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Batista S, Andreão FF, Palavani LB, Borges P, Verly G, Bertani R, Filho JAA, Paiva WS, de Abreu LV, Pessoa BL. Enhancing meningioma resection: a comprehensive study on the safety and effectiveness of Onyx™ presurgical embolization. Neurosurg Rev 2023; 46:299. [PMID: 37964033 DOI: 10.1007/s10143-023-02200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
Presurgical embolization (PE) has emerged as an interesting strategy to help turn brain tumor resection more amenable. This study aims to systematically review the safety and effectiveness of Onyx™ PE in meningioma resection. We followed Cochrane Collaboration and PRISMA for systematic review and meta-analysis, querying PUBMED, Cochrane Library, Web of Science, and Embase databases. Major complications were defined as other artery occlusion, visual deficits due to PE, or non temporary nerve damage, while minor included transitory conditions and others without clinical implications. A total of 186 patients were included, in which 120 were WHO grade I (80%), II (16%), and III (4%). Patient baseline characteristics and complications were distributed in groups without or with individual patient data analysis. Individual Patient Data Meta-Analysis (IPDMA) was performed on the last category, comprising 51 meningiomas that underwent Onyx™ PE. Among available data, 70%, 17%, and 13% were WHO grade I, II, and III, respectively. Considering all studies, tumor characteristics regarding grade underscored a certain homogeneity. Complications occurred at a rate of 9% (95% CI, 4 to 14%; I2 = 35%), with the rate of major complications significantly lower at only 1% (95% CI, 0 to 3%; I2 = 32%), whereas of minor complications was 7% (95% CI, 3 to 10%; I2 = 0%). Mean surgery blood loss was 668.7 (95% CI, 534.9 to 835.8; I2 = 0%) in IPDMA. Onyx™ PE is promising for safer surgical meningioma resection, despite limitations. Further studies are required to validate efficacy, enhance patient selection, and refine techniques.
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Affiliation(s)
- Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Cidade Universitária, Av. Carlos Chagas Filho, 373 Ilha do Fundão, Rio de Janeiro, 21941-590, Brazil
| | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Cidade Universitária, Av. Carlos Chagas Filho, 373 Ilha do Fundão, Rio de Janeiro, 21941-590, Brazil
| | | | - Pedro Borges
- Faculty of Medicine, Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, Brazil
| | - Gabriel Verly
- Faculty of Medicine, Federal University of Rio de Janeiro, Cidade Universitária, Av. Carlos Chagas Filho, 373 Ilha do Fundão, Rio de Janeiro, 21941-590, Brazil
| | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, Brazil
| | | | | | - Livia V de Abreu
- Faculty of Medicine, Federal University of Rio de Janeiro, Cidade Universitária, Av. Carlos Chagas Filho, 373 Ilha do Fundão, Rio de Janeiro, 21941-590, Brazil.
| | - Bruno L Pessoa
- Department of Neurosurgery, Federal Fluminense University, Rio de Janeiro, Brazil
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Injection of N‑butyl Cyanoacrylate Through a Dual-Lumen Balloon for Embolization of High-flow Intranidal Fistulas in Brain Arteriovenous Malformations: Technical Note. Clin Neuroradiol 2019; 30:313-319. [PMID: 30972426 DOI: 10.1007/s00062-019-00780-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE N-butyl cyanoacrylate (NBCA) glue is a valuable liquid embolic agent for the endovascular treatment of brain arteriovenous malformations (BAVM). The use of NBCA carries a risk of embolic agent reflux and distal migration with ensuing possibility of venous drainage compromise. The aim of this technical note is to describe a single center case series of high-flow intranidal fistulas embolized though a dual lumen balloon under local flow-arrest conditions. METHODS This article presents a retrospective description of a case series including five NBCA injections through a dual lumen balloon performed by a single operator in three patients with BAVM. Demographic, clinical, imaging and procedure-related data are reported. RESULTS The three patients presented with ruptured BAVMs. Of the patients, one underwent proximal flow-related ruptured aneurysm coiling before planned BAVM embolization. In the three patients, staged BAVM embolization as a first line treatment was decided. Preliminary embolization of high-flow BAVM fistulas by NBCA using a dual lumen balloon under local flow-arrest conditions was performed and five separate injections were carried out without any complications. No balloon entrapment or rupture was observed. CONCLUSION High-flow BAVM fistulas can be treated with NBCA embolization using a dual lumen balloon under local flow-arrest conditions.
