Is there a benefit of preoperative meningioma embolization?

OBJECTIVE: To evaluate the effect of preoperative embolization of meningiom as on surgery and outcomes. METHODS: In a prospective study, 60 consecutive patients with intracranial meningiomas who were treated in two neurosurgical centers were included. In Center A, embolization was performed for none of the patients (n = 30). In Center B, 30 consecutive patients with embolized meningiomas were treated. Preoperatively, tumor size and location, neurological status, and Barthel scale score were recorded. In Center B, the extent of tumor devascularizati on was evaluated using angiography and postembolization magnetic resonance imaging. Intraoperatively, blood loss, the numbers of blood units transfuse d, and the observations of the neurosurgeon concerning hempstasis, tumor co nsistency, and intratumoral necrosis were recorded. Postoperatively, the ne urological status and duration of hospitalization were recorded. Six months after surgery, the outcomes were assessed using the Barthel scale and neur ological examinations. RESULTS: The mean tumor sizes were 22.9 cc in Center A and 29.6 cc in Cente r B (P > 0.1). The mean blood losses did not differ significantly (646 mi i n Center A versus 636 mi in Center B; P > 0.5). However, for a subgroup of patients with subtotal devascularization (>90% of the tumor) on postemboliz ation magnetic resonance imaging scans in Center B, blood loss was less, co mpared with the entire group in Center A (P < 0.05). The observations of th e neurosurgeon regarding hemostasis, tumor consistency, and intratumoral ne crosis did not differ significantly. There were no surgery-related deaths i n either center. The rates of surgical morbidity, with permanent neurologic al worsening, were 20% (n = 6) in Center A and 16% (n = 5) in Center B. The re was one permanent neurological deficit (3%) caused by embolization. CONCLUSION: In this preliminary study, only complete embolization had an ef fect on blood loss. The value of preoperative embolization for all meningio mas must be reconsidered, especially in view of the high costs and risks of embolization.