Preoperative Embolization of Skull Base Meningiomas: Safety and Efficacy

Preoperative embolization of skull base meningioma prior to resection is a technique employed by some to reduce intraoperative blood loss and aid in ease of resection. Risks of preoperative embolization include neurological deficit, ischemia, and hemorrhage. We present a retrospective analysis of patients undergoing resection of skull base meningiomas between January 2020 and August 2022. We compare patients undergoing preoperative embolization with those that did not, evaluating complications from embolization and surgery as well as blood loss and transfusion requirement.

We present 32 patients who underwent successful resection of skull base meningiomas; 14 of which received preoperative embolization of target vessels with polyvinyl alcohol. There were 15 sphenoid wing, two clinoidal, one petroclival, one foramen magnum, two petrous, three olfactory groove, two planum sphenoidale, and two tuberculum sella meningiomas. This distribution was consistent between the preoperative embolization and non-embolization groups. An example of a foramen magnum with preoperative embolization is demonstrated in [Figs. 1] to [2].

Fig. 1 Pre and post-resection T1-weigthed MRI with gadolinium.

Fig. 2 Lateral views of left ascending pharyngeal run A. pre- and B. post-embolization with polyvinyl alcohol particles.

There were 18 patients who did not receive preoperative embolization. Four patients were considered for embolization but were intraoperatively deemed not candidates due to the lack of a suitable pedicle for access or the lack of safely accessible target vessels.

Average estimated blood loss (EBL) in the embolized group was 236 mL compared with 292 mL in the non-embolized group (p > 0.05). Preoperative embolization resections lasted on average 5.5 hours, ranging from 2.0 to 12.2 hours. Resections on non-embolized meningiomas similarly lasted 5.4 hours on average, ranging from 2.6 to 13.1 hours. There was a difference in hemoglobin drop between nonembolized and embolized meningiomas (2.1 vs. 0.9; p < 0.05). Three patients in the nonembolized group required RBC transfusions while only one patient in the embolized group required a transfusion. There was one complication from embolization due to non-target embolization.

Preoperative embolization of skull base meningiomas is a relatively safe preoperative procedure that is shown to reduce intraoperative blood loss and create an easier environment for the surgeon. It is unclear if preoperative embolization significantly improves blood loss and operative times. Preoperative embolization confers its own risks including blood loss, risks of anesthesia, threat to vision, neurological function, and death. To better assess the surgical utility of preoperative embolization, further studies that analyze tumor location, tumor size, comorbidities, bleeding risk, operative time, complications, and outcomes are required.

Publication History

Article published online:
01 February 2023