Delayed surgical resection reduces intraoperative blood loss for embolized meningiomas.
OBJECTIVE
Embolization before surgical resection of tumors has been demonstrated to reduce intraoperative blood loss, but the optimal time that should elapse between embolization and tumor resection has not been established. We evaluated whether immediate surgical resection (< or =24 h) after embolization or delayed surgical resection (>24 h) was more effective in minimizing intraoperative blood loss.


METHODS
We retrospectively analyzed the records for 50 patients with meningiomas who underwent preoperative embolization between 1993 and 1999. We divided the patients into two groups, i.e., those who underwent surgical resection of their meningiomas < or =24 hours after embolization and those who underwent surgery more than 24 hours after embolization. The extent of embolization, intraoperative blood loss, duration of surgery, and length of the hospital stay were compared for the two groups. Postoperative pathological specimens were examined for assessment of the extent of vascularity and necrosis caused by embolization.


RESULTS
Intraoperative blood loss was greater for the immediate group than for the delayed group (29% with blood loss of >1000 ml [median, 475 ml] versus 0% with blood loss of >700 ml [median, 337.5 ml]; P = 0.01). There were no statistically significant differences between the groups with respect to tumor volume, extent of embolization, degree of devascularization, necrosis, duration of surgery, or length of the hospital stay.


CONCLUSIONS
Contrary to previous studies that emphasized a need for tumor removal immediately after embolization, to prevent revascularization, surgical resection of meningiomas should be delayed more than 24 hours after embolization, because there is less intraoperative blood loss.
Chun
Jay Y
JY
Department of Neurological Surgery, Brain Tumor Research Center, University of California, San Francisco, San Francisco, California 94143-0112, USA. chunj@neurosurg.ucsf.edu
McDermott
Michael W
MW
Lamborn
Kathleen R
KR
Wilson
Charles B
CB
Higashida
Randall
R
Berger
Mitchel S
MS
D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002648:Child; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000628:therapy*; D008579:Meningioma / Q000628:therapy*; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D013997:Time Factors