Contemporary Endovascular Embolotherapy for Meningioma

 

 Buy Article Permissions and Reprints

Abstract

Preoperative endovascular tumor embolization has been used for 40 years. Meningiomas are the most common benign intracranial tumor in which preoperative embolization has been most extensively described in the literature. Advocates of embolization report that it reduces operative blood-loss, and softens the tumor, thus making surgery safer and easier. Opponents suggest that it adds additional risk and cost for patients without controlled studies showing conclusive benefit. The literature suggests a 3 to 6% neurological complication rate related to embolization. The combined external and internal carotid artery blood supply and complex anastomoses of the meninges can make embolization challenging. Positive outcomes require thorough knowledge of the pertinent vascular anatomy, familiarity with the neurovascular equipment and embolics, and meticulous technique. There remains debate on several aspects of embolization, including tumors most appropriate for embolization, embolic agent of choice, ideal size of embolic, and the choice of vessel(s) to embolize. This detailed review of pertinent vascular anatomy, embolization technique, results, and complications should allow practitioners to maximize treatment outcomes in this setting.

• References

• 1 Djindjian R, Cophignon J, Théron J, Merland JJ, Houdart R. Embolization by superselective arteriography from the femoral route in neuroradiology. Review of 60 cases. 1. Technique, indications, complications. Neuroradiology 1973; 6 (1) 20-26
  CrossrefPubMedGoogle Scholar
• 2 Manelfe C, Guiraud B, David J , et al. Embolization by catheterization of intracranial meningiomas [in French]. Rev Neurol (Paris) 1973; 128 (5) 339-351
  PubMedGoogle Scholar
• 3 Bendszus M, Klein R, Burger R, Warmuth-Metz M, Hofmann E, Solymosi L. Efficacy of trisacryl gelatin microspheres versus polyvinyl alcohol particles in the preoperative embolization of meningiomas. AJNR Am J Neuroradiol 2000; 21 (2) 255-261
  PubMedGoogle Scholar
• 4 Bendszus M, Rao G, Burger R , et al. Is there a benefit of preoperative meningioma embolization?. Neurosurgery 2000; 47 (6) 1306-1311 , discussion 1311–1312
  CrossrefPubMedGoogle Scholar
• 5 Berenstein A, Kricheff II. Microembolization techniques of vascular occlusion: radiologic, pathologic, and clinical correlation. AJNR Am J Neuroradiol 1981; 2 (3) 261-267
  PubMedGoogle Scholar
• 6 Chun JY, McDermott MW, Lamborn KR, Wilson CB, Higashida R, Berger MS. Delayed surgical resection reduces intraoperative blood loss for embolized meningiomas. Neurosurgery 2002; 50 (6) 1231-1235 , discussion 1235–1237
  PubMedGoogle Scholar
• 7 Dean BL, Flom RA, Wallace RC , et al. Efficacy of endovascular treatment of meningiomas: evaluation with matched samples. AJNR Am J Neuroradiol 1994; 15 (9) 1675-1680
  PubMedGoogle Scholar
• 8 Latchaw RE. Preoperative intracranial meningioma embolization: technical considerations affecting the risk-to-benefit ratio. AJNR Am J Neuroradiol 1993; 14 (3) 583-586
  PubMedGoogle Scholar
• 9 Manelfe C, Lasjaunias P, Ruscalleda J. Preoperative embolization of intracranial meningiomas. AJNR Am J Neuroradiol 1986; 7 (5) 963-972
  PubMedGoogle Scholar
• 10 Terada T, Kinoshita Y, Yokote H , et al. Preoperative embolization of meningiomas fed by ophthalmic branch arteries. Surg Neurol 1996; 45 (2) 161-166
  CrossrefPubMedGoogle Scholar
• 11 Wakhloo AK, Juengling FD, Van Velthoven V, Schumacher M, Hennig J, Schwechheimer K. Extended preoperative polyvinyl alcohol microembolization of intracranial meningiomas: assessment of two embolization techniques. AJNR Am J Neuroradiol 1993; 14 (3) 571-582
