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Commentary in response to ‘Preoperative tumor embolization prolongs time to recurrence of meningiomas: a retrospective propensity-matched analysis’
  1. Saksham Gupta,
  2. Omar Arnaout
  1. Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Saksham Gupta, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02120, USA; sgupta{at}bwh.harvard.edu

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We read the study ‘Preoperative tumor embolization prolongs time to recurrence of meningiomas: a retrospective propensity-matched analysis’ by Akimoto et al1 with great interest. In this study, the authors study propensity-matched retrospective cohorts of 42 patients each to determine the impact of preoperative embolization on outcomes after resection of WHO grade 1 meningioma. All patients underwent preoperative catheter-based angiography. The authors found that embolization reduced blood loss and operative time, but did not improve gross total resection (GTR) rates. Recurrence-free survival (RFS) is 49 months for the embolized group and 24 months for the non-embolized group, a statistically significant finding, though the overall incidence of recurrence at follow-up is non-significant.

We believe this study’s generalizability is limited by the outcomes presented and statistical methods used in this study. Additionally, we share reservations about such high utilization of preoperative embolization.

The 5-year recurrence rate within the 84-patient cohort is 17%, stratified to approximately 10% after GTR (including Simpson grade 1–3 resection) and 50% after subtotal resection (STR). In recent studies of WHO grade 1 meningiomas, the 5-year …

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Footnotes

  • Contributors SG and OA both contributed to analysis of the initial study as well as drafting and critically editing the commentary.

  • 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 None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.