Progressive intracranial meningioma regression after standalone endovascular embolization: a multicenter study

Area of Science:

• Neurology
• Interventional Radiology
• Neurosurgery

Background:

• Endovascular embolization is typically a preoperative method for intracranial meningiomas.
• Standalone embolization has been sporadically documented.
• This study presents the largest multicenter cohort on standalone embolization for intracranial meningiomas.

Purpose of the Study:

• To evaluate the efficacy and safety of endovascular embolization as a standalone treatment for intracranial meningiomas.
• To assess tumor response and clinical outcomes in patients treated with standalone embolization.

Main Methods:

• Retrospective analysis of 41 meningiomas in 40 patients across four centers.
• Serial volumetric MRI over 12 months to assess radiographic response (Enhancing Tumor Volume and Total Tumor Volume).
• Analysis of an early devascularization index (EDI) as a predictor of tumor response and modified Rankin Scale (mRS) for clinical outcomes.

Main Results:

• Significant median Total Tumor Volume reduction of 81.7% at 12 months (p≤0.002).
• Median Enhancing Tumor Volume decreased by 83.1% within 24-72 hours, with early devascularization index predicting shrinkage (pooled p=0.002).
• Modified Rankin Scale was stable or improved in 39 of 40 patients; 9.8% complication rate with one clinical decrement.

Conclusions:

• Standalone embolization is a successful standalone treatment for intracranial meningiomas.
• It induces significant, progressive tumor regression sustained up to 12 months.
• Prospective studies are warranted to further validate these findings.