P18.03.B Long term effects of therapeutic embolization of radiographically suspected meningiomas regarding tumour- and necrosis volume as well as patients' symptoms

Background

Preoperative embolization of radiographically suspected intracranial meningiomas is performed to reduce intraoperative blood loss and to facilitate resection. However, there is paucity of evidence examining the effect of embolization as a sole intervention on the tumor volume and the patient's neurocognitive symptoms. The objective of this study was to investigates the influence of therapeutic embolization on tumor- and necrosis volume and neurocognitive symptoms in absence of surgical intervention.

Material and Methods

Between January 2019 and June 2021, 4 patients (median age 82, 1 female) with 5 radiographically suspected intracranial meningiomas, underwent endovascular embolization with liquid embolizate and coils, without subsequent surgery. Indication for embolization was history of previous multiple surgery contraindicating further surgical intervention or patients will. Neurological status (on admission, discharge from hospital and 5 months after embolization), medical history, medication, MRI (location, tumor- and necrosis volume, development of edema, complications), DSA (extent of embolization, arterial supply) and procedural complications were recorded. In 3 patients with 4 tumors, an MRI scan was performed. The calculation of tumor- and necrosis volume was done manually with a semiautomatic segmentation tool. One patient with one tumor received CT scans due to a cardiac pacemaker and was therefore excluded from volumetric analysis.

Results

The average tumor volume was 44,83 ± 13,82 cm3 on admission, 45,33 ± 16,3 cm3 5 days after embolization (+1%) and 39,93 ± 29,39 cm3 (-11%) after 5 months. The average necrosis diameter was 41,76 ± 9,33 mm after 5 days and 6,05 ± 6,43 mm after 5 months. The perifocal oedema decreased in 2/3 Patients. Tumor blood supply was via 2,4 ± 1,34 vessels, 1,2 ± 0,45 vessels were embolised. On admission, 3 patients showed neurocognitive symptoms. At discharge and in the follow-up, in 2 patients the symptoms had improved, one patient experienced a complete symptom regression. In one patient the embolization was complicated by dissection of the middle meningeal artery. The same patients perifocal oedema increased in the further clinical course with accompanying deterioration of the pre-existing hemiparesis from moderate to severe. Supported with dexamethasone medication, the oedema and symptoms declined to a mild residual paresis. None of the patients developed a long-term neurocognitive deficit related to embolization.

Conclusion

Therapeutic endovascular embolization of radiographically suspected intracranial meningiomas reduced the tumor volume and led to long-term improvement of pre-existing neurocognitive symptoms. In the future, these effects should be verified in larger studies.

P18.02.B Influence of preoperative embolization on intraoperative parameters, hospital stay and neurocognitive outcome compared to surgery alone

Background

Preoperative embolization of meningiomas is used to reduce intraoperative blood loss and facilitate resection. So far, a risk-benefit stratification of this additional intervention on the neurocognitive outcome is missing. This study investigates the influence of preoperative embolization with liquid Embolisate on intraoperative parameters, length of hospital stays and functional outcome.

Material and Methods

Patients treated for intracranial meningiomas at a single center between January 2019 and June 2021 were reviewed in a retrospective matched-pair analysis. Patients were matched to group A (tumor resected) and group B (preoperatively embolized and tumor resected after 2,27 ± 3,05 days). Matching criteria were tumor diameter and location (convexity, falx cerebri or skull base, frontal, parietal, occipital, temporal). Data collection included MRI (location, tumor- and necrosis volume, edema, complications), DSA (tumor blush, arterial supply), medical history, histological, surgical, clinical course, complications, and haematological parameters, as well as neurocognitive symptoms on admission and discharge from hospital.

Results

44 patients with intracranial Meningiomas were included, divides into 2 groups, each encompassing 22 patients (mean age 62,41 years, 40,5% female). The matching criteria tumor diameter (64.21 vs. 63.55 mm, p=0.725) and tumor localisation (p=0.381) showed no significant differences. There were no significant differences in postoperative hospital stay (14.41 ± 9.5 vs. 14.25 ± 16.88 days, p=0.814) and in preoperative perifocal oedema (82% vs. 82%, p=0.397). Preoperative embolization was associated with decreased intraoperative tumor bleeding (67% vs. 14%, p=0.001, PHI= 0.534), longer duration of surgery (4:58 ± 2:44 vs. 06:07 ± 03:00 hours, p=0.037), trend for decrease in perifocal oedema (p=0.052, PHI=0,498), neurocognitive improvement on discharge from hospital (23% vs. 86%, p=0.045, PHI=0.339) and decreased of epileptic seizures (preoperative 18% vs. 18% and postoperative 23% vs. 5%). There was no increase in cumulative complication rate (p=1.0) and no long-term neurocognitive impairments associated with embolization.

