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Embolization of meningiomas: comparison of safety between calibrated microspheres and polyvinyl-alcohol particles as
M Sluzewski1, W J van Rooij, P N Lohle
1Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands.
Background And Purpose:
During embolization of meningiomas, intratumoral hemorrhagic complications may occur, especially with the use of small particle sizes. We compared the rate of hemorrhagic complications in 55 patients embolized with 400-μm calibrated microspheres (Embozene) with a historical cohort of 198 patients embolized with smaller PVA particles.
Materials And Methods:
Between September 2009 and February 2012, fifty-five patients with 55 meningiomas were embolized with 400-μm calibrated microspheres. Indications for embolization were preoperative in 47 and before radiosurgery in 2 patients; and in 6 patients, embolization was offered as sole therapy. There were 35 women and 20 men with a mean age of 60.3 years. Mean meningioma diameter was 53 mm (range, 23-97 mm). Hemorrhagic complications were recorded.
Results:
There were no hemorrhagic complications in the 55 embolized patients (0%; 95% CI, 0.0%-7.8%). The difference in complication rates between 400-μm calibrated microspheres in this study (0 of 55, 0%) and small PVA particles (45-150 μm) in the historical cohort (9 of 108, 8.3%) was just short of significance (P=.066). The difference in complication rates between 400-μm calibrated microspheres (0 of 55, 0%) and larger PVA particles (150-250 μm) in the historical cohort (1 of 93, 1.1%) was not significant (P=.8).
Conclusions:
In this series, embolization of meningiomas by using large (400-μm) calibrated microspheres did not result in any hemorrhagic complications.
Insights
Embolizing meningiomas with large, 400-μm microspheres showed no intratumoral hemorrhage. This contrasts with smaller particles, suggesting larger microspheres may reduce complication risks in meningioma embolization.
Area of Science:
- Interventional Neuroradiology
- Neurosurgery
- Oncology
Background:
- Intratumoral hemorrhage is a risk during meningioma embolization, particularly with small embolic agents.
- Previous embolization techniques using smaller particles have been associated with higher complication rates.
Purpose of the Study:
- To compare hemorrhagic complication rates in meningioma embolization using 400-μm calibrated microspheres versus historical data of smaller polyvinyl alcohol (PVA) particles.
- To evaluate the safety of larger calibrated microspheres in reducing intratumoral bleeding during meningioma embolization.
Main Methods:
- A prospective study of 55 patients with meningiomas embolized using 400-μm calibrated microspheres.
- Comparison of complication rates with a historical cohort of 198 patients embolized with smaller PVA particles (45-250 μm).
- Data collection focused on recording intratumoral hemorrhagic complications.
Main Results:
- No hemorrhagic complications were observed in the 55 patients treated with 400-μm microspheres (0%).
- The complication rate with 400-μm microspheres was significantly lower than with small PVA particles (0% vs. 8.3%, P=.066).
- No significant difference in complication rates was found when comparing 400-μm microspheres to larger PVA particles (0% vs. 1.1%, P=.8).
Conclusions:
- Embolization of meningiomas using 400-μm calibrated microspheres resulted in zero hemorrhagic complications in this series.
- Larger calibrated microspheres appear to be a safe alternative, potentially reducing hemorrhagic risks in meningioma embolization.
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