meningiomas is thought to be associated with a high complication risk. With advances in endovascular techniques, we systematically reviewed the current literature to improve our understanding of the safety and efficacy of transophthalmic artery embolization of intracranial meningiomas. We performed a systematic search using PubMed from inception until August 3, 2022. Twelve studies with 28 patients with intracranial meningiomas embolized through the transophthalmic artery were included. Baseline and technical characteristics and clinical and safety outcomes were collected. No statistical analysis was conducted. The average age of 27 patients was 49.5 (SD, 13) years. Eighteen (69%) meningiomas were located in the anterior cranial fossa, and 8 (31%), in the sphenoid ridge/wing. Polyvinyl alcohol particles were most commonly (n = 8, 31%) used to preoperatively embolize meningiomas, followed by n-BCA in 6 (23%), Onyx in 6 (23%), Gelfoam in 5 (19%), and coils in 1 patient (4%). Complete embolization of the target meningioma feeders was reported in 8 (47%) of 17 patients; partial embolization, in 6 (32%); and suboptimal embolization, in 3 (18%). The endovascular complication rate was 16% (4 of 25), which included visual impairment in 3 (12%) patients. Selection and publication biases were limitations. Transophthalmic artery embolization of intracranial meningiomas is feasible but is associated with a non-negligible complication rate.