1
|
Matsoukas S, Feng R, Faulkner DE, Odland IC, Durbin J, Tabani H, Schlachter L, Gutzwiller E, Kellner CP, Shigematsu T, Shoirah H, Majidi S, De Leacy R, Berenstein A, Mocco J, Fifi JT, Bederson JB, Shrivastava RK, Rapoport BI. Angiographic Features of Meningiomas Predicting Extent of Preoperative Embolization. Neurosurgery 2024; 95:00006123-990000000-01300. [PMID: 39087784 PMCID: PMC11449424 DOI: 10.1227/neu.0000000000003054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/10/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Preoperative embolization is used as an endovascular adjunct to surgical resection of meningiomas. However, there is no standardized system to assess the efficacy or extent of embolization during the embolization procedure. We sought to establish a purely angiographic grading system to facilitate consistent reporting of the outcome of meningioma embolization and to characterize the anatomic and other features of meningiomas that predict the degree of devascularization achieved through preoperative embolization. METHODS We identified patients with meningiomas who underwent preoperative cerebral angiography and subsequent resection between 2015 and 2021. Demographic, clinical, and imaging data were collected in a research registry. We defined an angiographic devascularization grading scale as follows: grade 0 for no embolization, 1 for partial embolization, 2 for majority embolization, 3 for complete external carotid artery embolization, and 4 for complete embolization. RESULTS Eighty consecutive patients were included, 60 of whom underwent preoperative tumor embolization (20 underwent angiography with an intention to treat but ultimately not embolization). Embolized tumors were larger (59.0 vs 35.9 cc; P = .03). Gross total resection, length of stay, and complication rates did not differ among groups. The distribution of arterial feeders differed significantly across tumors in a location-specific manner. Both the tumor location and the identity of arterial feeders were predictive of the extent of embolization. Anterior midline meningiomas were associated with internal carotid (ophthalmic, ethmoidal) supply and lower devascularization grades (P = .03). Tumors fed by meningeal feeders (convexity, falcine, lateral sphenoid wing) were associated with higher devascularization grades (P < .01). The procedural complication rate for tumor embolization was 2.5%. CONCLUSION Angiographic outcomes can be graded to indicate the extent of tumor embolization. This system may facilitate consistency of reported angiographic results. In addition, arterial feeders vary in a manner predicted by tumor location, and these patterns correlate with typical degrees of devascularization achieved in those tumor locations.
Collapse
Affiliation(s)
- Stavros Matsoukas
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Rui Feng
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Denzel E. Faulkner
- Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
- Mount Sinai BioDesign, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Ian C. Odland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
- Mount Sinai BioDesign, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - John Durbin
- Mount Sinai BioDesign, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Halima Tabani
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Leslie Schlachter
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Eveline Gutzwiller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Christopher P. Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Tomoyoshi Shigematsu
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Hazem Shoirah
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Alejandro Berenstein
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Johanna T. Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Joshua B. Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
- Mount Sinai BioDesign, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Raj K. Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | - Benjamin I. Rapoport
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
- Mount Sinai BioDesign, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| |
Collapse
|
2
|
Yamashiro K, Hayakawa M, Adachi K, Hasegawa M, Hirose Y. Tumor Embolization via the Meningohypophyseal and Inferolateral Trunk in Patients with Skull Base Tumors Using the Distal Balloon Protection Technique. AJNR Am J Neuroradiol 2024; 45:618-625. [PMID: 38290740 PMCID: PMC11288533 DOI: 10.3174/ajnr.a8169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/13/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND PURPOSE Tumor embolization through the meningohypophyseal trunk and inferolateral trunk is known to be effective in skull base tumors; however, microcatheter cannulation into these arteries is difficult, and the number of cases that can be safely embolized is limited. In this study, we present a novel embolization procedure for the meningohypophyseal trunk and inferolateral trunk using the distal balloon protection technique and detail its clinical efficacy and complication risks. We developed this procedure to allow safe embolization in patients who cannot be adequately cannulated with microcatheters into these arteries. MATERIALS AND METHODS Patients who underwent meningohypophyseal trunk or inferolateral trunk embolization using the distal balloon protection technique for skull base tumors at our institution between 2010 and 2023 were included. In this procedure, the ICA was temporarily occluded with a balloon at the ophthalmic artery bifurcation, the microcatheter was guided to the meningohypophyseal trunk or inferolateral trunk vicinity, and embolic particles were injected into the arteries. The balloon was deflated after the embolic particles that had refluxed into the ICA were aspirated. RESULTS A total of 25 meningohypophyseal trunks and inferolateral trunks were embolized during 21 operations. Of these 25 arteries, only 9 (36.0%) were successfully cannulated with microcatheters. Nevertheless, effective embolization was achieved in all cases. Permanent complications occurred in only 1 case (4.8%) in which the central retinal artery was occluded during inferolateral trunk embolization, resulting in a visual field defect. No permanent complications resulting from the embolic cerebral infarction were observed. Of 16 cases that underwent MR imaging within a week after embolization, however, 11 (68.8%) demonstrated embolic cerebral infarctions. CONCLUSIONS In patients with skull base tumors with meningohypophyseal trunk or inferolateral trunk feeders that cannot be catheterized directly, embolization using the distal balloon protection technique for tumor supply can be considered as a salvage technique.
Collapse
Affiliation(s)
- Kei Yamashiro
- From the Department of Neurosurgery (K.Y., M. Hayakawa), Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
- Department of Neurosurgery (K.Y., M. Hayakawa, K.A., Y.H.), Fujita Health University, Toyoake, Aichi, Japan
| | - Motoharu Hayakawa
- From the Department of Neurosurgery (K.Y., M. Hayakawa), Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
- Department of Neurosurgery (K.Y., M. Hayakawa, K.A., Y.H.), Fujita Health University, Toyoake, Aichi, Japan
| | - Kazuhide Adachi
- Department of Neurosurgery (K.Y., M. Hayakawa, K.A., Y.H.), Fujita Health University, Toyoake, Aichi, Japan
| | | | - Yuichi Hirose
- Department of Neurosurgery (K.Y., M. Hayakawa, K.A., Y.H.), Fujita Health University, Toyoake, Aichi, Japan
| |
Collapse
|
3
|
Raz E, Cavalcanti DD, Sen C, Nossek E, Potts M, Peschillo S, Lotan E, Narayan V, Ali A, Sharashidze V, Nelson PK, Shapiro M. Tumor Embolization through Meningohypophyseal and Inferolateral Trunks is Safe and Effective. AJNR Am J Neuroradiol 2022; 43:1142-1147. [PMID: 35902121 PMCID: PMC9575419 DOI: 10.3174/ajnr.a7579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/02/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Skull base tumors are commonly supplied by dural branches of the meningohypophyseal and inferolateral trunks. Embolization through these arteries is often avoided due to technical challenges and inherent risks; however, successful embolization can be a valuable surgical adjunct. We aimed to review the success and complications in our series of tumor embolizations through the meningohypophyseal and inferolateral trunks. MATERIALS AND METHODS We performed a retrospective review of patients with tumor treated with preoperative embolization at our institution between 2010 and 2020. We reviewed the following data: patients' demographics, tumor characteristics, endovascular embolization variables, and surgical results including estimated blood loss, the need for transfusion, and operative time. RESULTS Among 155 tumor embolization cases, we identified 14 patients in whom tumor embolization was performed using the meningohypophyseal (n = 13) or inferolateral (n = 4) trunk. In this group of patients, on average, 79% of tumors were embolized. No mortality or morbidity from the embolization procedure was observed in this subgroup of patients. The average estimated blood loss in the operation was 395 mL (range, 200-750 mL). None of the patients required a transfusion, and the average operative time was 7.3 hours. CONCLUSIONS Some skull base tumors necessitate embolization through ICA branches such as the meningohypophyseal and inferolateral trunks. Our series demonstrates that an effective and safe embolization may be performed through these routes.
