EFFICACY OF ENDOVASCULAR TREATMENT OF MENINGIOMAS - EVALUATION WITH MATCHED SAMPLES

PURPOSE: To evaluate the clinical efficacy, cost-effectiveness, and sa fety of presurgical devascularization of meningiomas. METHODS: Matched samples of embolized and nonembolized groups of meningiomas were comp ared. The study variables for clinical efficacy were estimated blood l oss, number of transfusions, surgical resection lime, and length of ho spitalization. The cost-effectiveness was evaluated by adjusting all h ospital costs to 1991 dollar amounts, and adding additional embolizati on costs and fees to the hospital cost totals for the embolized group. A qualitative comparison of complications was made. RESULTS: All depe ndent variables evaluating the clinical efficacy of the procedure (est imate blood loss, 533 cc versus 836 cc; number of transfusions, 0.39 u nits versus 1.56 units; surgical resection time, 305.8 minutes versus 337.5 minutes; and length of hospitalization, 10.6 days versus 15.0 da ys) displayed trends of higher means in the nonembolized group; howeve r, only the estimated blood loss and number of transfusions variables were significant. The cost-effectiveness of the procedure was not stat istically significant. The mean cost was $29,605 for the embolized gro up and $38,449 for the nonembolized group. There were three major and nine minor complications in the nonembolized group and zero major and six minor complications in the embolized group. There were four additi onal minor complications caused by the embolization procedure. CONCLUS ION: Endovascular devascularization of meningiomas is beneficial for l arge meningiomas because it diminishes the necessity of intraoperative transfusions and decreases blood loss. The additional day of hospital ization, embolization costs, and costs of complications do not convers ely increase treatment costs. There were no major complications or adv erse long-term effects caused by the embolization procedure.