Preoperative Tumor Embolization Research Articles

Angiographic Features of Meningiomas Predicting Extent of Preoperative Embolization.

Preoperative embolization is used as an endovascular adjunct to surgical resection of meningiomas. However, there is no standardized system to assess the efficacy or extent of embolization during the embolization procedure. We sought to establish a purely angiographic grading system to facilitate consistent reporting of the outcome of meningioma embolization and to characterize the anatomic and other features of meningiomas that predict the degree of devascularization achieved through preoperative embolization. We identified patients with meningiomas who underwent preoperative cerebral angiography and subsequent resection between 2015 and 2021. Demographic, clinical, and imaging data were collected in a research registry. We defined an angiographic devascularization grading scale as follows: grade 0 for no embolization, 1 for partial embolization, 2 for majority embolization, 3 for complete external carotid artery embolization, and 4 for complete embolization. Eighty consecutive patients were included, 60 of whom underwent preoperative tumor embolization (20 underwent angiography with an intention to treat but ultimately not embolization). Embolized tumors were larger (59.0 vs 35.9 cc; P = .03). Gross total resection, length of stay, and complication rates did not differ among groups. The distribution of arterial feeders differed significantly across tumors in a location-specific manner. Both the tumor location and the identity of arterial feeders were predictive of the extent of embolization. Anterior midline meningiomas were associated with internal carotid (ophthalmic, ethmoidal) supply and lower devascularization grades (P = .03). Tumors fed by meningeal feeders (convexity, falcine, lateral sphenoid wing) were associated with higher devascularization grades (P < .01). The procedural complication rate for tumor embolization was 2.5%. Angiographic outcomes can be graded to indicate the extent of tumor embolization. This system may facilitate consistency of reported angiographic results. In addition, arterial feeders vary in a manner predicted by tumor location, and these patterns correlate with typical degrees of devascularization achieved in those tumor locations.

Preoperative Embolization Performed Before Meningioma Resection Might Inhibit Tumor Recurrence

Recent advances in endovascular treatment have improved the safety and efficacy of this procedure, and the number of cases in which preoperative embolization is performed is likely to increase. Preoperative tumor embolization is still a controversial treatment, and as long as it carries a risk of complications, its primary benefit of reducing blood loss during surgery may not be sufficient to justify treatment. We recently reported that preoperative embolization does not significantly increase complications, but may prolong recurrence-free survival. However, currently, tumor embolization is only a preoperative adjunctive therapy, and there is no evidence that it is a stand-alone option for meningioma treatment. Nevertheless, the possibility that tumor embolization alone can promote tumor shrinkage and reduce peripheral oedema has been reported, although the number of cases is small. Further research is needed, but in the future, tumor embolization may become an in-office treatment under certain conditions, such as in cases of poor general condition, multiple meningiomas, recurrent and refractory cases, difficult surgery and cases where re-irradiation is difficult after post-radiation therapy.

Relevance of the Foramen of Vesalius for Preoperative Tumor Embolization in Skull Base Meningioma

ObjectiveTo investigate the role of the foramen of Vesalius (FV) in the pathogenesis of skull base meningioma by analyzing data from various multi-image modalities. MethodsFor this single-center retrospective study, 39 consecutive patients with skull base meningioma who underwent tumor resection between January 2020 and March 2023 were enrolled. The anatomical and pathological characteristics of the FV were evaluated using computed tomography (CT) and three-dimensional (3D)-digital subtraction angiography (DSA). The clinical significance of the FV in tumor hemodynamics and treatment, such as preoperative tumor embolization, was investigated using the 3D-DSA/CT fusion images. ResultsWe identified FV in 52% (17/27) of the finally included patients. In 10 (30%) patients, the FV was found bilaterally with no significant variation in appearance between the healthy and tumor-affected sides (p=0.786). The mean FV diameter was significantly larger on the tumor-affected side (p=0.010). No significant anatomical differences, like duplication and partial assimilation with the foramen ovale, were observed between the two sides. The FV was involved in venous skull base perfusion around the tumor in nine cases. In four cases where it was the pathway for tumor feeders, preoperative tumor embolization via the FV resulted in disappearance of the tumor stain. No complications associated with endovascular treatment were observed. ConclusionsThis study elucidated the anatomical asymmetry of the FV and its role in the hemodynamics of skull base meningioma. Our findings highlight the significance of performing anatomical and pathological evaluations of the FV in determining treatment strategies, including preoperative embolization, for skull base lesions.

