Safety Profile of Preoperative Meningioma Embolization: A Meta-Analysis Comparing Embolic Agents and Carotid Systems...

Meningiomas can be embolized to facilitate safe tumor resection. However, the procedure may be associated with complications that have not been well-characterized. We aimed to compare the safety of liquid versus particulate agents and to assess the safety of embolization using internal carotid artery (ICA) branches.

Studies evaluating outcomes of preoperative meningioma embolization from 1974 to 2024 were systematically searched on PubMed, Embase, and Scopus. Data on embolic agents used, feeder arteries embolized, and complication outcomes were extracted. Complication rates were statistically compared using Z-scores calculated from the standard errors of the pooled rates.

The meta-analysis encompassed 3,069 patients from 50 studies. Embolization appears safe with an overall complication rate of 3.2% (95% CI: 2.4-4.0%) and a permanent neurological deficit rate of only 1.2% (0.8-1.6%). Overall complication rates were comparable between liquid (4.1%, 1.8-6.5%) and particulate agents (2.7%, 1.7-3.6%) (P = 0.28). The rate of tumor edema causing neurologic deficits was slightly higher for liquid agents (2.4%, 0.6-4.2%) compared to particulate agents (0.5%, 0.2-0.8%) (P = 0.041). No significant differences were observed in hemorrhagic (liquid 2.3%, particulate 0.7%; P = 0.087) or ischemic complications (liquid 1.6%, particulate 1.1%; P = 0.53). For the carotid systems embolized, the pooled complication rate for ICA branches embolization (5.2%, 1.1-9.2%) was comparable to the pooled complication rate of external carotid artery embolization (2.5%, 1.8-3.2%) (P = 0.20).

Preoperative embolization is a safe adjunct for meningioma resection, with similarly low complication rates for liquid and particulate agents. Furthermore, embolization of ICA branches can be as safe as external carotid artery branches in select cases.