Collapse
Affiliation(s)
- E Raz
- From the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
| | - D D Cavalcanti
- From the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
| | - C Sen
- Neurointerventional Section, and Neurosurgery (C.S., E.N. P.K.N.), NYU Langone Health, New York, New York
| | - E Nossek
- Neurointerventional Section, and Neurosurgery (C.S., E.N. P.K.N.), NYU Langone Health, New York, New York
| | - M Potts
- Department of Neurological Surgery (M.P.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S Peschillo
- Department of Neurosurgery (S.P.), University of Catania, Catania, Italy
| | - E Lotan
- From the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
| | - V Narayan
- From the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
| | - A Ali
- From the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
| | - V Sharashidze
- From the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
| | - P K Nelson
- From the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.).,Neurointerventional Section, and Neurosurgery (C.S., E.N. P.K.N.), NYU Langone Health, New York, New York
| | - M Shapiro
- From the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
| |
Collapse
|
4
|
Embolization of Skull Base Meningiomas with Embosphere® Microspheres: Factors Predicting Treatment Response and Evaluation of Complications. World Neurosurg 2022; 162:e178-e186. [PMID: 35247619 DOI: 10.1016/j.wneu.2022.02.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Preoperative embolization for intracranial meningiomas can cause tumor necrosis, reduce intraoperative blood loss, and facilitate surgery. This study aimed to evaluate the efficacy of tumor embolization using Embosphere® microspheres for skull base meningiomas and analyze post-embolization plain computed tomography (CT) and magnetic resonance imaging (MRI) scans to identify findings that could potentially predict treatment response. METHODS Between April 2014 and April 2020, 80 patients with skull base meningiomas presenting at our medical center underwent embolization with Embosphere® microspheres. The effects of tumor embolization were evaluated through a comparison of post-embolization plain CT and contrast-enhanced MRI. RESULTS A total of 143 vessels (102/108 external carotid artery branches; 41/65 internal carotid artery branches) from 80 skull base meningiomas were embolized with Embosphere® microspheres. Microspheres 100-300 μm in size were used in two cases, microspheres 300-500 μm in size were used in 12 cases, and microspheres 500-700 μm in size were used in 66 cases. Post-embolization contrast-enhanced MRI showed reductions in enhancing lesions within the tumor in 55/80 cases. Post-embolization plain CT scans showed high-density lesions within the tumor in 41/55 cases. Thus, reductions in enhancing lesions on post-embolization contrast-enhanced MRI were statistically significantly associated with the presence of high-density lesions on post-embolization plain CT (P<0.001). Embolization-related neurological complications occurred in three cases. CONCLUSIONS Embosphere® microspheres are user friendly and effective embolic materials for the embolization of skull base meningiomas. Post-embolization contrast-enhanced MRI and plain CT findings may be useful for evaluating the effects of tumor embolization.
Collapse
|
5
|
Kayahara T, Kurita H, Irie K, Nakahara I, Sasaki T. Intracranial chondrosarcoma located in the region of the posterior clinoid process: a case report. Radiol Case Rep 2021; 17:115-118. [PMID: 34777675 PMCID: PMC8577103 DOI: 10.1016/j.radcr.2021.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022] Open
Abstract
Intracranial chondrosarcomas located in the region of the posterior clinoid process have not been focused on. Here, we report the case of a 29-year-old woman with a skull base tumor in that region. Seven years after the diagnosis, the tumor had grown and showed calcification and tumor stain; chondrosarcoma, posterior clinoid meningioma, and chordoma were suspected. The patient underwent subtotal tumor resection, and the histopathological study revealed that the tumor was a low-grade chondrosarcoma. Chondrosarcomas can be located in the region of the posterior clinoid process, and not only chordomas but also posterior clinoid meningiomas should be considered as a differential diagnosis of tumors located in that region, especially when the tumor has calcification or receives a vascular supply.
Collapse
Affiliation(s)
- Tomomichi Kayahara
- Department of Neurosurgery, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawaku, Nagoya, Aichi 454-0933, Japan
- Corresponding author: T. Kayahara
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Keiko Irie
- Department of Neurosurgery, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawaku, Nagoya, Aichi 454-0933, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Tomio Sasaki
- Department of Neurosurgery, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawaku, Nagoya, Aichi 454-0933, Japan
| |
Collapse
|
6
|
Long-term outcome of Simpson IV meningioma resection: Would it improve with adjuvant SRS? Clin Neurol Neurosurg 2021; 207:106766. [PMID: 34166979 DOI: 10.1016/j.clineuro.2021.106766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Subtotal meningioma resection (STR) is often performed to minimize surgical morbidity. Nevertheless, only a few studies have reported on patient outcome after STR. We studied the long-term outcome of SIV (Simpson grade IV) resection and identified predictive factors of overall survival (OS), progression-free survival (PFS) and time to progression (TTP). METHODS A retrospective analysis was performed on 68 patients who underwent SIV resection of meningioma (grade I) from 2004 to 2010. Data were collected from clinical, surgical and pathology records and radiological imaging. Long-term outcomes were evaluated at least 10 years after surgery. RESULTS Permanent morbidity was 11.8%, 30-day mortality 2.9% and progression rate 50.0% for a median follow-up duration of 126.6 months. Median TTP was 86.2 months. Adjuvant SRS was the only significant factor associated with longer PFS (p = 0.0052) and TTP (p = 0.0079). Higher age (p = 0.0022), KPS (p = 0.0182), postoperative ECOG score (p = 0.0182) were reliable predictors of shortened OS and aSRS (p = 0.0445) was reliable predictor of longer OS. CONCLUSION STR in intracranial meningioma is still viable and often the only treatment option available in high-risk patients or high-risk tumors. Although surgical morbidity and mortality are high, the OS rate was 85.3% at 5 years and 79.4% at 10 years. Because of the considerable progression rate and rather a long term OS the adjuvant SRS should be considered following SIV resection.
Collapse
|
7
|
Yoshida K, Akiyama T, Takahashi S, Miwa T, Horiguchi T, Sasaki H, Toda M. Cone-Beam Computed Tomography Fusion Technique for Vascular Assessment of Skull Base Meningiomas. World Neurosurg 2021; 151:61-69. [PMID: 33901735 DOI: 10.1016/j.wneu.2021.04.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Cone-beam computed tomography (CBCT) images for skull base tumors provide detailed vascular information and localization in regard to surrounding bony structures. We report use of the CBCT fusion technique for skull base meningiomas. METHODS Six patients with petroclival or petrotentorial meningiomas supplied by multiple arterial systems were preoperatively evaluated using CBCT fusion imaging. Fusion images were reconstructed from three-dimensional rotational angiography with contrast agent injections from the internal carotid artery (ICA) and external carotid artery in 4 cases, vertebral artery and external carotid artery in 1 case, and ICA and vertebral artery in 1 case. RESULTS The feeding pedicles and tumor stains from 2 arterial systems were differentiated by separate colors. The courses and territories of the ICA dural feeders or ICA/vertebral artery pial feeders were easily distinguished from the external carotid artery dural feeders. Anastomoses between thin feeders from different arterial systems could be detected. Mixed stain (stain with both colors) was observed in some tumor compartments, suggesting dual supply from 2 arterial systems and the presence of peritumoral anastomoses. All patients underwent preoperative embolization without complications. CONCLUSIONS CBCT fusion images clearly visualized the feeders from each arterial system, the vascular compartments within the tumor, and possible peritumoral anastomoses. This technique provides a substantial contribution to both preoperative embolization and surgical resection of skull base meningiomas.
Collapse
Affiliation(s)
- Keisuke Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan; Department of Neurosurgery, Mihara Memorial Hospital, Gunma, Japan
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
| | - Satoshi Takahashi
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoru Miwa
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Horiguchi
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Hikaru Sasaki
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
8
|
Przybylowski CJ, Zhao X, Baranoski JF, Borba Moreira L, Gandhi S, Chapple KM, Almefty KK, Sanai N, Ducruet AF, Albuquerque FC, Little AS, Nakaji P. Preoperative embolization versus no embolization for WHO grade I intracranial meningioma: a retrospective matched cohort study. J Neurosurg 2021; 134:693-700. [PMID: 32217797 DOI: 10.3171/2020.1.jns19788] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 01/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The controversy continues over the clinical utility of preoperative embolization for reducing tumor vascularity of intracranial meningiomas prior to resection. Previous studies comparing embolization and nonembolization patients have not controlled for detailed tumor parameters before assessing outcomes. METHODS The authors reviewed the cases of all patients who underwent resection of a WHO grade I intracranial meningioma at their institution from 2008 to 2016. Propensity score matching was used to generate embolization and nonembolization cohorts of 52 patients each, and a retrospective review of clinical and radiological outcomes was performed. RESULTS In total, 52 consecutive patients who underwent embolization (mean follow-up 34.8 ± 31.5 months) were compared to 52 patients who did not undergo embolization (mean follow-up 32.8 ± 28.7 months; p = 0.63). Variables controlled for included patient age (p = 0.82), tumor laterality (p > 0.99), tumor location (p > 0.99), tumor diameter (p = 0.07), tumor invasion into a major dural sinus (p > 0.99), and tumor encasement around the internal carotid artery or middle cerebral artery (p > 0.99). The embolization and nonembolization cohorts did not differ in terms of estimated blood loss during surgery (660.4 ± 637.1 ml vs 509.2 ± 422.0 ml; p = 0.17), Simpson grade IV resection (32.7% vs 25.0%; p = 0.39), perioperative procedural complications (26.9% vs 19.2%; p = 0.35), development of permanent new neurological deficits (5.8% vs 7.7%; p = 0.70), or favorable modified Rankin Scale (mRS) score (a score of 0-2) at last follow-up (96.0% vs 92.3%; p = 0.43), respectively. When comparing the final mRS score to the preoperative mRS score, patients in the embolization group were more likely than patients in the nonembolization group to have an improvement in mRS score (50.0% vs 28.8%; p = 0.03). CONCLUSIONS After controlling for patient age, tumor size, tumor laterality, tumor location, tumor invasion into a major dural sinus, and tumor encasement of the internal carotid artery or middle cerebral artery, preoperative meningioma embolization intended to decrease tumor vascularity did not improve the surgical outcomes of patients with WHO grade I intracranial meningiomas, but it did lead to a greater chance of clinical improvement compared to patients not treated with embolization.