Pre-operative spine tumour embolization: Clinical outcomes and effect of embolization completeness.

To assess the association between the impact of the completeness of pre-operative spine tumour embolisation and clinical outcomes, including estimated blood loss (EBL), neurological status and complications. Retrospective chart review of all preoperative spine tumour embolisation procedures performed over 11 years by a single operator (2007-2018) at Vancouver General Hospital on 44 consecutive patients (mean age 57; 77% males) with 46 embolisation procedures, of which surgery was done en bloc in 26 cases and intralesional in the remaining 20. A multivariable negative binomial regression model was fit to examine the association between EBL and surgery type, tumour characteristics, embolisation completeness and operative duration. Among intralesional surgeries, complete versus incomplete embolisation was associated with reduced blood loss (772 vs 1428 mL, P < 0.01). There was no statistically significant difference in neurological outcomes or complications between groups. Highly vascular tumours correlated with greater blood loss than their less vascular counterparts, but tumour location did not have a statistically significant effect. This study provides evidence in support of our hypothesis that complete as opposed to incomplete tumour embolisation correlates with reduced blood loss in intralesional surgeries. Randomised control trials with larger samples are necessary to confirm this benefit and to ascertain other potential clinical benefits.

Safety and Efficacy of Preoperative Embolization in Giant Intracranial Meningiomas Compared with Resection Surgery Alone

Background: Endovascular embolization of intracranial meningiomas is commonly performed as an adjunct to surgical resection and may reduce intraoperative blood loss and surgical time. However, it remains unclear whether preoperative embolization improves the surgical outcomes of meningioma patients. Objectives: This study aimed to assess the safety and efficacy of preoperative embolization in patients with giant intracranial meningiomas. Methods: This retrospective cohort study included patients diagnosed with cranial meningiomas who underwent surgical treatment. The population group was subdivided into 2 categories: Surgery alone and preoperative meningioma embolization. Outcome variables included the degree of devascularization, intraprocedural complications, intraoperative complications, intraoperative blood loss, surgical time, postoperative complications, and the necessity of blood transfusions. Results: In this study, a total of 189 patients with meningiomas were enrolled. Among them, 22 patients underwent preoperative tumor embolization. The tumor volume was significantly larger in the combined treatment group compared to the surgery-alone group (P = 0.002). Additionally, there was a significant difference in tumor location between the groups (P &lt; 0.001), with more meningiomas being situated deeper in the combined group. In the subgroup analysis of giant meningiomas, intraoperative blood loss was significantly lower in embolized patients compared to non-embolized patients (P = 0.034), while no difference in surgical time was observed (P = 0.570). Conclusions: Preoperative embolization in appropriately selected patients with giant intracranial meningiomas, especially those in deeper locations, was safe and feasible, showing a substantial degree of tumor devascularization with an acceptably low rate of complications. This may have had a positive effect on intraoperative blood loss and the duration of surgery.

Differences and Advantages of Particles versus Liquid Material for Preoperative Intracranial Tumor Embolization: A Retrospective Multicenter Study.