  PubMedGoogle Scholar
• 12 Macpherson P. The value of pre-operative embolisation of meningioma estimated subjectively and objectively. Neuroradiology 1991; 33 (4) 334-337
  CrossrefPubMedGoogle Scholar
• 13 Bendszus M, Martin-Schrader I, Schlake HP, Solymosi L. Embolisation of intracranial meningiomas without subsequent surgery. Neuroradiology 2003; 45 (7) 451-455
  CrossrefPubMedGoogle Scholar
• 14 Bendszus M, Martin-Schrader I, Warmuth-Metz M, Hofmann E, Solymosi L. MR imaging- and MR spectroscopy-revealed changes in meningiomas for which embolization was performed without subsequent surgery. AJNR Am J Neuroradiol 2000; 21 (4) 666-669
  PubMedGoogle Scholar
• 15 Carli DFM, Sluzewski M, Beute GN, van Rooij WJ. Complications of particle embolization of meningiomas: frequency, risk factors, and outcome. AJNR Am J Neuroradiol 2010; 31 (1) 152-154
  CrossrefPubMedGoogle Scholar
• 16 Das D, Singh V. A sphenoid wing meningioma presenting with intraparenchymal and intraventricular hemorrhage treated with endovascular embolization alone: case report and radiologic follow-up. J Neurointerv Surg 2012; 4 (6) e36
  CrossrefPubMedGoogle Scholar
• 17 Gruber A, Killer M, Mazal P, Bavinzski G, Richling B. Preoperative embolization of intracranial meningiomas: a 17-years single center experience. Minim Invasive Neurosurg 2000; 43 (1) 18-29
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Hekster RE, Matricali B, Luyendijk W. Presurgical transfemoral catheter embolization to reduce operative blood loss. Technical note. J Neurosurg 1974; 41 (3) 396-398
  CrossrefPubMedGoogle Scholar
• 19 Koike T, Sasaki O, Tanaka R, Arai H. Long-term results in a case of meningioma treated by embolization alone—case report. Neurol Med Chir (Tokyo) 1990; 30 (3) 173-177
  CrossrefPubMedGoogle Scholar
• 20 Richter HP, Schachenmayr W. Preoperative embolization of intracranial meningiomas. Neurosurgery 1983; 13 (3) 261-268
  CrossrefPubMedGoogle Scholar
• 21 Bendszus M, Monoranu CM, Schütz A, Nölte I, Vince GH, Solymosi L. Neurologic complications after particle embolization of intracranial meningiomas. AJNR Am J Neuroradiol 2005; 26 (6) 1413-1419
  PubMedGoogle Scholar
• 22 Kallmes DF, Evans AJ, Kaptain GJ , et al. Hemorrhagic complications in embolization of a meningioma: case report and review of the literature. Neuroradiology 1997; 39 (12) 877-880
  CrossrefPubMedGoogle Scholar
• 23 Suyama T, Tamaki N, Fujiwara K, Hamano S, Kimura M, Matsumoto S. Peritumoral and intratumoral hemorrhage after gelatin sponge embolization of malignant meningioma: case report. Neurosurgery 1987; 21 (6) 944-946
  CrossrefPubMedGoogle Scholar
• 24 Waldron JS, Sughrue ME, Hetts SW , et al. Embolization of skull base meningiomas and feeding vessels arising from the internal carotid circulation. Neurosurgery 2011; 68 (1) 162-169 , discussion 169
  CrossrefPubMedGoogle Scholar
• 25 Bondy M, Ligon BL. Epidemiology and etiology of intracranial meningiomas: a review. J Neurooncol 1996; 29 (3) 197-205
  CrossrefPubMedGoogle Scholar
• 26 Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. J Neurooncol 2010; 99 (3) 307-314
  CrossrefPubMedGoogle Scholar
• 27 Alexiou GA, Gogou P, Markoula S, Kyritsis AP. Management of meningiomas. Clin Neurol Neurosurg 2010; 112 (3) 177-182
  CrossrefPubMedGoogle Scholar
• 28 Cheng MH, Lin JW. Intracranial meningioma with intratumoral hemorrhage. J Formos Med Assoc 1997; 96 (2) 116-120
  PubMedGoogle Scholar