Collapse
|
9
|
Fujimori T, Okauchi M, Toyota Y, Ogawa D, Okada M, Hatakeyama T, Shindo A, Kawanishi M, Miyake K, Tamiya T. Clinicopathologic Factors Associated with Tumor Necrosis after Preoperative Embolization of Meningiomas. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 15:517-524. [PMID: 37502761 PMCID: PMC10370582 DOI: 10.5797/jnet.oa.2020-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/04/2020] [Indexed: 07/29/2023]
Abstract
Objective Preoperative embolization of meningiomas induces necrosis prior to surgery and facilitates resection. Lack of contrast enhancement on postembolization MRI correlates with pathological findings of necrosis and can be used to assess embolization efficacy. This study aimed to examine clinicopathologic factors associated with tumor necrosis after embolization. Methods A total of 119 patients with intracranial meningioma who underwent 145 surgical resections between 2010 and 2019 at our institute were reviewed. Inclusion criteria for the study were preoperative embolization with trisacryl gelatin microspheres (Embosphere) or absorbable gelatine sponge (Gelfoam). Postembolization Gd-enhanced T1-weighted and angiographic imaging, and histopathologic examination results were reviewed to evaluate the effectiveness of embolization. Results In all, 66 patients satisfied the inclusion criteria. In total, 36 patients were embolized with Embosphere and 30 patients were embolized with Gelfoam. Patients embolized with Embosphere had a significantly higher necrosis rate (NR) than patients with Gelfoam (21% vs. 7.1%, P <0.01). The 36 Embosphere patients were analyzed regarding clinicopathologic factors associated with NR. Tumors in 12 patients were located in the parasagittal/falx region; these patients had a significantly lower NR compared with tumors in other locations (10.6% vs. 26.2%, P = 0.016). In all, 13 patients had feeders arising from only the middle meningeal artery (MMA), which was associated with a significantly higher NR (29.3% vs. 14.4%, P = 0.015). In total, 11 patients had meningeal feeders arising from internal carotid artery (ICA), which was associated with a significantly lower NR (9.0% vs. 26.3%, P <0.01). Conclusion This study showed embolization agent, tumor location, and blood supply were important factors predicting necrosis after preoperative embolization.
Collapse
Affiliation(s)
- Takeshi Fujimori
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Masanobu Okauchi
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Yoshinori Toyota
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Daisuke Ogawa
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Masaki Okada
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Tetsuhiro Hatakeyama
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Atsushi Shindo
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Masahiko Kawanishi
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Keisuke Miyake
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| | - Takashi Tamiya
- Department of Neurological Surgery, Kagawa University Faculty of Medicine, Kita-gun, Kagawa, Japan
| |
Collapse
|
10
|
Abstract
Interventional neuro-oncology encompasses an array of image-guided therapies-intra-arterial chemotherapy, regional drug delivery, chemoembolization, tumor ablation-along with techniques to improve therapy delivery such as physical or chemical blood-brain barrier disruption and percutaneous catheter placement. Endovascular and percutaneous image-guided approaches to the treatment of the brain, eye, and other head and neck tumors will be discussed.
Collapse
Affiliation(s)
- Monica S Pearl
- Division of Interventional Neuroradiology, Johns Hopkins Hospital, Baltimore, MD, United States; Department of Radiology, Children's National Medical Center, Washington, DC, United States.
| | - Nalin Gupta
- Division of Pediatric Neurosurgery, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, United States
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| |
Collapse
|
11
|
Hiramatsu M, Sugiu K, Hishikawa T, Haruma J, Takahashi Y, Murai S, Nishi K, Yamaoka Y, Shimazu Y, Fujii K, Kameda M, Kurozumi K, Date I. Detailed Arterial Anatomy and Its Anastomoses of the Sphenoid Ridge and Olfactory Groove Meningiomas with Special Reference to the Recurrent Branches from the Ophthalmic Artery. AJNR Am J Neuroradiol 2020; 41:2082-2087. [PMID: 33004344 DOI: 10.3174/ajnr.a6790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/15/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Detailed arterial anatomy of the sphenoid ridge and olfactory groove meningiomas is complicated due to the fine angioarchitecture and anastomoses between each feeder. Herein, we present details of the arterial anatomy and the relationships of feeders in these lesions. MATERIALS AND METHODS This study included 20 patients admitted to our department between April 2015 and March 2020. Conditions of subjects consisted of 16 sphenoid ridge meningiomas and 4 olfactory groove meningiomas. We mainly analyzed arterial anatomy using 3D rotational angiography and slab MIP images of these lesions. We also analyzed the anastomoses of each feeder. RESULTS We found that 19 (95%), 15 (75%), and 15 (75%) lesions had feeders from the ophthalmic, internal carotid, and external carotid arteries, respectively. As feeders from the ophthalmic artery, recurrent meningeal arteries were involved in 18 lesions (90%). Fifteen lesions (75%) had anastomoses between each feeder. CONCLUSIONS Most of the meningiomas in the sphenoid ridge and olfactory groove had feeders from the ophthalmic and internal carotid arteries. There were various anastomoses between each feeder. This is the first report to demonstrate the detailed arterial anatomy and frequency of recurrent branches from the ophthalmic artery and their anastomoses using detailed imaging techniques.
Collapse
Affiliation(s)
- M Hiramatsu
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Sugiu
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - T Hishikawa
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - J Haruma
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Takahashi
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - S Murai
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Nishi
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Yamaoka
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Shimazu
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Fujii
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - M Kameda
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Kurozumi
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Neurosurgery (K.K.), Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - I Date
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
12
|
Dabus G, Linfante I, McDermott MW. Angiography and embolization of meningiomas. HANDBOOK OF CLINICAL NEUROLOGY 2020; 169:193-202. [PMID: 32553290 DOI: 10.1016/b978-0-12-804280-9.00013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
The preoperative embolization of meningiomas has been part of the surgical treatment of large meningiomas for over 45 years. During that time there have been huge advances in the field of endovascular surgery with respect to techniques and instrumentation. Angiography and embolization are usually reserved for the largest tumors where there are concerns over potential blood loss with surgical excision. In this chapter, we discuss the technical aspects of angiography and embolization as well as results and complications.
Collapse
Affiliation(s)
- Guilherme Dabus
- Miami Neuroscience Institute, Baptist Health of South Florida, Miami, FL, United States; Miami Cardiac & Vascular Institute, Baptist Health of South Florida, Miami, FL, United States.
| | - Italo Linfante
- Miami Neuroscience Institute, Baptist Health of South Florida, Miami, FL, United States; Miami Cardiac & Vascular Institute, Baptist Health of South Florida, Miami, FL, United States
| | - Michael W McDermott
- Miami Neuroscience Institute, Baptist Health of South Florida, Miami, FL, United States; Division of Neuroscience, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| |
Collapse
|
13
|
Catapano JS, Whiting AC, Mezher AW, Przybylowski CJ, See AP, Labib MA, Fredrickson VL, Cavalcanti DD, Lawton MT, Ducruet AF, Albuquerque FC, Sanai N. Postembolization Change in Magnetic Resonance Imaging Contrast Enhancement of Meningiomas Is a Better Predictor of Intraoperative Blood Loss Than Angiography. World Neurosurg 2019; 135:e679-e685. [PMID: 31884126 DOI: 10.1016/j.wneu.2019.12.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preoperative embolization of meningiomas to reduce tumor vascularity and intraoperative blood loss remains controversial. Incomplete devascularization on angiography is not significantly correlated with intraoperative estimated blood loss (EBL). Magnetic resonance imaging (MRI) may provide a better assessment of devascularization and prediction of EBL. METHODS We retrospectively analyzed patients undergoing preoperative embolization for intracranial meningiomas. Cohorts based on postembolization devascularization (>50% vs. ≤50%) were compared. RESULTS Of 84 patients with meningioma undergoing preoperative embolization, 35 (42%) had a postembolization MRI before resection and met study inclusion criteria. The mean tumor diameter was 4.9 ± 1.3 cm, and mean intraoperative EBL was 576 ± 341 mL. Compared with MRI, angiography overestimated devascularization in 22 patients (63%). Using pre- versus postembolization MRIs, 17 (49%) patients had a >50% decrease in enhancement, which was associated with lower mean intraoperative blood loss (444 ± 255 mL) compared with 17 patients with ≤50% devascularization (700 ± 374 mL) (P = 0.03). On angiography, the 22 (63%) patients who demonstrated >50% devascularization during embolization did not statistically differ in intraoperative EBL when compared with 13 (37%) patients with <50% angiographic devascularization. Patients with a ≤50% decrease in contrast enhancement on postembolization MRI were 9 times more likely to lose >500 mL blood intraoperatively during resection (95% confidence interval 1.6-54, P = 0.01). CONCLUSIONS Postembolization contrast-enhanced MRI is a better predictor of intraoperative blood loss during meningioma resection than postembolization angiography, which overestimates the degree of embolic devascularization. Postembolization preoperative MRI is warranted for optimal patient management.