The superiority and usefulness of liquid material over particles for embolization have been a topic of debate due to differences in materials and techniques. This study aimed to identify the complications and outcomes associated with both embolization materials. This retrospective multicenter cohort study included 93 patients from an endovascular treatment registry, treated from January 1, 2018 to May 31, 2022. It included patients who underwent preoperative embolization for meningioma, solitary fibrous tumor/hemangiopericytoma, and hemangioblastoma. Data for patient characteristics, procedural factors, complications, and outcomes were collected from medical records. A tortuous access route was the only factor independently associated with complications (p = 0.020). Although liquid material was more frequently used for embolization in relatively high-risk conditions, complication rates did not differ significantly between the groups (p = 0.999). In the liquid material group, the tip of the microcatheter could be guided closer to the tumor (p <0.001) using a distal access catheter and flow-guide microcatheters. The subgroup middle meningeal artery embolization had less operative bleeding in the liquid material group (p <0.001), whereas the particles group exhibited less intraoperative blood loss than the liquid material group (p = 0.006). The vascular tortuosity of the access route was only associated with complications in preoperative tumor embolization. Liquid material and particles showed no difference in complication rates. The use of particles in embolization may reduce intraoperative bleeding, but not in all cases can it be used safely. Therefore, a thorough understanding of the characteristics of both approaches and their relative advantages in clinical practice is essential to opt for the appropriate material according to the case.

Teleproctoring in therapeutic neurointervention: Experience from Iraq-Saudi Arabia collaboration.

Proctoring in neuroendovascular surgery is one of the potential solutions for the shortage of personnel and experience, particularly in unstable and limited-resource areas such as Iraq. The study was conducted at the Baghdad Neurovascular Center (BNC), the first Hybrid neurovascular institution in Iraq, where sequential online zoom-based meetings between the BNC team and the expert from the Kingdom of Saudi Arabia were used for teleproctoring for neurointerventional procedures. A total of 28 sessions were conducted, four sessions for each case. Seven cases with various intracranial vascular lesions were operated for neuroendovascular procedures from July/2021 to March/2022. The teleproctoring for each case included four sequential sessions: (1) preoperative planning, (2) device selection and preparation, (3) intraoperative live-stream proctoring, and (4) postoperative reflection and follow-up planning. The procedures include coiling for dural arteriovenous fistula; preoperative tumor embolization; preoperative, partial, and staged embolization for arteriovenous malformation; coiling for intracranial aneurysm; and attempted Giant aneurysm flow-diversion. Major complications were avoided through teleproctoring, and all patients had good outcomes. In addition, the teleproctoring provided an effective training experience to the local neuroendovascular team that is otherwise not feasible. Teleproctoring is an effective and feasible tool to improve patient outcomes and provide a training experience to the local neuroendovascular teams in resource-limited regions.

Utilisation of the Scepter Mini dual-lumen balloon - An illustrative series.

Dual-lumen balloon microcatheters can aid in the safety and efficacy of endovascular embolisation of cerebrospinal vascular malformations. The Scepter Mini dual-lumen balloon is a novel device with a smaller profile than previous balloon microcatheters, opening up new indications not only in the treatment of cerebrospinal malformations but in various other neurovascular therapeutic and diagnostic scenarios. Following institutional ethics review board approval, a retrospective review of our prospectively maintained database of cases employing the Scepter Mini dual-lumen microballoon catheter was conducted. Five cases in particular were highlighted, demonstrating utilisation of this device, which may be of interest to the Neurointerventionalist. Patient demographics, procedure details, complications and clinical outcome data were reviewed. Five cases employing the Scepter Mini dual-lumen microballoon catheter are presented; trans-arterial embolisation of cerebral AVM, pre-operative tumour embolisation, diagnostic angiography, trans-venous embolisation of cerebral AVM and trans-arterial embolisation of DAVF. No intraprocedural complications were recorded, one patient had a delayed haemorrhage. Potential utilisation of the Scepter Mini lies not only in the trans-arterial embolisation of cerebrospinal vascular malformations, but in a range of other diagnostic and therapeutic indications as demonstrated.

Minimizing blood loss with direct percutaneous polymethylmethacrylate embolization before corpectomy for vascular spinal tumors.

