The role of preoperative embolization in meningiomas

• Κύριος συγγραφέας: Παπουτσάκης, Δημήτριος
• Άλλοι συγγραφείς: Papoutsakis, Dimitrios
• Γλώσσα: English
• Έκδοση: 2021
• Θέματα: Meningiomas; Embolization; Diagnostic imaging; Blood loss; Μηνιγγιώματα

Meningiomas refer to a type of brain tumor that originates from the meninges and more specifically from arachnoid cap cells. They appear more often in women aged 20–60 years. They account for 13 to 26% of primary intracranial tumors in adults and < 2% of all intracranial tumors in children. Non-malignant meningioma is the most frequently reported histologic type. Treating meningiomas has evolved over the past few decades due to advanced diagnostic imaging, more effective surgical and neuroendovascular procedures. Our review of the literature revealed that preoperative embolization relies upon a thorough knowledge of pertinent anatomy (including potential collaterals and cranial nerve [CN] supply), careful analysis of tumoral blood supply, skillful catheterization of feeding vessels and accurate delivery of the appropriate embolic agent. It can be used safely in cases where the tumor is located in difficult areas, whereas special attention is needed in case of dangerous anastomoses with cerebral vessels. Challenging meningiomas include mainly those located at the sphenoid wing, middle cranial fossa (MCF) and those located at the vicinity of cavernous sinus. Current data suggests that preoperative embolization of meningiomas may reduce blood loss during surgery and minimize transfusion requirements (red blood cells, platelets). Therefore, embolization could effectively facilitate surgical procedure. There are no findings that preoperative embolization diminishes meningioma recurrence rates after surgery. The literature suggests a 3% to 6% neurological complication rate related to embolization. These may include groin hematoma, contrast reaction, vessel dissection, intra-tumoral hemorrhage and ischemic stroke. Overall, the maximum benefit of the patient requires careful selection and preparation. Treatment should be applied in an interdisciplinary manner, which depends on the preference of the neurosurgeon, the location and blood supply of the tumor, as well as the surgical risk assessment. In this study we aimed to overview the currently available data regarding the application of preoperative embolization in cases of meningiomas.