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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]
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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.
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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
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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.
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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
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Wanibuchi M, Komatsu K, Akiyama Y, Mikami T, Iihoshi S, Miyata K, Mikuni N. Quantitative Assessment of Flow Reduction After Feeder Embolization in Meningioma by Using Pseudocontinuous Arterial Spin Labeling. World Neurosurg 2016; 93:237-45. [DOI: 10.1016/j.wneu.2016.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
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Park S, Hwang SM, Lim OK, Hwang C, Lee DH. Compliant neurovascular balloon catheters may not be compatible with liquid embolic materials: intraprocedural rupture of the protecting balloon during tumor embolization using n-butyl cyanoacrylate and lipiodol mixture. J Neurointerv Surg 2014; 7:740-3. [PMID: 25165384 DOI: 10.1136/neurintsurg-2014-011331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 08/04/2014] [Indexed: 11/03/2022]
Affiliation(s)
- Soonchan Park
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seon Moon Hwang
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ok Kyun Lim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Changmo Hwang
- Biomedical R&D Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Li Q, Fang YB, Huang QH, Zhang Q, Hong B, Zhao WY, Liu JM, Xu Y. Transarterial embolization of dural arteriovenous fistulas of the anterior cranial fossa with Onyx. J Clin Neurosci 2012; 20:287-91. [PMID: 23219832 DOI: 10.1016/j.jocn.2012.03.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 03/24/2012] [Accepted: 03/26/2012] [Indexed: 11/16/2022]
Abstract
Dural arteriovenous fistulas (DAVF) of the anterior cranial fossa are often associated with hemorrhage and are usually treated surgically. This clinical study summarizes our preliminary experience in the transarterial embolization of these lesions. We retrospectively reviewed the data for 11 patients with anterior cranial fossa DAVF who underwent transarterial embolization with the Onyx Liquid Embolic System (eV3 Endovascular, Plymouth, MN, USA) at our institute between 2007 and 2011. In four patients, a balloon-assisted technique was used to facilitate superselective catheterization. According to the Cognard classification of DAVF, three fistulas were type III, and the other eight were type IV. DAVF were completely obliterated in 10 patients after treatment via a single ethmoidal artery, but the other patient was not completely cured. No signs of rebleeding or symptom progression were observed at a mean follow-up of 18.5 months (range: 2-49 months). Transarterial embolization using Onyx is therefore feasible and effective for the management of DAVF of the anterior cranial fossa.
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Affiliation(s)
- Qiang Li
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
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Ellis JA, D'Amico R, Sisti MB, Bruce JN, McKhann GM, Lavine SD, Meyers PM, Strozyk D. Pre-operative intracranial meningioma embolization. Expert Rev Neurother 2011; 11:545-56. [PMID: 21469927 DOI: 10.1586/ern.11.29] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pre-operative embolization is a routinely utilized therapeutic adjunct to the resection of hypervascular lesions of the head and neck. In particular, pre-operative cerebral angiography and tumor embolization has become standard practice at many centers in the management of select intracranial meningiomas. However, controversy remains regarding its specific indications and clinical utility. In this article, we examine the principles of meningioma embolization, emphasizing the indications, risks and benefits associated with its use in the pre-operative setting.
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Affiliation(s)
- Jason A Ellis
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University Medical Center, 710 West 168th Street, New York, NY 10032, USA.
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Trivelatto F, Nakiri GS, Manisor M, Riva R, Al-Khawaldeh M, Kessler I, Mounayer C. Preoperative onyx embolization of meningiomas fed by the ophthalmic artery: a case series. AJNR Am J Neuroradiol 2011; 32:1762-6. [PMID: 21835949 DOI: 10.3174/ajnr.a2591] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Embolization of head and neck hypervascular tumors is a well-established therapeutic technique. Preoperative embolization reduces intraoperative blood loss, shortens the length of surgery, and decreases surgical morbility and mortality. This study assesses the safety and efficacy of preoperative embolization of meningiomas fed by the OPH by using Onyx liquid embolic agent.
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Affiliation(s)
- F Trivelatto
- Department of Interventional Neuroradiology, Dupuytren University Hospital, Limoges, France
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