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Predictors of preoperative endovascular embolization of meningiomas: subanalysis of anatomic location and arterial supply
  1. Guilherme Barros1,
  2. Abdullah H Feroze1,
  3. Rajeev Sen1,
  4. Cory M Kelly1,2,
  5. Jason Barber1,
  6. Danial K Hallam1,3,
  7. Basavaraj Ghodke1,3,
  8. Joshua W Osbun4,5,6,
  9. Louis J Kim1,2,3,
  10. Michael R Levitt1,2,3,7
  1. 1Neurological Surgery, University of Washington, Seattle, Washington, USA
  2. 2Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
  3. 3Radiology, University of Washington, Seattle, Washington, USA
  4. 4Neurological Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
  5. 5Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
  6. 6Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
  7. 7Mechanical Engineering, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Michael R Levitt, Neurological Surgery, University of Washington, Seattle WA 98104, USA; respub{at}


Introduction Endovascular embolization of intracranial meningiomas is commonly used as an adjunct to surgical resection. We sought to describe the anatomic locations and vascular supplies of meningiomas to identify characteristics predictive of successful preoperative endovascular embolization.

Methods We conducted a retrospective review of 139 meningioma cases receiving cerebral angiograms for possible preoperative endovascular embolization at our institution between December 2000 and March 2017. The extent of embolization, arterial supply, anatomic location, and procedural complications were recorded for each case. Univariate and multivariate analyses were performed to identify tumor characteristics that predicted successful embolization.

Results Of the total meningioma patients undergoing preoperative angiography, 78% (108/139) were successfully embolized, with a 2.8% periprocedural complication rate (3/108). Within the subset of patients with successful embolization, 31% (33/108) achieved complete angiographic embolization. Significant multivariate predictors of embolization (either partial or complete) were convexity/parasagittal locations (OR 5.15, 95% CI 0.93 to 28.54, p=0.060), meningohypophyseal trunk (MHT, OR 4.65, 95% CI 1.63 to 13.23, p=0.004), middle meningeal artery (MMA, OR 10.89, 95% CI 3.43 to 34.64, p<0.001), and ascending pharyngeal artery supply (APA, OR 9.96, 95% CI 1.88 to 52.73, p=0.007). Significant predictors for complete embolization were convexity/parasagittal locations (OR 4.79, 95% CI 1.66 to 13.84, p=0.004) and embolized APA supply (OR 6.94, 95% CI 1.90 to 25.39, p=0.003). Multiple arterial supply was a negative predictor of complete embolization (OR 0.38, 95% CI 0.15 to 0.98, p=0.05).

Conclusions Tumor characteristics can be used to predict the likelihood of preoperative meningioma embolization. Parasagittal and convexity meningiomas, and those with APA supply, are most likely to achieve complete angiographic embolization.

  • meningioma
  • endovascular
  • embolization
  • tumor

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  • Contributors Each author contributed to the study design, acquisition of data, interpretation of data and/or manuscript drafting and revision, and each provided final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JWO has received grants and personal fees from MicroVention and personal fees from Terumo Medical and Microbot. MRL has received grants from Medtronic and Stryker, personal fees from Minnetronix, and equity interest from eLoupes, Inc.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No further data available for sharing.

  • Patient consent for publication Not required.