Collapse
Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Alexander C Whiting
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew W Mezher
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Colin J Przybylowski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Alfred P See
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mohamed A Labib
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Vance L Fredrickson
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Daniel D Cavalcanti
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nader Sanai
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
| |
Collapse
|
14
|
Salaud C, Decante C, Ploteau S, Hamel A. Implication of the inferolateral trunk of the cavernous internal CAROTID artery in cranial nerve blood supply: Anatomical study and review of the literature. Ann Anat 2019; 226:23-28. [DOI: 10.1016/j.aanat.2019.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/18/2019] [Accepted: 07/01/2019] [Indexed: 11/29/2022]
|
15
|
A comparison of the prevalence and risk factors of complications in intracranial tumor embolization between the Japanese Registry of NeuroEndovascular Therapy 2 (JR-NET2) and JR-NET3. Acta Neurochir (Wien) 2019; 161:1675-1682. [PMID: 31172282 DOI: 10.1007/s00701-019-03970-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The Japanese Registry of NeuroEndovascular Therapy 2 (JR-NET2) and 3 (JR-NET3) were nationwide surveys that evaluated clinical outcomes after neuroendovascular therapy in Japan. The aim of this study was to compare the prevalence and risk factors of complications of intracranial tumor embolization between JR-NET2 and JR-NET3. METHODS A total of 1018 and 1545 consecutive patients with intracranial tumors treated with embolization were enrolled in JR-NET2 and JR-NET3, respectively. The prevalence of complications in intracranial tumor embolization and related risk factors were compared between JR-NET2 and JR-NET3. RESULTS The prevalence of complications in JR-NET3 (3.69%) was significantly higher than that in JR-NET2 (1.48%) (p = 0.002). The multivariate analysis in JR-NET2 showed that embolization for tumors other than meningioma was the only significant risk factor for complication (odds ratio [OR], 3.88; 95% confidence interval [CI], 1.13-12.10; p = 0.032), and that in JR-NET3 revealed that embolization for feeders other than external carotid artery (ECA) (OR, 3.56; 95% CI, 2.03-6.25; p < 0.001) and use of liquid materials (OR, 2.65; 95% CI, 1.50-4.68; p < 0.001) were significant risks for complications. The frequency of embolization for feeders other than ECA in JR-NET3 (15.3%) was significantly higher than that in JR-NET2 (9.2%) (p < 0.001). Also, there was a significant difference in the frequency of use of liquid materials between JR-NET2 (21.2%) and JR-NET3 (41.2%) (p < 0.001). CONCLUSIONS Embolization for feeders other than ECA and use of liquid materials could increase the complication rate in intracranial tumor embolization.
Collapse
|
16
|
Predictors of preoperative endovascular embolization of meningiomas: subanalysis of anatomic location and arterial supply. J Neurointerv Surg 2019; 12:204-208. [DOI: 10.1136/neurintsurg-2019-015129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 11/03/2022]
Abstract
IntroductionEndovascular embolization of intracranial meningiomas is commonly used as an adjunct to surgical resection. We sought to describe the anatomic locations and vascular supplies of meningiomas to identify characteristics predictive of successful preoperative endovascular embolization.MethodsWe conducted a retrospective review of 139 meningioma cases receiving cerebral angiograms for possible preoperative endovascular embolization at our institution between December 2000 and March 2017. The extent of embolization, arterial supply, anatomic location, and procedural complications were recorded for each case. Univariate and multivariate analyses were performed to identify tumor characteristics that predicted successful embolization.ResultsOf the total meningioma patients undergoing preoperative angiography, 78% (108/139) were successfully embolized, with a 2.8% periprocedural complication rate (3/108). Within the subset of patients with successful embolization, 31% (33/108) achieved complete angiographic embolization. Significant multivariate predictors of embolization (either partial or complete) were convexity/parasagittal locations (OR 5.15, 95% CI 0.93 to 28.54, p=0.060), meningohypophyseal trunk (MHT, OR 4.65, 95% CI 1.63 to 13.23, p=0.004), middle meningeal artery (MMA, OR 10.89, 95% CI 3.43 to 34.64, p<0.001), and ascending pharyngeal artery supply (APA, OR 9.96, 95% CI 1.88 to 52.73, p=0.007). Significant predictors for complete embolization were convexity/parasagittal locations (OR 4.79, 95% CI 1.66 to 13.84, p=0.004) and embolized APA supply (OR 6.94, 95% CI 1.90 to 25.39, p=0.003). Multiple arterial supply was a negative predictor of complete embolization (OR 0.38, 95% CI 0.15 to 0.98, p=0.05).ConclusionsTumor characteristics can be used to predict the likelihood of preoperative meningioma embolization. Parasagittal and convexity meningiomas, and those with APA supply, are most likely to achieve complete angiographic embolization.
Collapse
|
17
|
Preoperative embolization of skull base meningiomas: A systematic review. J Clin Neurosci 2019; 59:259-264. [DOI: 10.1016/j.jocn.2018.06.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/06/2018] [Indexed: 11/18/2022]
|
18
|
Przybylowski CJ, Baranoski JF, See AP, Flores BC, Almefty RO, Ding D, Chapple KM, Sanai N, Ducruet AF, Albuquerque FC. Preoperative Embolization of Skull Base Meningiomas: Outcomes in the Onyx Era. World Neurosurg 2018; 116:e371-e379. [DOI: 10.1016/j.wneu.2018.04.208] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 11/30/2022]
|
19
|
Katati M, Ortiz García I, Chamorro CI, Horcajadas Á, Hurtado A, Sánchez C, Iañez B, Saura E, García E, Busquier H. Complete resection of hypervascularised extraventricular neurocytoma after preoperative embolisation. Neurocirugia (Astur) 2018; 30:44-49. [PMID: 29680750 DOI: 10.1016/j.neucir.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 11/26/2022]
Abstract
A 13-year-old female arrived at the Emergency Department with a two-week history of headache, and bilateral papilloedema on examination. The initial study with CT and MRI showed a large multicystic left frontal mass with calcification surrounded by peripheral oedema, subacute intralesional bleeding and association of multiple large vessels. She was initially operated on in another centre where a subacute haematoma was found, evacuating to multiple vessels and arteriolised veins. Despite the earlier neuroimaging findings, arteriovenous malformation (AVM) was suspected, so she was referred to our centre for further treatment. We performed angiography, MR angiography and MRI with advanced sequences, diagnosing a highly vascularised intra-axial tumour which was embolised. The patient was then definitively operated on, with the resulting finding of extraventricular neurocytoma (EVN). EVN are extremely rare lesions, not previously described in the literature as hypervascularised lesions, which in our case required prior angiography and embolisation for proper diagnosis and adequate management.
Collapse
Affiliation(s)
- Majed Katati
- Servicio de Neurocirugía, Hospital Virgen de las Nieves, Granada, España.
| | | | | | - Ángel Horcajadas
- Servicio de Neurocirugía, Hospital Virgen de las Nieves, Granada, España
| | - Alicia Hurtado
- Servicio de Neurocirugía, Hospital Virgen de las Nieves, Granada, España
| | - Carlos Sánchez
- Servicio de Neurocirugía, Hospital Virgen de las Nieves, Granada, España
| | - Benjamín Iañez
- Servicio de Neurocirugía, Hospital Virgen de las Nieves, Granada, España
| | - Enrique Saura
- Servicio de Neurocirugía, Hospital Virgen de las Nieves, Granada, España
| | - Ernesto García
- Servicio de Radiología, Hospital Virgen de las Nieves, Granada, España
| | | |
Collapse
|
20
|
Meningiomas: skull base versus non-skull base. Neurosurg Rev 2018; 42:163-173. [PMID: 29627874 DOI: 10.1007/s10143-018-0976-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 01/31/2018] [Accepted: 03/28/2018] [Indexed: 11/27/2022]
Abstract
To identify differences between skull base meningiomas (SBM) and non-skull base meningiomas (NSBM). All adult patients (18.0-69.9 years) operated for intracranial meningiomas between 1990 and 2010 at our institution were investigated. Al-Mefty's definition was used to dichotomize tumors into SBM and NSBM. Overall, 1148 consecutive patients were identified. Median age at surgery was 54.2 years [18.1-69.9]. Median follow-up was 7.4 years [0.0-20.9]. There were 562 patients (49%) with SBM and 586 (51%) with NSBM. The two groups were similar with respect to patient age, follow-up time, and number of patients. Overall female-to-male ratio was 2.6:1, but 3.2:1 in SBM and 2.2:1 in NSBM (p < 0.005). With respect to presenting symptoms, SBMs had more often neurological deficits (risk ratio (RR) 1.4; p < 0.0001) and less often seizures (RR 0.4; p < 0.0001). Gross total resections were less frequent in SBM than NSBM (62 vs 84%) (RR 1.3; p < 0.0001). SBMs had a lower risk of WHO grades II and III histology (4.5 vs 9.5%) (RR 0.5; p < 0.001). Worsening of neurological function was more frequent in SBM (21 vs 121%) (RR 1.8; p < 0.001). Retreatment-free survival at 5, 10, and 15 years, respectively, was 80, 70, and 62% for SBM versus 90, 82, and 74% for NSBM (p < 0.0001). Overall survival at 5, 10, and 15 years, respectively, was 93, 85, and 78% for SBM and 96, 91, and 79% for NSBM (p = 0.14). Patients with SBMs had more new-onset neurological deficits and significantly shorter retreatment-free survivals, but this did not adversely affect the overall survival.
