Embolization of Meningiomas with Ultralow Concentration N-Butyl 2-Cyanoacrylate

Preoperative embolization of meningiomas with n-butyl 2-cyanoacrylate (NBCA) is problematic as its adhesive nature may force termination prior to achieving adequate embolization of intratumoral vessels. Herein, we report the use of ultralow concentration NBCA embolization to address this issue.

Seventeen patients with meningiomas underwent embolization with ultralow concentration NBCA. Twenty-four tumor-feeding vessels were embolized with 5% NBCA to allow infiltration of the intratumoral vessels. Overall, this method achieved a reduced operative time and blood loss during the resection as compared with those of the nonembolized group.

Embolization was achieved in all patients at ultralow concentrations. Additionally, 20 vessels (83.3%) were embolized up to the intratumoral level. Warmed 5% NBCA aided in the embolization of intratumoral vessels. Embolization effectively controlled bleeding in all patients, while in 15 patients (88.2%), some form of tumor necrosis or softening was observed, predominantly in the area of dural attachment, demonstrating the efficacy of embolization in tumor removal. No embolization-related complications were observed. The mean operative time for resection was significantly different between the embolization (17 patients) and nonembolization (9 patients) groups (316 vs. 412 minutes, p  = 0.0271). In these two groups, the mean blood loss was 349 versus 575 mL, the mean maximum tumor diameter was 56.8 versus 35.4 mm ( p  = 0.0089), and the mean age was 73.3 versus 72.3 years, respectively, with the significantly larger embolization group having shorter operation time and less blood loss.

Embolization of meningiomas with ultralow concentrations of NBCA can help to reach intratumoral vessels.