P18.02.B Influence of preoperative embolization on intraoperative parameters, hospital stay and neurocognitive outcome compared to surgery alone

Abstract

Abstract Background Preoperative embolization of meningiomas is used to reduce intraoperative blood loss and facilitate resection. So far, a risk-benefit stratification of this additional intervention on the neurocognitive outcome is missing. This study investigates the influence of preoperative embolization with liquid Embolisate on intraoperative parameters, length of hospital stays and functional outcome. Material and Methods Patients treated for intracranial meningiomas at a single center between January 2019 and June 2021 were reviewed in a retrospective matched-pair analysis. Patients were matched to group A (tumor resected) and group B (preoperatively embolized and tumor resected after 2,27 ± 3,05 days). Matching criteria were tumor diameter and location (convexity, falx cerebri or skull base, frontal, parietal, occipital, temporal). Data collection included MRI (location, tumor- and necrosis volume, edema, complications), DSA (tumor blush, arterial supply), medical history, histological, surgical, clinical course, complications, and haematological parameters, as well as neurocognitive symptoms on admission and discharge from hospital. Results 44 patients with intracranial Meningiomas were included, divides into 2 groups, each encompassing 22 patients (mean age 62,41 years, 40,5% female). The matching criteria tumor diameter (64.21 vs. 63.55 mm, p=0.725) and tumor localisation (p=0.381) showed no significant differences. There were no significant differences in postoperative hospital stay (14.41 ± 9.5 vs. 14.25 ± 16.88 days, p=0.814) and in preoperative perifocal oedema (82% vs. 82%, p=0.397). Preoperative embolization was associated with decreased intraoperative tumor bleeding (67% vs. 14%, p=0.001, PHI= 0.534), longer duration of surgery (4:58 ± 2:44 vs. 06:07 ± 03:00 hours, p=0.037), trend for decrease in perifocal oedema (p=0.052, PHI=0,498), neurocognitive improvement on discharge from hospital (23% vs. 86%, p=0.045, PHI=0.339) and decreased of epileptic seizures (preoperative 18% vs. 18% and postoperative 23% vs. 5%). There was no increase in cumulative complication rate (p=1.0) and no long-term neurocognitive impairments associated with embolization. Conclusion This study suggests that preoperative embolization of intracranial meningiomas significantly decreased intraoperative tumor blood loss but is also associated to an improvement on neurocognitive abilities compared to surgery alone. Importantly, complication rate is not increased. In the future, larger studies and perhaps a randomised control trial might be of value in corroborating these findings. Furthermore, the neurocognitive symptoms should be assessed in a standardised examination form, qualitative parameters such as bleeding tendency should be supplemented by quantifiable parameters, e.g., blood loss in ml.