Collapse
|
21
|
Yoon N, Shah A, Couldwell WT, Kalani MYS, Park MS. Preoperative embolization of skull base meningiomas: current indications, techniques, and pearls for complication avoidance. Neurosurg Focus 2018; 44:E5. [DOI: 10.3171/2018.1.focus17686] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Skull base meningiomas are technically challenging tumors to treat because of their deep vascular supply that can preclude early devascularization during resection. Preoperative embolization of these arterial feeders is thought to decrease blood loss and facilitate resection; however, given the complex and varied anatomy of these skull base lesions, preoperative embolization is not without risk. It is essential for both endovascular and skull base neurosurgeons to understand these risks in light of the potential benefits. The authors review the vascular anatomy of skull base meningiomas, indications for preoperative devascularization, endovascular techniques, and published results regarding embolization of these lesions.
Collapse
Affiliation(s)
- Nam Yoon
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
| | - Aatman Shah
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
| | - William T. Couldwell
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
| | - M. Yashar S. Kalani
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
- 2Departments of Neurosurgery and Neurology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Min S. Park
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
- 2Departments of Neurosurgery and Neurology, University of Virginia School of Medicine, Charlottesville, Virginia
| |
Collapse
|
22
|
Dayawansa S, Konda S, Lesley WS, Noonan PT, Huang JH. Improving Forward Infusion Pressure during Brain Tumor Embolization with the Double Catheter and Coil Technique. Neurointervention 2017; 12:116-121. [PMID: 28955514 PMCID: PMC5613043 DOI: 10.5469/neuroint.2017.12.2.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/22/2017] [Accepted: 07/24/2017] [Indexed: 11/24/2022] Open
Abstract
Endovascular embolization or embosurgery of brain tumors can be used to reduce neoplasm vascularity prior to surgical resection. Two challenges with embosurgery relate to insufficient perfusion pressure into the tumor and inadvertent escape of infused agents into parenchymal branches of the adjacent brain. This report describes a multi-catheter and coil technique to improve tumor perfusion and prevent reflux into normal branches.
Collapse
Affiliation(s)
- Sam Dayawansa
- Neurosurgery, Baylor Scott & White Neuroscience Institute, Temple, USA.,College of Medicine, Texas A&M Health Sciences Center, Temple, TX, USA
| | - Sneha Konda
- College of Medicine, Texas A&M Health Sciences Center, Temple, TX, USA
| | - Walter S Lesley
- Neurosurgery, Baylor Scott & White Neuroscience Institute, Temple, USA.,NeuroInterventional Surgery, Baylor Scott & White Neuroscience Institute, Temple, USA.,College of Medicine, Texas A&M Health Sciences Center, Temple, TX, USA
| | - Patrick T Noonan
- Neurosurgery, Baylor Scott & White Neuroscience Institute, Temple, USA.,NeuroInterventional Surgery, Baylor Scott & White Neuroscience Institute, Temple, USA.,College of Medicine, Texas A&M Health Sciences Center, Temple, TX, USA
| | - Jason H Huang
- Neurosurgery, Baylor Scott & White Neuroscience Institute, Temple, USA.,College of Medicine, Texas A&M Health Sciences Center, Temple, TX, USA
| |
Collapse
|
23
|
[Extra-axial tumors of the central nervous system]. Radiologe 2017; 57:715-727. [PMID: 28812110 DOI: 10.1007/s00117-017-0291-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Extra-axial tumors are intracranial neoplasms but are not located within the brain parenchyma. The localization of intracranial neoplasms helps to narrow down the possible differential diagnoses and also plays a deciding role in the treatment strategy and the prognosis. For this reason exact localization of these lesions is extremely important. Extra-axial tumors are the most common neoplasms among adults. They can be divided in a broad spectrum of histopathological subgroups. The most common extra-axial tumors are meningiomas, which arise from the dura mater. In the vast majority of cases they are benign and slowly growing. Only a few rare subgroups show aggressive behavior.
Collapse
|
24
|
Almefty RO, Patel NJ, See AP, Dunn IF, Al-Mefty O, Aziz-Sultan MA. Hybrid Surgery Management of Giant Hypervascular Tumors: Intraoperative Endovascular Embolization with Microsurgical Resection. World Neurosurg 2017; 102:157-166. [DOI: 10.1016/j.wneu.2017.02.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/17/2017] [Accepted: 02/19/2017] [Indexed: 10/20/2022]
|
25
|
Alvernia JE, Hidalgo J, Sindou MP, Washington C, Luzardo G, Perkins E, Nader R, Mertens P. The maxillary artery and its variants: an anatomical study with neurosurgical applications. Acta Neurochir (Wien) 2017; 159:655-664. [PMID: 28191601 DOI: 10.1007/s00701-017-3092-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The maxillary artery (MA) has gained attention in neurosurgery particularly in cerebral revascularization techniques, intracranial endonasal approaches and endovascular procedures. OBJECTIVES To describe and illustrate the anatomy of the MA and its neurosurgical importance in a detailed manner. METHODS Six cadaveric heads (12 MAs) were injected with latex. The arteries and surrounding structures were dissected and studied using microsurgical techniques. The dimensions, course and branching patterns of the MA were recollected. In addition, 20 three-dimensional reconstruction CT head and neck angiograms (3D CTAs) of actual patients were correlated with the cadaveric findings. RESULTS The MA can be divided in three segments: mandibular, pterygoid and pterygopalatine. Medial and lateral trunk variants regarding its course around the lateral pterygoid muscle can be found. The different branching patterns of the MA have a direct correlation with the course of its main trunk at the base of the skull. Branching and trunk variants on one side do not predict the findings on the contralateral side. CONCLUSION In this study the highly variable course, branching patterns and relations of the MA are illustrated and described in human cadaveric heads and 3D CTAs. MA 3D CTA with bone reconstruction can be useful preoperatively for the identification of the medial or lateral course variants of this artery, particularly its pterygoid segment, which should be taken into account when considering the MA as a donor vessel for an EC-IC bypass.
Collapse
Affiliation(s)
- Jorge E Alvernia
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Joaquin Hidalgo
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Marc P Sindou
- CHU de Lyon-Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France
| | - Chad Washington
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gustavo Luzardo
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Eddie Perkins
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Remi Nader
- Texas Center for Neuroscience, Houston, TX, USA
| | - Patrick Mertens
- CHU de Lyon-Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France
| |
Collapse
|
26
|
Iacobucci M, Danieli L, Visconti E, Maresca M, Anile C, Colosimo C, Pedicelli A. Preoperative embolization of meningiomas with polyvinyl alcohol particles: The benefits are not outweighed by risks. Diagn Interv Imaging 2017; 98:307-314. [DOI: 10.1016/j.diii.2016.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/09/2016] [Accepted: 08/15/2016] [Indexed: 11/16/2022]
|
27
|
Suzuki K, Nagaishi M, Matsumoto Y, Fujii Y, Inoue Y, Sugiura Y, Hirata K, Suzuki R, Kawamura Y, Nakae R, Tanaka Y, Hyodo A. Preoperative Embolization for Skull Base Meningiomas. J Neurol Surg B Skull Base 2017; 78:308-314. [PMID: 28725517 DOI: 10.1055/s-0037-1598195] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022] Open
Abstract
The results of preoperative embolization for skull base meningiomas were retrospectively evaluated to confirm the efficacy of this procedure. Skull base meningiomas that were treated with preoperative embolization were evaluated in 20 patients. The occluded arteries, embolic materials, treatment time, excision rate, neurologic manifestations, and complications were analyzed. The embolic material was 80% liquid, 30% coils, and 15% particles. The surgery was normally completed within 3 to 5 hours. Blood loss was normally approximately 250 mL, excluding four patients having the following conditions: malignant meningioma, a large tumor located on the medial side of the sphenoidal ridge, the petroclival tumor, and infiltrated tumor into the sigmoid sinus. The mean excision rate was 90%, achieving a Simpson grade III, but 10% were graded as Simpson grade IV. No permanent complications due to the preoperative embolization occurred. No neurologic symptoms occurred after excision. Current cerebral endovascular treatment is sophisticated, and the complication rate has markedly decreased. Although it was impossible to compare directly with or without operative embolization, preoperative embolization should be actively used as part of the treatment for this benign tumor, with better understanding of dangerous anastomosis.