• 29 Kurokawa H, Kikuchi K, Kamisato N, Miura S, Ishida Y. Massive intracerebral hemorrhage due to convexity meningioma [in Japanese]. Rinsho Hoshasen 1989; 34 (6) 723-726
  PubMedGoogle Scholar
• 30 Lang I, Jackson A, Strang FA. Intraventricular hemorrhage caused by intraventricular meningioma: CT appearance. AJNR Am J Neuroradiol 1995; 16 (6) 1378-1381
  PubMedGoogle Scholar
• 31 Latchaw Jr JP, Dohn DF, Hahn JF, von der Luft E. Subarachnoid hemorrhage from an intracranial meningioma. Neurosurgery 1981; 9 (4) 433-435
  CrossrefPubMedGoogle Scholar
• 32 Hayashi T, Shojima K, Utsunomiya H, Moritaka K, Honda E. Subarachnoid hemorrhage after preoperative embolization of a cystic meningioma. Surg Neurol 1987; 27 (3) 295-300
  CrossrefPubMedGoogle Scholar
• 33 Kohli CM, Crouch RL. Meningioma with intracerebral hematoma. Neurosurgery 1984; 15 (2) 237-240
  CrossrefPubMedGoogle Scholar
• 34 Lazaro RP, Messer HD, Brinker RA. Intracranial hemorrhage associated with meningioma. Neurosurgery 1981; 8 (1) 96-101
  CrossrefPubMedGoogle Scholar
• 35 Olivero WC, Lister JR, Elwood PW. The natural history and growth rate of asymptomatic meningiomas: a review of 60 patients. J Neurosurg 1995; 83 (2) 222-224
  CrossrefPubMedGoogle Scholar
• 36 Nakamura M, Roser F, Michel J, Jacobs C, Samii M. The natural history of incidental meningiomas. Neurosurgery 2003; 53 (1) 62-70 , discussion 70–71
  CrossrefPubMedGoogle Scholar
• 37 Go RS, Taylor BV, Kimmel DW. The natural history of asymptomatic meningiomas in Olmsted County, Minnesota. Neurology 1998; 51 (6) 1718-1720
  CrossrefPubMedGoogle Scholar
• 38 Rockhill J, Mrugala M, Chamberlain MC. Intracranial meningiomas: an overview of diagnosis and treatment. Neurosurg Focus 2007; 23 (4) E1
  Google Scholar
• 39 Goldsmith BJ, Wara WM, Wilson CB, Larson DA. Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 1994; 80 (2) 195-201
  CrossrefPubMedGoogle Scholar
• 40 Kondziolka D, Mathieu D, Lunsford LD , et al. Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 2008; 62 (1) 53-58 , discussion 58–60
  CrossrefPubMedGoogle Scholar
• 41 Chamberlain MC, Blumenthal DT. Intracranial meningiomas: diagnosis and treatment. Expert Rev Neurother 2004; 4 (4) 641-648
  CrossrefPubMedGoogle Scholar
• 42 Berenstein A, Russell E. Gelatin sponge in therapeutic neuroradiology: a subject review. Radiology 1981; 141 (1) 105-112
  PubMedGoogle Scholar
• 43 Derdeyn CP, Graves VB, Salamat MS, Rappe A. Collagen-coated acrylic microspheres for embolotherapy: in vivo and in vitro characteristics. AJNR Am J Neuroradiol 1997; 18 (4) 647-653
  PubMedGoogle Scholar
• 44 Kominami S, Watanabe A, Suzuki M, Mizunari T, Kobayashi S, Teramoto A. Preoperative embolization of meningiomas with N-butyl cyanoacrylate. Interv Neuroradiol 2012; 18 (2) 133-139
  CrossrefPubMedGoogle Scholar
• 45 Morimura T, Takeuchi J, Maeda Y, Tani E. Preoperative embolization of meningiomas: its efficacy and histopathological findings. Noshuyo Byori 1994; 11 (2) 123-129
  PubMedGoogle Scholar
• 46 Teasdale E, Patterson J, McLellan D, Macpherson P. Subselective preoperative embolization for meningiomas. A radiological and pathological assessment. J Neurosurg 1984; 60 (3) 506-511
  CrossrefPubMedGoogle Scholar
• 47 Beretta L, Dell'Acqua A, Giorgi E , et al. Complications during preoperative embolization in intracranial meningioma [in Italian]. Minerva Anestesiol 1992; ; 58 (4) (Suppl. 01) 111-114
  PubMedGoogle Scholar
• 48 Sluzewski M, van Rooij WJ, Lohle PN, Beute GN, Peluso JP. Embolization of meningiomas: comparison of safety between calibrated microspheres and polyvinyl-alcohol particles as embolic agents. AJNR Am J Neuroradiol 2013; 34 (4) 727-729
