title: Safety and efficacy of medium-sized particle embolisation for skull-base meningioma.
abstract: OBJECTIVE
  To determine the effectiveness and safety of preoperative tumour embolisation for skull-base meningiomas via external carotid artery (ECA) feeders using medium-sized (150-250 μm) polyvinyl alcohol (PVA) particles.
  
  
  METHODS
  This study included 114 consecutive patients with skull-base meningiomas who underwent preoperative tumour embolisation using medium-sized PVA particles from January 2004 to December 2013. Tumours were categorised according to feeding artery as follows: type 1, tumour staining at ECA angiography only; type 2, tumour staining at both the ECA and internal carotid artery (ICA) angiography; or type 3, little or no tumour staining at ECA angiography. The effectiveness was based on the percent reduction in the enhanced area: >75% was considered effective, 25-75% was considered partially effective, and <25% was considered ineffective.
  
  
  RESULTS
  Tumour embolisation was performed in patients with dominant feeding vessels originating from the ECA. Procedural-related complications occurred in two (1.8%) patients. Post-procedural MRI images were available for 51 patients, which revealed effective embolisation in only 13 (25.5%) patients. Identification of an ICA feeding vessel was associated with ineffective embolisation (p=0.011). Effective embolisation was associated with low estimated blood loss during surgery.
  
  
  CONCLUSIONS
  ECA embolisation using medium-sized PVA is ineffective in patients in whom a definitive ICA feeding vessel was identified, even if preprocedural angiography showed that the dominant feeder originated from the ECA. When the risks of surgical morbidity and mortality are expected to be high, ICA feeder embolisation should also be considered.
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: K I
authors.initials: KI
authors.lastname: Jo
authors.affiliation: Department of Radiology, Anam Hospital, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea.
authors.forename: B
authors.initials: B
authors.lastname: Kim
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: M J
authors.initials: MJ
authors.lastname: Cha
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: P
authors.initials: P
authors.lastname: Jeon
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address: somatom.kim@samsung.com.
authors.forename: K H
authors.initials: KH
authors.lastname: Kim
mesh_terms: D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000628:therapy*; D008875:Middle Aged; D011142:Polyvinyl Alcohol; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D011142:Polyvinyl Alcohol