Efficacy of trisacryl gelatin microspheres versus polyvinyl alcohol particles in the preoperative embolization of meningiomas.
OBJECTIVE
Trisacryl gelatin microspheres are a new, commercially available nonabsorbable embolic agent. The purpose of this study was to evaluate their efficacy in the preoperative embolization of meningiomas as compared with polyvinyl alcohol (PVA) particles of various sizes.


METHODS
In 30 consecutive patients, trisacryl gelatin microspheres (150-300 microm) were used for the preoperative superselective embolization of meningiomas (group 1). Thirty other consecutive patients had embolization with PVA particles of 45 to 150 microm (n = 15, group 2) and of 150 to 250 microm (n = 15, group 3). Extent of devascularization, intraoperative blood loss, blood transfusion, and hemostasis at the time of surgery were recorded for every patient. The inflammatory reaction, the extent of necrotic areas, and the most distal intravascular location of the embolic agent (arterial, arteriolar, precapillary, capillary) were recorded.


RESULTS
There was no significant difference in the extent of angiographic devascularization among the groups. Intraoperative blood loss differed significantly between groups 1 and 2 and groups 1 and 3, but not between groups 2 and 3. The trisacryl gelatin microspheres were located more distally in tumor vessels than were the PVA particles of either size. The extent of intratumoral necrosis was not significantly different between the two embolic agents. In all groups there was a mild inflammatory tissue reaction in the vicinity of the embolic agent.


CONCLUSIONS
Trisacryl gelatin microspheres may be effective in the preoperative embolization of meningiomas, producing significantly less blood loss at surgery than seen with PVA particles of either size, possibly because of the significantly more distal vascular penetration of the microspheres.
Bendszus
M
M
Department of Neuroradiology, University of Würzburg, Germany.
Klein
R
R
Burger
R
R
Warmuth-Metz
M
M
Hofmann
E
E
Solymosi
L
L
D000179:Acrylates / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002196:Capillaries / Q000473:pathology; D004621:Embolization, Therapeutic; D005260:Female; D005549:Foreign-Body Reaction / Q000473:pathology; D005780:Gelatin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000098:blood supply / Q000601:surgery*; D008578:Meninges / Q000098:blood supply / Q000473:pathology; D008579:Meningioma / Q000098:blood supply / Q000601:surgery*; D008863:Microspheres; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010316:Particle Size; D011142:Polyvinyl Alcohol / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D000179:Acrylates; D005780:Gelatin; D011142:Polyvinyl Alcohol; C036658:acrylic acid