Collapse
Affiliation(s)
- Kensuke Suzuki
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Saitama, Japan
| | - Masaya Nagaishi
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Saitama, Japan
| | - Yoshiyuki Matsumoto
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Saitama, Japan
| | - Yoshiko Fujii
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Saitama, Japan
| | - Yuki Inoue
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Saitama, Japan
| | - Yoshiki Sugiura
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Saitama, Japan
| | - Koji Hirata
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Saitama, Japan
| | - Ryotaro Suzuki
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Saitama, Japan
| | - Yosuke Kawamura
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Saitama, Japan
| | - Ryuta Nakae
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Saitama, Japan
| | - Yoshihiro Tanaka
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Saitama, Japan
| | - Akio Hyodo
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Saitama, Japan
| |
Collapse
|
28
|
Omodaka S, Ogawa Y, Sato K, Matsumoto Y, Tominaga T. Preoperative embolization and immediate removal of a giant pituitary adenoma: a case report. BMC Res Notes 2017; 10:63. [PMID: 28126010 PMCID: PMC5270227 DOI: 10.1186/s13104-017-2383-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 01/10/2017] [Indexed: 11/11/2022] Open
Abstract
Background Giant pituitary adenomas, with maximum diameter of at least 40 mm, continue to involve high surgical risks despite recent advances in microsurgical and/or endoscopic surgery. We treated a case of giant pituitary adenoma with preoperative endovascular embolization in an attempt to reduce blood loss. Case presentation A 48-year-old Japanese Woman presented with severe right visual disturbance. Magnetic resonance imaging revealed a giant pituitary adenoma with maximum diameter of 82 mm. Angiography revealed significant tumor stain, with blood supply mainly from the branches of the right meningohypophyseal trunk. These feeding arteries were endovascularly embolized with n-butyl cyanoacrylate. Subsequently, the tumor was safely removed by transsphenoidal surgery in two stages. The patient showed significant improvement of visual disturbance postoperatively, and was discharged without other neurological deficit. The surgical policy was explained preoperatively to the patients and written informed consents were obtained. Conclusions Preoperative embolization of a giant pituitary adenoma is a useful procedure that can potentially decrease the morbidity and mortality of this devastating tumor.
Collapse
Affiliation(s)
- Shunsuke Omodaka
- Department of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachiminami, Taihaku-ku, Sendai, Miyagi, 982-8523, Japan
| | - Yoshikazu Ogawa
- Department of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachiminami, Taihaku-ku, Sendai, Miyagi, 982-8523, Japan.
| | - Kenichi Sato
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Yasushi Matsumoto
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
29
|
Lum MA, Martin AJ, Alexander MD, McCoy DB, Cooke DL, Lillaney P, Moftakhar P, Amans MR, Settecase F, Nicholson A, Dowd CF, Halbach VV, Higashida RT, McDermott MW, Saloner D, Hetts SW. Intra-Arterial MR Perfusion Imaging of Meningiomas: Comparison to Digital Subtraction Angiography and Intravenous MR Perfusion Imaging. PLoS One 2016; 11:e0163554. [PMID: 27802268 PMCID: PMC5089755 DOI: 10.1371/journal.pone.0163554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 09/11/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the ability of IA MR perfusion to characterize meningioma blood supply. METHODS Studies were performed in a suite comprised of an x-ray angiography unit and 1.5T MR scanner that permitted intraprocedural patient movement between the imaging modalities. Patients underwent intra-arterial (IA) and intravenous (IV) T2* dynamic susceptibility MR perfusion immediately prior to meningioma embolization. Regional tumor arterial supply was characterized by digital subtraction angiography and classified as external carotid artery (ECA) dural, internal carotid artery (ICA) dural, or pial. MR perfusion data regions of interest (ROIs) were analyzed in regions with different vascular supply to extract peak height, full-width at half-maximum (FWHM), relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), and mean transit time (MTT). Linear mixed modeling was used to identify perfusion curve parameter differences for each ROI for IA and IV MR imaging techniques. IA vs. IV perfusion parameters were also directly compared for each ROI using linear mixed modeling. RESULTS 18 ROIs were analyzed in 12 patients. Arterial supply was identified as ECA dural (n = 11), ICA dural (n = 4), or pial (n = 3). FWHM, rCBV, and rCBF showed statistically significant differences between ROIs for IA MR perfusion. Peak Height and FWHM showed statistically significant differences between ROIs for IV MR perfusion. RCBV and MTT were significantly lower for IA perfusion in the Dural ECA compared to IV perfusion. Relative CBF in IA MR was found to be significantly higher in the Dural ICA region and MTT significantly lower compared to IV perfusion.
Collapse
Affiliation(s)
- Mark A. Lum
- School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Alastair J. Martin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Matthew D. Alexander
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - David B. McCoy
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Daniel L. Cooke
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Prasheel Lillaney
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Parham Moftakhar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Matthew R. Amans
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Fabio Settecase
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Andrew Nicholson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Christopher F. Dowd
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States of America
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, United States of America
| | - Van V. Halbach
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States of America
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, United States of America
| | - Randall T. Higashida
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States of America
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, United States of America
| | - Michael W. McDermott
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States of America
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Steven W. Hetts
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| |
Collapse
|
30
|
Felbaum DR, Mueller K, Liu AH, Armonda RA. Onyx Embolization of a Meningioma with a Dysplastic Aneurysmal Anterior Cerebral Artery Vessel. Cureus 2016; 8:e776. [PMID: 27738575 PMCID: PMC5059145 DOI: 10.7759/cureus.776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Preoperative embolization of meningiomas can be safely performed using a variety of embolic agents. Most commonly, the vascular supply from branches of the external carotid artery is the target of embolization. In our report, we detail the treatment of a patient with a parafalcine meningioma that received its supply via branches of the anterior cerebral artery. One of the feeder vessels appeared to contain a dysplastic aneurysmal dilatation of the vessel. Due to patient circumstances, embolization was performed using standard microcatheterization techniques to minimize intraoperative blood loss. We report a rare instance of endovascular treatment of a pial vessel to treat an intracranial meningioma using Onyx.
Collapse
Affiliation(s)
| | - Kyle Mueller
- Neurosurgery, Medstar Georgetown University Hospital
| | - Ai-Hsi Liu
- Neurointerventional Radiology, Medstar Washington Hospital Center
| | | |
Collapse
|
31
|
Fang QR, He XY, Li XF, Zhang X, Chen M, Li H, Li W, Wang ZQ, Duan CZ. Comparative efficacy of Glubran and polyvinyl-alcohol particles in the embolization of meningiomas. Int J Neurosci 2016; 126:1112-9. [PMID: 26707920 DOI: 10.3109/00207454.2015.1134525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Preoperative embolization of meningiomas decreases intraoperative bleeding and shortens operation time. However, in meningiomas predominantly vascularized by the internal carotid artery (ICA) or vertebral artery (VA) branches, embolization of external carotid artery feeder branches may lead to a hemodynamic increase in blood supply from the ICA or VA, whereas embolization of ICA or VA feeder branches with particle embolic agents may be associated with complications. This study investigated the safety and efficacy of Glubran, a liquid embolic agent, for the embolization of this type of meningioma compared with polyvinyl-alcohol (PVA) particles. MATERIALS AND METHODS From January 2006 to June 2015, 157 consecutive patients (98 females; mean age = 48.3 years) who suffered from meningiomas and were preoperatively referred for embolization were retrospectively analyzed. Glubran (n = 40) and PVA (n = 55) were used to devascularize tumors. Sixty-two patients were not embolized because of dangerous anastomosis or other tumor characteristics. Intraoperative blood loss, intraoperative time, degree of angiographic devascularization and embolization-related complications were analyzed. RESULTS The intraoperative blood loss and operative time were significantly lower in the Glubran-embolized versus non-embolized group. Furthermore, Glubran embolization significantly reduced intraoperative blood loss and operative time for meningiomas that received their primary blood supply from the ICA and/or VA compared with PVA embolization. CONCLUSIONS Preoperative meningioma embolization with Glubran decreases intraoperative blood loss and operative time. Furthermore, embolization with Glubran produces more effective devascularization compared with PVA for meningiomas supplied by the ICA and/or VA. Thus, Glubran may represent a better embolic agent for this meningioma subtype.
Collapse
Affiliation(s)
- Qin-Rui Fang
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Xu-Ying He
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Xi-Feng Li
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Xin Zhang
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Min Chen
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Hui Li
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Wei Li
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Ze-Qun Wang
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| | - Chuan-Zhi Duan
- a The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital , Southern Medical University , Guangzhou , China
| |
Collapse
|
32
|
Jo KI, Kim B, Cha MJ, Choi JH, Jeon P, Kim KH. Safety and efficacy of medium-sized particle embolisation for skull-base meningioma. Clin Radiol 2016; 71:335-40. [PMID: 26791376 DOI: 10.1016/j.crad.2015.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/16/2015] [Accepted: 12/02/2015] [Indexed: 11/28/2022]
Abstract
AIM 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. MATERIALS AND 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. CONCLUSION 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.
Collapse
Affiliation(s)
- K I Jo
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - B Kim
- Department of Radiology, Anam Hospital, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea
| | - M J Cha
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J-H Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - P Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - K H Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
33
|
Hanak BW, Haussen DC, Ambekar S, Ferreira M, Ghodke BV, Peterson EC. Preoperative embolization of intracranial hemangiopericytomas: case series and introduction of the transtumoral embolization technique. J Neurointerv Surg 2015; 8:1084-94. [DOI: 10.1136/neurintsurg-2015-011980] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/25/2015] [Indexed: 11/03/2022]
Abstract
Background and purposeHemangiopericytomas (HPCs) are rare dural-based neoplasms. Preoperative embolization of these notoriously hypervascular tumors can be challenging as they often receive their dominant blood supply from pial feeders arising from the internal carotid artery (ICA) or vertebrobasilar (VB) circulation. This study reviews our historical experience with HPC embolization and introduces the transtumoral technique for backfilling pial tumor vasculature by delivering Onyx-18 through diminutive external carotid artery (ECA) feeders.MethodsA retrospective review of all preoperative HPC embolizations performed at Anonymous University #1 (September 2002–November 2014) and Anonymous University #2 (January 2014–November 2014) is presented.ResultsFifteen patients with pathologically confirmed HPC underwent 17 embolizations. More extensive devascularization percentages were achieved for HPCs with primarily ECA blood supply (76.4±10.7%; n=6) than with HPCs supplied via the ICA/VB circulation (57.9±26.9%; n=8; p=0.046). There was a trend towards greater devascularization of ICA/VB-dominant HPCs embolized with Onyx (70.0±34.6%; n=4) versus polyvinyl alcohol particles (33.3±15.3%; n=3). The extent of angiographic devascularization negatively correlated with intraoperative blood loss (rho=−0.71; p=0.005). There were no embolization-related complications.ConclusionsThe extent of preoperative embolization of HPCs correlates with decreased intraoperative blood loss. However, HPCs with an ICA/VB-dominant blood supply remain challenging embolization targets, demonstrating reduced devascularization percentages compared with ECA-dominant counterparts. The authors favor the use of Onyx for ICA/VB-dominant HPCs, noting a trend towards an improved devascularization rate.
