title: The safety and efficacy of preoperative embolization of meningioma with N-butyl cyanoacrylate.
abstract: OBJECTIVE
  Preoperative embolization of meningioma is commonly performed; however, there is no consensus on the best embolic material to reduce intraoperative blood loss and surgery time.
  
  
  METHODS
  We retrospectively assessed the safety and efficacy of 56 cases of preoperative embolization of the middle meningeal artery with N-butyl cyanoacrylate (NBCA) in 105 cases of surgery for meningioma. We also defined a blood loss to tumor volume ratio to compensate for bias caused by tumor volume, and analyzed limited cases (the embolized group n = 52, the non-embolized group n = 21) of the convexity, the parasagittal region, the falx, and the sphenoidal ridge.
  
  
  RESULTS
  The blood loss to tumor volume ratio was significantly less in the embolized group (p < 0.007). Preoperative embolization could be useful for cases with the external carotid artery as the dominant feeder vessel (p < 0.02); however, the efficacy decreased for cases with an internal carotid artery feeder. Transient complications occurred in four cases (hemiparesis secondary to edema: two cases; intratumoral bleeding: one case; trigeminal nerve disorder: one case). The cases that showed a postoperative increase in edema or intratumoral bleeding were large tumors with the early filling of veins. For such cases, surgeons should pay close attention to slow injection speed and higher NBCA viscosity, not to cause the occlusion of draining vessels.
  
  
  CONCLUSIONS
  Tumor embolization with NBCA can be safely performed, and the procedure significantly reduces intraoperative blood loss.
authors.affiliation: Department of Endovascular Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan hideaki@saitama-med.ac.jp.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Ishihara
authors.affiliation: Department of Endovascular Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Ishihara
authors.affiliation: Department of Endovascular Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Niimi
authors.affiliation: Department of Endovascular Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Neki
authors.affiliation: Department of Endovascular Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kakehi
authors.affiliation: Department of Endovascular Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
authors.forename: Nahoko
authors.initials: N
authors.lastname: Uemiya
authors.affiliation: Department of Endovascular Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kohyama
authors.affiliation: Department of Endovascular Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Yamane
authors.affiliation: Department of Neurosurgery, Ken-o Tokorozawa Hospital, Tokorozawa, Saitama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kato
authors.affiliation: Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
authors.forename: Tomonari
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Adachi
authors.affiliation: Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Mishima
authors.affiliation: Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Nishikawa
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D014014:Tissue Adhesives; D004659:Enbucrilate
keywords: Endovascular treatment; Meningioma embolization; N-butyl cyanoacrylate (NBCA)