Standard surgical treatment for vascular spinal tumors, including renal cell carcinomas and hemangiomas, may result in significant blood loss despite preoperative arterial tumor embolization. This is a retrospective review of 12 patients who underwent direct percutaneous polymethylmethacrylate embolization (DPPE) with or without feeding artery embolization before partial or complete corpectomy for the resection of vascular spinal tumors (2013-2018). Estimated blood loss (EBL) was compared to the blood loss reported in the literature and to patients receiving standard arterial embolization before surgery. The mean EBL for 12 patients was 1030 mL; three of 12 patients required blood transfusions. For the single level corpectomies, the EBL ranged from 100 mL to 3900 mL (mean 640 mL). This mean blood loss was not increased in patients receiving only DPPE preoperatively versus those patients receiving preoperative arterial embolization in addition to DPPE (1005 vs. 1416 mL); in fact, the EBL was significantly reduced for those undergoing DPPE alone. In this initial study, nine patients treated with DPPE embolization alone before spinal tumor resection demonstrated reduction of intraoperative blood loss compared to three patients having arterial embolization with DDPE.

Preoperative Endovascular Embolization of Intracranial Hemangioma: A Case Report

Highlight: Preoperative tumor embolization was performed to reduce intraoperative risk and maximize resection success Endovascular embolization has developed into an important and effective adjuvant in tumor management before a surgical resection. ABSTRACT Introduction: Hypervascular tumors of the head, neck, and central nervous system are associated with a high risk of bleeding during surgery. Hemangioma is a benign neoplasm that tends to grow rapidly, bleed, and have a high recurrence rate, especially after partial resection. Considering that hemangioma is a type of tumor with high vascularity, preoperative tumor embolization was performed to reduce intraoperative risk and maximize resection success. Case: A 33-year-old female came with the chief complaint of chronic progressive headaches and vision loss in the last 5 years. She got a lump on her forehead and had a visual acuity of 1/∞ in both eyes. She had already been diagnosed with hemangioma at a secondary regional hospital, where she bled profusely on the operating table, causing the resection to be discontinued. She was referred to our hospital for preoperative embolization. She underwent an endovascular embolization procedure with PVA particles to seal the feeder artery to the tumor. After embolization, angiography showed a complete devascularized tumor lesion. A total resection was done three days later with minimal bleeding compared to the first surgery. After a three-month follow-up, there was no new neurological deficit, and her headache was resolved completely, although her vision still did not improve. Conclusion: Endovascular embolization has developed into an important and effective adjuvant in tumor management before a surgical resection. Advances in catheter-based techniques, in conjunction with the development of the neurointervention field, are expected to raise the number of perioperative embolization procedures performed.

Minimally invasive treatment for glioblastoma through endoscopic surgery including tumor embolization when necessary: a technical note.

Although there have been some reports on endoscopic glioblastoma surgery, the indication has been limited to deep-seated lesions, and the difficulty of hemostasis has been a concern. In that light, we attempted to establish an endoscopic procedure for excision of glioblastoma which could be applied even to hypervascular or superficial lesions, in combination with pre-operative endovascular tumor embolization. Medical records of six consecutive glioblastoma patients who received exclusive endoscopic removal between September and November 2020 were analyzed. Preoperative tumor embolization was performed in cases with marked tumor stain and proper feeder arteries having an abnormal shape, for instance, tortuous or dilated, without passing through branches to the normal brain. Endoscopic tumor removal through a key-hole craniotomy was performed by using an inside-out excision for a deep-seated lesion, with the addition of an outside-in extirpation for a shallow portion when needed. Endoscopic removal was successfully performed in all six cases. Before resection, endovascular tumor embolization was performed in four cases with no resulting complications, including ischemia or brain swelling. Gross total resection was achieved in three cases, and near total resection in the other three cases. Intraoperative blood loss exceeded 1,000 ml in only one case, whose tumor showed a prominent tumor stain but no proper feeder artery for embolization. In all patients, a smooth transition to adjuvant therapy was possible with no surgical site infection. Endoscopic removal for glioblastoma was considered to be a promising procedure with minimal invasiveness and a favorable impact on prognosis.