Collapse
|
34
|
Pabaney AH, Mazaris PA, Kole MK, Reinard KA. Endovascular management of fusiform aneurysm of anterior temporal artery: Technical report. Surg Neurol Int 2015; 6:119. [PMID: 26290771 PMCID: PMC4521225 DOI: 10.4103/2152-7806.161239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/27/2015] [Indexed: 11/09/2022] Open
Abstract
Background: The treatment of a rare, nontraumatic, fusiform aneurysm of the anterior temporal artery (ATA) via endovascular techniques is presented, and procedural nuances are highlighted. Methods: We performed a retrospective chart review and collected demographic and clinical data on the patient presented here; procedural details were extracted from operative notes. Results: Following successful balloon test occlusion (BTO) of the ATA, complete coil embolization of the ATA, and its associated fusiform aneurysm was performed. Postprocedurally, the patient did not suffer any adverse neurological sequelae. Conclusion: Selective BTO of intracranial branch vessels is safe, technically feasible, and could serve as a useful technical tool in the treatment of complex, fusiform intracranial aneurysms.
Collapse
Affiliation(s)
| | - Paul A Mazaris
- Department of Neurosurgery, Hartford Hospital, Hartford, CT, USA
| | - Max K Kole
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Kevin A Reinard
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| |
Collapse
|
35
|
Ali R, Khan M, Chang V, Narang J, Jain R, Marin H, Rock J, Kole M. MRI Pre- and Post-Embolization Enhancement Patterns Predict Surgical Outcomes in Intracranial Meningiomas. J Neuroimaging 2015; 26:130-5. [DOI: 10.1111/jon.12256] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/19/2015] [Accepted: 03/30/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rushna Ali
- Departments of Neurosurgery Henry Ford Health System; Detroit MI 48202
| | - Muhib Khan
- Department of Neurology, Warren Alpert Medical School; Brown University; Providence RI
| | - Victor Chang
- Departments of Neurosurgery Henry Ford Health System; Detroit MI 48202
| | - Jayant Narang
- Departments of Radiology, Neuroscience Institute; Henry Ford Health System; Detroit MI 48202
| | - Rajan Jain
- Division of Neuroradiology, NYU School of Medicine; NYU Langone Medical Center; New York NY 10016
| | - Horia Marin
- Departments of Radiology, Neuroscience Institute; Henry Ford Health System; Detroit MI 48202
| | - Jack Rock
- Departments of Neurosurgery Henry Ford Health System; Detroit MI 48202
| | - Max Kole
- Departments of Neurosurgery Henry Ford Health System; Detroit MI 48202
| |
Collapse
|
36
|
Raper DMS, Starke RM, Henderson F, Ding D, Simon S, Evans AJ, Jane JA, Liu KC. Preoperative embolization of intracranial meningiomas: efficacy, technical considerations, and complications. AJNR Am J Neuroradiol 2014; 35:1798-804. [PMID: 24722303 DOI: 10.3174/ajnr.a3919] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Preoperative embolization for intracranial meningiomas offers potential advantages for safer and more effective surgery. However, this treatment strategy has not been examined in a large comparative series. The purpose of this study was to review our experience using preoperative embolization to understand the efficacy, technical considerations and complications of this technique. MATERIALS AND METHODS We performed a retrospective review of patients undergoing intracranial meningioma resection at our institution (March 2001 to December 2012). Comparisons were made between embolized and nonembolized patients, including patient and tumor characteristics, embolization method, operative blood loss, complications, and extent of resection. Logistic regression analyses were used to identify factors predictive of operative blood loss and extent of resection. RESULTS Preoperatively, 224 patients were referred for embolization, of which 177 received embolization. No complications were seen in 97.1%. There were no significant differences in operative duration, extent of resection, or complications. Estimated blood loss was higher in the embolized group (410 versus 315 mL, P=.0074), but history of embolization was not a predictor of blood loss in multivariate analysis. Independent predictors of blood loss included decreasing degree of tumor embolization (P=.037), skull base location (P=.005), and male sex (P=.034). Embolization was not an independent predictor of gross total resection. CONCLUSIONS Preoperative embolization is a safe option for selected meningiomas. In our series, embolization did not alter the operative duration, complications, or degree of resection, but the degree of embolization was an independent predictor of decreased operative blood loss.
Collapse
Affiliation(s)
- D M S Raper
- From the Department of Neurosurgery (D.M.S.R., R.M.S., D.D., J.A.J., K.C.L.)
| | - R M Starke
- From the Department of Neurosurgery (D.M.S.R., R.M.S., D.D., J.A.J., K.C.L.)
| | - F Henderson
- School of Medicine (F.H.), University of Virginia Health System, Charlottesville, Virginia
| | - D Ding
- From the Department of Neurosurgery (D.M.S.R., R.M.S., D.D., J.A.J., K.C.L.)
| | - S Simon
- Department of Neurosurgery (S.S.), Penn State Hershey, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - J A Jane
- From the Department of Neurosurgery (D.M.S.R., R.M.S., D.D., J.A.J., K.C.L.)
| | - K C Liu
- From the Department of Neurosurgery (D.M.S.R., R.M.S., D.D., J.A.J., K.C.L.)
| |
Collapse
|
37
|
Singla A, Deshaies EM, Melnyk V, Toshkezi G, Swarnkar A, Choi H, Chin LS. Controversies in the role of preoperative embolization in meningioma management. Neurosurg Focus 2014; 35:E17. [PMID: 24289125 DOI: 10.3171/2013.9.focus13351] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The role of preoperative embolization in meningioma management remains controversial, even though 4 decades have passed since it was first described. It has been shown to offer benefits such as decreased blood loss and "softening of the tumor" during subsequent resection. However, the actual benefits remain unclear, and the potential harm of an additional procedure along with the cost of embolization have limited its use to a small proportion of the meningiomas treated. In this article the authors retrospectively reviewed their experience with preoperative embolization of meningiomas over the previous 6 years (March 2007-March 2013). In addition, they performed a MEDLINE search using a combination of the terms "meningioma," "preoperative," and "embolization" to analyze the indications, embolizing agents, timing, and complications reported during preoperative embolization of meningiomas. In this retrospective review, 18 cases (female/male ratio 12:6) were identified in which endovascular embolization was used prior to resection of an intracranial meningioma. Craniotomy for tumor resection was performed within 4 days after endovascular embolization in all cases, with an average time to surgery of 1.9 days. The average duration of surgery was 4 hours and 18 minutes, and the average blood loss was 574 ml, with a range of 300-1000 ml. Complications following endovascular therapy were identified in 3 (16.7%) of 18 cases, including one each of transient hemiparesis, permanent hemiparesis, and tumor swelling. The literature review returned 15 articles consisting of a study population greater than 25 patients. No randomized controlled study was found. The use of small polyvinyl alcohol particles (45-150 μm) is more effective in preoperative devascularization than larger particles (150-250 μm), but is criticized due to the higher risk of complications such as cranial nerve palsies and postprocedural hemorrhage. Time to surgery after embolization is inconsistently reported across the articles, and conclusions on the appropriate timing of surgery could not be drawn. The overall complication rate reported after treatment with preoperative meningioma embolization ranges from as high as 21% in some of the older literature to approximately 6% in recent literature describing treatment with newer embolization techniques. The evidence in the literature supporting the use of preoperative meningioma embolization is mainly from case series, and represents Level III evidence. Due to the lack of randomized controlled clinical trials, it is difficult to draw any significant conclusions on the overall usefulness of preoperative embolization during the management of meningiomas to consider it a standard practice.
Collapse
|
38
|
Dubel GJ, Ahn SH, Soares GM. Contemporary endovascular embolotherapy for meningioma. Semin Intervent Radiol 2014; 30:263-77. [PMID: 24436548 DOI: 10.1055/s-0033-1353479] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Preoperative endovascular tumor embolization has been used for 40 years. Meningiomas are the most common benign intracranial tumor in which preoperative embolization has been most extensively described in the literature. Advocates of embolization report that it reduces operative blood-loss, and softens the tumor, thus making surgery safer and easier. Opponents suggest that it adds additional risk and cost for patients without controlled studies showing conclusive benefit. The literature suggests a 3 to 6% neurological complication rate related to embolization. The combined external and internal carotid artery blood supply and complex anastomoses of the meninges can make embolization challenging. Positive outcomes require thorough knowledge of the pertinent vascular anatomy, familiarity with the neurovascular equipment and embolics, and meticulous technique. There remains debate on several aspects of embolization, including tumors most appropriate for embolization, embolic agent of choice, ideal size of embolic, and the choice of vessel(s) to embolize. This detailed review of pertinent vascular anatomy, embolization technique, results, and complications should allow practitioners to maximize treatment outcomes in this setting.
