Preoperative embolization of meningiomas with polyvinyl alcohol particles: The benefits are not outweighed by risks.
OBJECTIVE
The purpose of this study was to define the feasibility, the efficacy and the safety of preoperative embolization (POE) of meningiomas using polyvinyl alcohol (PVA) particles.


METHODS
Between January 2006 and June 2014, 191 consecutive patients were referred to our institution for the treatment of meningiomas; of these 57 patients were excluded from the study. A total of 64 patients (22 men and 42 women) with a mean age of 58.4±10.8 [SD] years (range: 14-82years) who underwent POE with PVA particles, achieving extensive (>90%) devascularization were ultimately included and compared to 70 patients who had surgery without POE. Surgical time and intraoperative blood loss were compared between the two groups. The duration of procedures and complications related to POE were analyzed.


RESULTS
No differences were found between the two groups with respect to intraoperative blood loss. A significant reduction in surgical time was observed for the group who had POE (207.4±79.5 [SD] min vs. 226.9±117.6 [SD] min; P=0.028). In a subgroup analysis, the size and location of meningiomas did not influence these results. The duration of procedures was 41.4±10.5 [SD] min. Minor complications related to POE occurred in 3 out of 64 patients (4.7%).


CONCLUSIONS
POE of meningiomas using PVA particles is effective in reducing surgical time, when extensive tumor devascularization is achieved. However, radiation exposure, the duration of procedures and complications related to POE with PVA particles do not justify this technique in most patients.
Department of Radiological Sciences, Catholic University of Sacred Heart, "A. Gemelli" Hospital, Largo Agostino Gemelli 8, 00168 Rome, Italy. Electronic address: marta.iacobucci@gmail.com.
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Iacobucci
Department of Neuroradiology, Neurocenter of Southern Switzerland, Civico Hospital, Via Tesserete 46, 6900 Lugano, Switzerland.
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Danieli
Department of Radiological Sciences, Catholic University of Sacred Heart, "A. Gemelli" Hospital, Largo Agostino Gemelli 8, 00168 Rome, Italy.
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Visconti
Transfusion Medicine Department, Catholic University of Sacred Heart, "A. Gemelli" Hospital, Largo Agostino Gemelli 8, 00168 Rome, Italy.
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Maresca
Department of Neurosurgery, Catholic University of Sacred Heart, "A. Gemelli" Hospital, Largo Agostino Gemelli 8, 00168 Rome, Italy.
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Anile
Department of Radiological Sciences, Catholic University of Sacred Heart, "A. Gemelli" Hospital, Largo Agostino Gemelli 8, 00168 Rome, Italy.
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Colosimo
Department of Radiological Sciences, Catholic University of Sacred Heart, "A. Gemelli" Hospital, Largo Agostino Gemelli 8, 00168 Rome, Italy.
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Pedicelli
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000503:physiopathology; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000098:blood supply / Q000601:surgery*; D008579:Meningioma / Q000098:blood supply / Q000601:surgery*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D061646:Operative Time; D011142:Polyvinyl Alcohol; D011300:Preoperative Care; D055815:Young Adult
D011142:Polyvinyl Alcohol
Arterial embolization; Cerebral angiography; Meningiomas; Polyvinyl alcohol particles; Preoperative embolization