  CrossrefPubMedGoogle Scholar
• 49 Lee JH. Meningiomas: Diagnosis, Treatment, and Outcomes. New York, NY: Springer; 2009
  Google Scholar
• 50 Trivelatto F, Nakiri GS, Manisor M , et al. Preoperative onyx embolization of meningiomas fed by the ophthalmic artery: a case series. AJNR Am J Neuroradiol 2011; 32 (9) 1762-1766
  CrossrefPubMedGoogle Scholar
• 51 Salamon GM, Combalbert A, Raybaud C, Gonzalez J. An angiographic study of meningiomas of the posterior fossa. J Neurosurg 1971; 35 (6) 731-741
  PubMedGoogle Scholar
• 52 Horton JA, Kerber CW. Lidocaine injection into external carotid branches: provocative test to preserve cranial nerve function in therapeutic embolization. AJNR Am J Neuroradiol 1986; 7 (1) 105-108
  PubMedGoogle Scholar
• 53 Rodiek SO, Stölzle A, Lumenta ChB. Preoperative embolization of intracranial meningiomas with Embosphere microspheres. Minim Invasive Neurosurg 2004; 47 (5) 299-305
  Article in Thieme ConnectPubMedGoogle Scholar
• 54 Jungreis CA. Skull-base tumors: ethanol embolization of the cavernous carotid artery. Radiology 1991; 181 (3) 741-743
  PubMedGoogle Scholar
• 55 Rosen CL. Meningiomas: the role of preoperative angiography and embolization. Neurosurg Focus 2003; 15 (4) 1-4 , ECP4
  PubMedGoogle Scholar
• 56 Kai Y, Hamada J, Morioka M , et al. Appropriate interval between embolization and surgery in patients with meningioma. Am J Neuroradiol 2002; 23 (1) 139-142
  PubMedGoogle Scholar
• 57 Brismar J, Cronqvist S. Therapeutic embolization in the external carotid artery region. Acta Radiol Diagn (Stockh) 1978; 19 (5) 715-731
  PubMedGoogle Scholar
• 58 Matsumoto M, Kodama N, Endo Y , et al. Dynamic 3D-CT angiography. AJNR Am J Neuroradiol 2007; 28 (2) 299-304
  PubMedGoogle Scholar
• 59 Grand C, Bank WO, Balériaux D , et al. Gadolinium-enhanced MR in the evaluation of preoperative meningioma embolization. AJNR Am J Neuroradiol 1993; 14 (3) 563-569
  PubMedGoogle Scholar
• 60 Martin AJ, Cha S, Higashida RT , et al. Assessment of vasculature of meningiomas and the effects of embolization with intra-arterial MR perfusion imaging: a feasibility study. AJNR Am J Neuroradiol 2007; 28 (9) 1771-1777
  CrossrefPubMedGoogle Scholar
• 61 Sasao A, Hirai T, Nishimura S , et al. Assessment of vascular supply of hypervascular extra-axial brain tumors with 3T MR regional perfusion imaging. AJNR Am J Neuroradiol 2010; 31 (3) 554-558
  CrossrefPubMedGoogle Scholar
• 62 Hirai T, Korogi Y, Ono K, Uemura S, Yamashita Y. Preoperative embolization for meningeal tumors: evaluation of vascular supply with angio-CT. AJNR Am J Neuroradiol 2004; 25 (1) 74-76
  PubMedGoogle Scholar
• 63 Kaji T, Hama Y, Iwasaki Y, Kyoto Y, Kusano S. Preoperative embolization of meningiomas with pial supply: successful treatment of two cases. Surg Neurol 1999; 52 (3) 270-273
  CrossrefPubMedGoogle Scholar
• 64 Motozaki T, Otuka S, Sato S , et al. Preoperative embolization with gelfoam powder for intracranial meningioma causing unusual peritumoral hemorrhage—with reference to the mechanism of hemorrhage [in Japanese]. No Shinkei Geka 1987; 15 (1) 95-101
  PubMedGoogle Scholar
• 65 Rosen CL, Ammerman JM, Sekhar LN, Bank WO. Outcome analysis of preoperative embolization in cranial base surgery. Acta Neurochir (Wien) 2002; 144 (11) 1157-1164
  CrossrefPubMedGoogle Scholar
• 66 Watanabe K, Matsumura K, Matsuda M, Handa J. Meningioma with intratumoral and subdural hemorrhage as an immediate complication of therapeutic embolization. Case report [in Japanese]. Neurol Med Chir (Tokyo) 1986; 26 (11) 904-907
  CrossrefPubMedGoogle Scholar