Collapse
Affiliation(s)
- Gregory J Dubel
- Department of Diagnostic Imaging, Division of Interventional Radiology Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Sun Ho Ahn
- Department of Diagnostic Imaging, Division of Interventional Radiology Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Gregory M Soares
- Department of Diagnostic Imaging, Division of Interventional Radiology Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| |
Collapse
|
39
|
Borg A, Ekanayake J, Mair R, Smedley T, Brew S, Kitchen N, Samandouras G, Robertson F. Preoperative Particle and Glue Embolization of Meningiomas: Indications, Results, and Lessons Learned from 117 Consecutive Patients. Oper Neurosurg (Hagerstown) 2013; 73:ons244-51; discussion ons252. [DOI: 10.1227/neu.0000000000000187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Preoperative embolization of meningiomas remains contentious, with persisting uncertainty over the safety and efficacy of this adjunctive technique.
OBJECTIVE:
To evaluate the safety of presurgical embolization of meningiomas and its impact on subsequent transfusion requirement with respect to the extent of embolization and technique used.
METHODS:
One hundred seventeen consecutive patients between 2001 and 2010 were referred for embolization of presumed intracranial meningioma before surgical resection. Glue and/or particles were used to devascularize the tumor in 107 patients, all of whom went on to operative resection. The extent and nature of embolization-related complications, degree of angiographic devascularization, and the intraoperative blood transfusion requirements were analyzed.
RESULTS:
Mean blood transfusion requirement during surgery was 0.8 units per case (range, 1-14 units). Blood transfusion was significantly lower in patients whose meningiomas were completely, angiographically devascularized (P = .035). Four patients had complications as a direct result of the embolization procedure. These included intratumoral hemorrhage in 2, sixth cranial nerve palsy in 1, and scalp necrosis requiring reconstructive surgery in 1 patient.
CONCLUSION:
The complication rate was 3.7%. No relationship between the embolic agent and the degree of devascularization was observed. Achieving a complete devascularization resulted in a lower blood transfusion requirement, considered an indirect measure of operative blood loss. This series demonstrates that preoperative meningioma embolization is safe and may reduce operative blood loss. We present distal intratumoral injection of liquid embolic as a safe and effective alternative to more established particle embolization techniques.
Collapse
Affiliation(s)
- Anouk Borg
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jinendra Ekanayake
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Richard Mair
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Thomas Smedley
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Stefan Brew
- Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Neil Kitchen
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - George Samandouras
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Lila Weston Research Laboratories, Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Fergus Robertson
- Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| |
Collapse
|
40
|
Shah AH, Patel N, Raper DMS, Bregy A, Ashour R, Elhammady MS, Aziz-Sultan MA, Morcos JJ, Heros RC, Komotar RJ. The role of preoperative embolization for intracranial meningiomas. J Neurosurg 2013; 119:364-72. [DOI: 10.3171/2013.3.jns121328] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
As endovascular techniques have become more advanced, preoperative embolization has become an increasingly used intervention in the management of meningiomas. To date, however, no consensus has been reached on the use of this technique. To clarify the role of preoperative embolization in the management of meningiomas, the authors conducted a systematic review of case reports, case series, and prospective studies to increase the current understanding of the management options for these common lesions and complications associated with preoperative embolization.
Methods
A PubMed search was performed to include all relevant studies in which the management of intracranial meningiomas with preoperative embolization was reported. Immediate complications of embolization were reported as major (sustained) or minor (transient) deficits, death, or no neurological deficits.
Results
A total of 36 studies comprising 459 patients were included in the review. Among patients receiving preoperative embolization for meningiomas, 4.6% (n = 21) sustained complications as a direct result of embolization. Of the 21 patients with embolization-induced complications, the incidence of major complications was 4.8% (n = 1) and the mortality rate was 9.5% (n = 2).
Conclusions
Preoperative embolization is associated with an added risk for morbidity and mortality. Preoperative embolization may be associated with significant complications, but careful selection of ideal cases for embolization may help reduce any added morbidity with this procedure. Although not analyzed in the authors' study, embolization may still reduce rates of surgical morbidity and mortality and therefore may still have a potential benefit for selected patients. Future prospective studies involving the use of preoperative embolization in certain cases of meningiomas may further elucidate its potential benefit and risks.
Collapse
Affiliation(s)
- Ashish H. Shah
- 1Department of Neurological Surgery, University of Miami, Florida; and
| | - Neal Patel
- 1Department of Neurological Surgery, University of Miami, Florida; and
| | - Daniel M. S. Raper
- 2Department of Neurological Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Amade Bregy
- 1Department of Neurological Surgery, University of Miami, Florida; and
| | - Ramsey Ashour
- 1Department of Neurological Surgery, University of Miami, Florida; and
| | | | | | - Jacques J. Morcos
- 1Department of Neurological Surgery, University of Miami, Florida; and
| | - Roberto C. Heros
- 1Department of Neurological Surgery, University of Miami, Florida; and
| | | |
Collapse
|
41
|
Grossman R, Maimon S, Levite R, Ram Z. Multimodal Treatment of Hemorrhagic Pituitary Metastasis as First Manifestation of Renal Cell Carcinoma. World Neurosurg 2013; 79:798.E1-5. [DOI: 10.1016/j.wneu.2012.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/28/2012] [Accepted: 09/11/2012] [Indexed: 10/27/2022]
|
42
|
|
43
|
Ren JG, Wang HF, Chen G, Zhang W, Jia HZ, Feng J, Zhao YF. In vivo synergetic effect of in situ sclerotherapy and transient embolotherapy designed for fast-flow vascular malformation treatments with the aid of injectable hydrogel. J Mater Chem B 2013; 1:2601-2611. [DOI: 10.1039/c3tb20196a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
44
|
Effect of systemic celecoxib on human meningioma after intracranial transplantation into nude mice. Acta Neurochir (Wien) 2013; 155:173-82. [PMID: 23143216 DOI: 10.1007/s00701-012-1534-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Meningiomas are mostly benign, but they may have a notorious tendency to recur when total resection is not possible. Systemic chemotherapeutical treatment has been largely disappointing. The treatment of meningiomas with the cyclooxygenase-2 (COX-2) inhibitor celecoxib showed inhibitory-growth effects in vitro and in vivo after subcutaneous transplantation into mouse. So far, celecoxib has never been tested in an orthotopic model of meningioma. In this work, we tested the effects of celecoxib on the growth of human benign meningiomas after transplantation into the prefrontal cortex of nude mice after confirming the inhibitory in vitro effect on these cells. METHODS Primary cell cultures were stereotactically implanted into mice and were treated with 0, 750, or 1,500 ppm celecoxib for 3 months. The mice were then killed and blood was analyzed for celecoxib concentration. The mice brains were histologically processed for measurement of tumor volume, COX-2 expression, proliferation index (PI), intratumoral microvessel density (iMVD), and vascular endothelial growth factor (VEGF) expression. RESULTS Treatment with celecoxib had no effect on tumor volume, despite the fact that we found a dose-dependent inhibitory effect on cell cultures and there was a sufficiently high celecoxib concentration in blood plasma and brain tissue. Additionally, celecoxib had neither an effect on COX-2 and VEGF expression nor on the PI and iMVD. CONCLUSIONS Our findings suggest that celecoxib may not be effective on meningioma growth in clinical settings. In general, these results may indicate that the effect of treatment on brain tumors should not only be tested in a heterotopic environment but also in the orthotopic location of these tumors.
Collapse
|
45
|
Trivelato FP, Manzato LB, Rezende MT, Barroso PMC, Faleiro RM, Ulhôa AC. Preoperative embolization of choroid plexus papilloma with Onyx via the anterior choroidal artery: technical note. Childs Nerv Syst 2012; 28:1955-8. [PMID: 23014951 DOI: 10.1007/s00381-012-1928-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 09/08/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Total surgical resection is the treatment of choice for choroid plexus tumors. However, the hypervascular nature of such lesions imposes challenges to the surgical treatment. Preoperative embolization for intracranial tumors has been widely used in an attempt to reduce blood loss, but rarely with choroid plexus tumors. CASE REPORT We describe the first case of preoperative embolization of choroid plexus papilloma with Onyx via the anterior choroidal artery. The procedure underwent without any complications and surgical treatment was possible with minimal blood loss. DISCUSSION Embolization of choroid plexus tumors via anterior choroidal artery is potentially dangerous, but following a meticulous technique, it can be used as a safe and effective preoperative procedure.
Collapse
Affiliation(s)
- Felipe Padovani Trivelato
- Division of Interventional Neuroradiology, Hospital Felício Rocho, Rua Timbiras 3616, Barro Preto, Belo Horizonte, Minas Gerais, Brazil CEP 30140-062.
| | | | | | | | | | | |
Collapse
|