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.
