Abstract
Background
Embolization of extra-axial tumors has shown its effectiveness in reducing perisurgical blood loss. However, the complication rate of this procedure is poorly reported. We aimed to evaluate the rate of procedure-related complications and their risk factors.
Methods
From 1998 to 2011, 193 consecutive patients (141 females, 52 males; mean age = 52.9 years) were referred to our institution for presurgical embolization of an extra-axial tumor (meningiomas: n = 178; solitary fibrous tumors: n = 3; other: n = 12). Of 193 patients, 137 (71 %) underwent 141 embolizations (by microparticles: n = 133; by glue: n = 8). The remaining 56 patients (29 %) were not embolized due to unstable catheterization or dangerous anastomosis. Occurrence of neurological deficit was systematically assessed during and after embolization. The risk factors of procedure-related neurological complications were evaluated.
Results
Neither intratumoral hemorrhage nor procedure-related death was reported. Two of the 137 patients (1.5 %) had ischemic events with permanent neurological deficit after microparticles embolization. One patient had cortical blindness and one had hemiparesis. Both complications involved the vertebrobasilar system. The first patient had direct intratumoral anastomosis between the middle and the posterior meningeal arteries (PMA); the second one had reflux in the vertebral artery during particles injection in the PMA. Occurrence of ischemic complication was not related to the size of the microparticles.
Conclusions
Though embolization of meningeal tumors is considered as a safe technique, serious neurological complications may occur. Opening of dangerous anastomosis or uncontrolled reflux caused two neurological complications (1.5 %). The size of the microparticles was not associated with the occurrence of neurological event.
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References
Alaywan M, Sindou M (1993) Prognostic factors in the surgery for intracranial meningioma. Role of the tumoral size and arterial vascularization originating from the pia mater. Study of 150 cases. Neurochirurgie 39:337–347
Bendszus M, Monoranu CM, Schutz A, Nolte I, Vince GH, Solymosi L (2005) Neurologic complications after particle embolization of intracranial meningiomas. AJNR Am J Neuroradiol 26:1413–1419
Bendszus M, Rao G, Burger R, Schaller C, Scheinemann K, Warmuth-Metz M, Hofmann E, Schramm J, Roosen K, Solymosi L (2000) Is there a benefit of preoperative meningioma embolization? Neurosurgery 47:1306–1311, discussion 1311–1302
Carli DF, Sluzewski M, Beute GN, van Rooij WJ (2010) Complications of particle embolization of meningiomas: frequency, risk factors, and outcome. AJNR Am J Neuroradiol 31:152–154
Clarencon F, Bonneville F, Rousseau A, Galanaud D, Kujas M, Naggara O, Cornu P, Chiras J (2011) Intracranial solitary fibrous tumor: imaging findings. Eur J Radiol 80:387–394
Dean BL, Flom RA, Wallace RC, Khayata MH, Obuchowski NA, Hodak JA, Zabramski JM, Spetzler RF (1994) Efficacy of endovascular treatment of meningiomas: evaluation with matched samples. AJNR Am J Neuroradiol 15:1675–1680
Ellis JA, D’Amico R, Sisti MB, Bruce JN, McKhann GM, Lavine SD, Meyers PM, Strozyk D (2011) Pre-operative intracranial meningioma embolization. Expert Rev Neurother 11:545–556
Geibprasert S, Pongpech S, Armstrong D, Krings T (2009) Dangerous extracranial-intracranial anastomoses and supply to the cranial nerves: vessels the neurointerventionalist needs to know. AJNR Am J Neuroradiol 30:1459–1468
Gruber A, Killer M, Mazal P, Bavinzski G, Richling B (2000) Preoperative embolization of intracranial meningiomas: a 17-years single center experience. Minim Invasive Neurosurg 43:18–2
Hirohata M, Abe T, Morimitsu H, Fujimura N, Shigemori M, Norbash AM (2003) Preoperative selective internal carotid artery dural branch embolisation for petroclival meningiomas. Neuroradiology 45:656–660
Kallmes DF, Evans AJ, Kaptain GJ, Mathis JM, Jensen ME, Jane JA, Dion JE (1997) Hemorrhagic complications in embolization of a meningioma: case report and review of the literature. Neuroradiology 39:877–880
Maiuri F, Donzelli R, de Divitiis O, Fusco M, Briganti F (1998) Anomalous meningeal branches of the ophthalmic artery feeding meningiomas of the brain convexity. Surg Radiol Anat 20:279–284
Manelfe C, Lasjaunias P, Ruscalleda J (1986) Preoperative embolization of intracranial meningiomas. AJNR Am J Neuroradiol 7:963–972
Probst EN, Grzyska U, Westphal M, Zeumer H (1999) Preoperative embolization of intracranial meningiomas with a fibrin glue preparation. AJNR Am J Neuroradiol 20:1695–1702
Yoon YS, Ahn JY, Chang JH, Cho JH, Suh SH, Lee BH, Lee KS (2008) Pre-operative embolisation of internal carotid artery branches and pial vessels in hypervascular brain tumours. Acta Neurochir (Wien) 150:447–452
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Law-ye, B., Clarençon, F., Sourour, NA. et al. Risks of presurgical embolization of feeding arteries in 137 intracranial meningeal tumors. Acta Neurochir 155, 707–714 (2013). https://doi.org/10.1007/s00701-013-1632-1
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DOI: https://doi.org/10.1007/s00701-013-1632-1