Conclusion

This study suggests that preoperative embolization of intracranial meningiomas significantly decreased intraoperative tumor blood loss but is also associated to an improvement on neurocognitive abilities compared to surgery alone. Importantly, complication rate is not increased. In the future, larger studies and perhaps a randomised control trial might be of value in corroborating these findings. Furthermore, the neurocognitive symptoms should be assessed in a standardised examination form, qualitative parameters such as bleeding tendency should be supplemented by quantifiable parameters, e.g., blood loss in ml.

The Silk Vista Baby - The UK experience

BACKGROUND

The Silk Vista Baby (SVB) flow diverter (FDS) is the only FDS deliverable via a 0.017 inch microcatheter and is specifically designed for the distal vasculature. We sought to evaluate the safety and efficacy of the SVB.

MATERIALS AND METHODS

We performed a retrospective review to identify SVB cases at 4 tertiary neurosurgical centres within the U.K. Clinical, procedural, angiographic and follow-up data were collected.

RESULTS

We identified 60 patients (35 female, 58%) of average age 54 ± 10.5 (range 30-72) with 61 aneurysms, 50 (81.9%) located in the anterior circulation. The majority of the aneurysms treated were unruptured (46, 75.4%) and saccular (46, 75.4%). Dome size was 6.2 ± 6.2 mm (range 1-36mm) and parent vessel diameter was 2.3 ± 0.4 mm (range 1.2-3.3 mm).An average number of 1.07 devices were implanted. Coils or other devices were implanted in 14 aneurysms (23.3%). At last angiographic follow-up (n = 55), 7.5 ± 4.2 months post-procedure, 32 aneurysms (57.1%) were graded as RRC I, 7 (12.5%) RRC II, and 17 RRC III (30.4%).Clinical complications, excluding death, were seen in 4 patients (6.8%) including 1 delayed aneurysm rupture and 3 symptomatic ischaemic events. Only one patient had permanent morbidity (mRS 1). 3 patients died during follow-up (5.1%); 2 deaths were related to the aneurysms (3.4%) - one ruptured dissecting MCA aneurysm, and one giant partially thrombosed posterior circulation aneurysm. 93% of patients were mRS ≤ 2 at last follow-up.

CONCLUSION

The SVB has high rates of technical success and an acceptable safety profile. Distal aneurysms may occlude slower due to relative oversizing of the devices.

High risk for microcarcinoma in thyroid benign diseases. Incidence in a one year period of total thyroidectomies

Over the last few years, incidental thyroid microcarcinoma (TMC) has become a frequent disease and its incidence in some reports is considerable. The discovery of new cases depends on the progress of the diagnostics (US scan, fine needle biopsy and cytology, CT, MRI), on the extended indications to thyroidectomy for benign disease and on the attention in pathologic examination of the specimen. The clinical evolution of this disease is not well known: in spite of a high incidence reported in some autoptic series, suggesting that this tumour could have a good prognosis, some authors report an overall incidence of up to 11% of local recurrence, metastasis and mortality. For these reasons the treatment of TMC is still controversial today. Aim of this study was to estimate the incidence and the clinico-pathological findings of TMC over a one year period of total thyroidectomies for diffuse benign thyroid diseases, and to evaluate, on the basis of the frequency of incidental microcarcinoma, if the surgical procedure of complete removal of the gland should be adopted in any case. In this series no patient had pre-operative diagnosis or tentative diagnosis of carcinoma and the incidence of TMC at the final histologic examination was 27.4%. Total thyroidectomy confirmed to be the treatment of choice for diffuse benign diseases and appeared necessary to obtain both, diagnosis and treatment of incidental TMC.

[Antisalmonellal agglutination in liver cirrhosis and chronic hepatitis]

A positive serum diagnosis for Salmonellae was obtained in 7 patients with cirrhosis of the liver and 18 with chronic hepatitis (22 males and 3 females), even though their history was negative and they had not even been vaccinated against thyphus and paratyphus. The results are seen as a warning that laboratory data that might lead to a mistaken diagnosis and incorrect treatment should be interpreted with particular care.