Contemporary endovascular embolotherapy for meningioma

Area of Science:

• Neurosurgery
• Interventional Radiology
• Vascular Neurology

Background:

• Preoperative endovascular tumor embolization is a long-standing technique, particularly for meningiomas, the most common benign intracranial tumors.
• The procedure aims to reduce surgical blood loss and tumor consistency, potentially enhancing surgical safety and ease.
• However, its benefits are debated, with concerns about added risks, costs, and a lack of conclusive evidence from controlled studies.

Purpose of the Study:

• To review the pertinent vascular anatomy, embolization techniques, outcomes, and complications associated with preoperative embolization for intracranial tumors, specifically meningiomas.
• To provide a comprehensive overview to help practitioners optimize treatment outcomes.
• To address ongoing debates regarding optimal tumor selection, embolic agents, and target vessels.

Main Methods:

• Literature review focusing on preoperative endovascular tumor embolization for meningiomas.
• Analysis of reported neurological complication rates (3-6%).
• Discussion of challenges related to complex vascular anatomy and anastomoses.

Main Results:

• Embolization can reduce operative blood loss and soften tumors, potentially making surgery safer.
• Challenges include complex arterial supply and anastomoses, requiring specialized knowledge and technique.
• Neurological complication rates associated with embolization are reported between 3% and 6%.

Conclusions:

• Effective embolization demands deep understanding of vascular anatomy, equipment, and meticulous technique.
• Key areas of ongoing debate include patient selection, embolic agent choice, and target vessel selection.
• This review aims to equip practitioners with the knowledge to maximize treatment success and minimize risks.