Middle meningeal artery embolization using cone-beam computed tomography augmented guidance in patients with cancer

PurposeThe purpose of this study was to evaluate the safety and efficacy of middle meningeal artery embolization (MMAE) performed under cone-beam computed tomography (CBCT) augmented guidance in patients with cancer. Materials and methodsEleven patients with cancer (seven women, four men; median age, 75 years; age range: 42–87 years) who underwent 17 MMAEs under CBCT with a combination of particles and coils for chronic subdural hematoma (SDH) (n = 6), postoperative SDH (n = 3), or preoperative embolization of meningeal tumor (n = 2) from 2022 to 2023 were included. Technical success, fluoroscopy time (FT), reference dose (RD), kerma area product (KAP) were analyzed. Adverse events and outcomes were recorded. ResultsThe technical success rate was 100% (17/17). Median MMAE procedure duration was 82 min (interquartile range [IQR]: 70, 95; range: 63–108 min). The median FT was 24 min (IQR: 15, 48; range: 21.5–37.5 min); the median RD was 364 mGy (IQR: 37, 684; range: 131.5–444.5 mGy); and the median KAP was 46.4 Gy.cm2 (9.6, 104.5; range: 30.2–56.6 Gy.cm2). No further interventions were needed. The adverse event rate was 9% (1/11), with one pseudoaneurysm at the puncture site in a patient with thrombocytopenia, which was treated by stenting. The median follow-up was 48 days (IQR; 14, 251; range: 18.5–91 days]. SDH reduced in 11 of 15 SDHs (73%) as evidenced by follow-up imaging, with a size reduction greater than 50% in 10/15 SDHs (67%) . ConclusionMMAE under CBCT is a highly effective treatment option, but appropriate patient selection and careful consideration of potential risks and benefits is important for optimal patient outcomes.

ROLE OF PREOPERATIVE EMBOLIZATION IN BONE TUMORS- A case control study

Preoperative embolization of bone tumor is a minimally invasive angiographic intervention technique and effective adjuvant treatment option for bone tumors. In 1975, Feldman was the rst to use the pre-operative arterial embolization technique to downstage the vascularity of bone tumors, thus reducing blood loss during surgery. Surgery remains the mainstay treatment option for bone tumors. Embolization reduces tumor vascularity and hence decreases intraoperative blood loss and intraoperative blood transfusion. It enables more accurate delineation of tissue planes during surgery, resulting in complete removal of the bone tumor. The most frequent bone tumors that typically need preoperative embolization are those difcult to operate on because of their huge size, high degree of vascularity, proximity to critical tissues, or difcult surgical access. PVA particles are regarded as a workhorse in preoperative transarterial embolization and thus used commonly as an embolizing agent. It is safe procedure and therefore can be used as part of the multidisciplinary approach to the management highly vascular bone tumors.

Surgical treatment of cervical neurovascular bundle tumors

To determine the main principles of a patient-oriented individual approach to diagnosis and surgical treatment of cervical neurovascular bundle tumors considering the capabilities of neurosurgical hospital. There were 92 patients with cervical soft tissue tumors affecting neurovascular bundle. Age of patients ranged from 9 to 81 years (mean 47). There were 65.1% women and 34.9% men. We found chemodectoma (47.4%), neurofibroma (15.8%), neurinoma (13.2%), papillary thyroid cancer (5.3%), salivary gland heterotopia (5.3%), salivary gland adenocarcinoma (5.3%), Hodgkin lymphoma (2.6%), hemangioendothelioma (2.6%) and cavernous lymphangioma (2.6%). Diagnostic algorithm included neurological examinations, Doppler ultrasound of supra-aortic arteries, transcranial ultrasound of cerebral vessels, MRI of cervical soft tissues, CT-AG, MR-AG, CT-perfusion, direct selective angiography. A total of 94 surgical interventions were performed. All surgeries were performed using surgical optics and neurophysiological monitoring of cranial nerves IX, X, XII. We chose resection technique depending on localization, histological features and blood supply of tumor. En-bloc resection was performed in 46 cases, removal of fragments - in 23 cases, intracapsular resection of tumor followed by resection of the capsule - in 26 cases. Total and subtotal resection was performed in 68 (72%) and 23 (24%) cases, respectively. Three (4%) patients underwent partial resection of infiltrative tumors for carotid artery decompression and histological analysis. In 76% of cases, baseline symptoms of disease regressed after surgery. Persistent moderate bulbar disorders were observed in 16 patients (17%). Ischemic complications with additional surgical interventions were observed in 2 cases. Patients with cervical soft tissue tumors require individual approach regarding choosing the optimal surgical treatment including possible preoperative embolization of tumor, en-bloc or intracapsular resection and carotid artery repair.

