A Greater Degree of Tumor Softness, Decrease in Tumor Blush, and Gross Total Resection Is Achieved at 24 Hours or Less between Meningioma Preoperative Embolization to Tumor Resection

Background: Although preoperative embolization of hypervascular meningiomas helps to remove the tumor more safely and easily which improves post-operative outcomes of patients, the best time for surgery after embolization of meningiomas remains unclear. Here, we aim to determine the optimal time interval between tumor embolization and surgical resection in a multi-institutional meningioma patient cohort.

Objective: To determine the optimal time interval between tumor embolization and surgical resection, referred to as time from embolization to resection (TER), in patients with meningiomas.

Methods: A retrospective data extraction was conducted between 2010 and 2023 from 102 patients undergoing embolization prior to craniotomy for meningioma. Demographic data, the time interval between embolization and tumor resection, tumor blush reduction, tumor consistency post embolization, and extent of tumor resection were among the extracted variables.

Results: Tumor volume demonstrated a significantly positive correlation with TER, p < 0.0001. The postembolization angiograms showed a significantly higher rate of decrease in tumor blush in patients with 24 hours or less TER compared to those with >48 and ≤72 hours TER, p = 0.01 (43.1% vs. 13,7%). Patients at 24 hours or less TER achieved greater gross total resection (GTR) compared to those with > 48 and ≤ 72 hours TER, p = 0.026 (32.4% vs. 7.84%). Additionally, a greater degree of tumor softness was noted in patients at 24 hours or less TER, p < 0.0001. However, a higher rate of firm tumor consistency with areas of necrosis secondary to embolization was noted in patients with 24 hours or less TER compared to those with >48 and ≤72 hours TER, p < 0.0001 (33.3% vs. 2.9%).

Conclusions: Prolonging the interval of TER had no further beneficial effects given that a significant reduction of tumor blush, a greater degree of soft tumor consistency, and GTR can be achieved with shorter intervals between embolization and tumor resection which makes it possible to remove the tumor more safely and easily. Additionally, shorter intervals are optimal to prevent recanalization after embolization. Further studies are warranted to investigate the effect of necrotic or cystic components of a meningioma as a probable risk factor for the benefit of preoperative embolization.

Publikationsverlauf

Artikel online veröffentlicht:
05. Februar 2024