Preoperative embolization of juvenile nasopharyngeal angiofibroma using medium to large size particles

Introduction. Juvenile nasopharyngeal angiofibroma are benign tumors, with locally aggressive behavior. Preoperative tumor embolization with polyvinyl alcohol particles can reduce intraoperative blood loss and facilitate surgical resection. Case outline. A 16-year-old male was admitted to hospital due to profuse epistaxis and sense of nose fullness. Multidetector computed tomographic angiography examination showed a tumor mass in the right nasal cavity with extension to the right maxillary sinus and ethmoidal cells on the right, and in the left nasal cavity. It rested on the nasal septum, but without bone destruction. After application of contrast agent, described mass became intensely opacified. Preprocedural digital subtraction angiography of external and internal carotid arteries of both sides showed extensive pathological vascularization, which received main contribution from branches of maxillary artery on right and, to a lesser extent, on left side. Due to danger of penetration of a particle embolization agent of smaller diameter into orbital branches and possible retrograde migration into carotid artery, we decided to apply particle embolization agent of larger diameter (500?700 ?m) than prescribed by modern standards. Tumor was completely surgically removed third day after embolization, and patient was discharged without any neurological deficit. Control contrast enhanced multidetector computed tomographic angiographies were performed at third and seventh month after surgery and showed no tumor residue or recurrence. Conclusion. The use of particles of larger diameter gave satisfactory results during operation ? surgical excision of tumor, when dangerous anastomoses do not allow use of particles of smaller diameter and can be safely performed without significant neurological nor systemic complications.

Spinal tumor embolization: benefit for surgical resection.

The embolization of hypervascular spinal tumors preoperatively has shown to be a worthwhile adjunctive procedure to minimize the elevated risks associated with surgical resection, such as intraoperative blood loss and its associated complications. Resection of these hypervascular tumors is necessary for local tumor control, reduction in patient-reported pain, improved neurological functioning, and spinal stability. This adjunctive procedure has been associated with improved surgical outcomes and easier facilitation of surgical resection. As such, we provide a review of the current literature examining the employment of this technique. Specifically, this article (a) reviews the techniques of embolization, with anatomical considerations of the arterial framework of the spinal network; (b) relativizes and outlines the post-embolization management of spinal tumor resection; (c) provides a critical outlook on the reported benefit of preoperative embolization before surgical resection with support from clinical studies in the literature; and (d) discusses the efficacy and reliability of provocative testing and post-procedural management and follow-up. Ultimately, a thorough and updated review of preoperative spinal tumor embolization and its clinical benefits will summarize the current fund of knowledge and encourage future research toward continued improvements in patient outcomes for those needing to undergo surgical resection of spinal lesions.

Preoperative Balloon Occlusion Test of the Carotid Artery and Preoperative Tumor Embolization on Paraganglioma of Carotid Body: 20-Year Experience in a Single Institute and Literature Review

Background and Objectives Carotid body paraganglioma is the common type of carotid body tumor for which angiography, carotid artery balloon occlusion test (BOT) and tumor embolization could be considered before the surgery. We analyzed cases in a single institute and reviewed related literature to investigate the necessity of these preoperative examinations.Subjects and Method Medical records of patients who were diagnosed with paraganglioma were retrospectively analyzed from 2000 to 2019.Results Sixteen patients were identified. Of the total, 14 patients underwent surgery at this institute, and 13 underwent angiography. Of the 13 patients who underwent angiography, 6 patients underwent carotid artery BOT, and 12 patients underwent tumor embolization. The average tumor size of 6 patients who underwent carotid artery BOT was 28.7 mm, and 8 patients who did not undergo carotid artery BOT was 30.1 mm. The average tumor size of 12 patients who underwent tumor embolization was 29.4 mm. Two patients did not undergo tumor embolization, and their average tumor size was 30 mm. In 1 patient, both preoperative angiography and carotid artery BOT were performed, but tumor embolization was not performed due to spasm of tumor vessels.Conclusion Preoperative carotid artery BOT can be performed to reduce side effects in patients with the potential for carotid resection. In addition, tumor embolization is performed regardless of tumor size. By reducing the amount of bleeding during surgery and reducing the size of the tumor, it is possible to secure an appropriate surgical field of view to facilitate operation during surgery; however, its effectiveness needs to be clearly identified.

Surgical complications and recurrence factors for asymptomatic meningiomas: a single-center retrospective study.

Observation is the first management option in asymptomatic meningiomas, but when an enlargement or mass effect is observed, surgery is indicated. This study is aimed at exploring risk factors for complications and recurrence after surgery for asymptomatic meningioma. We also examined the impact of preoperative tumor embolization, which is considered controversial. We retrospectively reviewed 109 patients with primary asymptomatic meningiomas surgically treated at our institute between April 2007 and March 2021. Patients who only had headaches as a nonspecific complaint were included in the asymptomatic group. Complications, time to recurrence, and Glasgow Outcome Scale (GOS) score were the endpoints of the study. Risk factors for complications and recurrence were explored. Moreover, the effect of the resection on nonspecific headaches was also explored. The permanent postoperative complication rate related to the surgical procedure was 1.8%. Of the total, 107 patients (98.2%) with asymptomatic meningiomas who were surgically treated achieved a GOS score of 5 1year after the operation. Preoperative headache was present in 31 patients and improved postoperatively in 21 patients. Multivariate analysis using the Cox proportional hazard model showed that preoperative tumor embolization with > 80% resolution of tumor staining (p < 0.001) was negatively related to recurrence, whereas age (p = 0.046) and Simpson grade IV resection (p = 0.041) were positively related to recurrence. Although surgery for asymptomatic meningiomas can, in many cases, be safe, it is not free of complications Thus, surgical intervention for asymptomatic meningiomas should be considered cautiously. However, more than half the patients with headaches showed improvement. Simpson grade IV resection cases should be assessed for recurrence, and preoperative tumor embolization might be effective in controlling recurrence.

Distal radial artery approach is safe and effective for cerebral angiography and neuroendovascular treatment: A single-center experience with ultrasonographic measurement.

The transradial artery approach to cerebral angiography can reduce both patient stress following examination and the risk of major complications due to hematoma. Recently, the distal radial artery approach (DRA) has garnered attention in cardiology as a minimally invasive method. DRA is also considered applicable to neurosurgery, although concerns about procedural difficulty and complications persist. Therefore, this study aimed to evaluate the efficacy of the DRA in cerebral angiography and neuroendovascular treatment. We retrospectively selected 30 consecutive patients for whom the DRA was attempted for cerebral angiography at our hospital. The patients' age, sex, height, weight, and medical history information was collected and correlated with successful puncture and complications. The diameter of the distal radial artery (RA) was measured using ultrasonography. The median patient age was 67 years (range, 32-87 years) and 21 (70%) were men. The median diameter of the distal RA was 2.3 mm (range, 1.7-3.2 mm). Distal RA puncture was successful in 23 patients (77%) and no complications were noted; however there was no significant correlation between successful puncture and any of the patient factors. Carotid artery stenting and preoperative tumor embolization were performed via DRA in six and three cases, respectively. Although puncture site hematoma occurred in only one case, all treatments were successful, and no major complications were observed. DRA can be safely used for cerebral angiography and neuroendovascular treatment.

Preoperative tumor embolization prolongs time to recurrence of meningiomas: a retrospective propensity-matched analysis

BackgroundMeningiomas are often embolized preoperatively to reduce intraoperative blood loss and facilitate tumor resection. However, the procedure is controversial and its effects have not yet been reported. We evaluated preoperative...