Preoperative Embolization of Skull Base Meningiomas: Outcomes in the Onyx Era

Authors

Colin J. PrzybylowskiFollow
Jacob F. BaranoskiFollow
Alfred P. See
Bruno C. Flores
Rami O. Almefty, Barrow Neurological InstituteFollow
Dale Ding
Kristina M. ChappleFollow
Nader Sanai, Barrow Neurological InstituteFollow
Andrew F. Ducruet, Barrow Neurological InstituteFollow
Felipe C. Albuquerque, Barrow Neurological InstituteFollow

Department

neurosurgery

Document Type

Article

Abstract

Objective: Preoperative embolization may facilitate skull base meningioma resection, but its safety and efficacy in the Onyx era have not been investigated. In this retrospective cohort study, we evaluated the outcomes of preoperative embolization of skull base meningiomas using Onyx as the primary embolysate. Methods: We queried an endovascular database for patients with skull base meningiomas who underwent preoperative embolization at our institution in 2007–2017. Patient, tumor, procedure, and outcome data were analyzed. Results: Twenty-eight patients (28 meningiomas) underwent successful preoperative meningioma embolization. The mean patient age ± SD was 56 ± 13 years, and 18 patients (64%) were women. The mean tumor size was 49 cm3. There were 1, 2, or 3 arterial pedicles embolized in 21 cases (75%), 6 cases (21%), and 1 case (4%), respectively. The embolized pedicles included branches of the middle meningeal artery in 19 cases (68%), the internal maxillary artery in 8 cases (29%), the ascending pharyngeal artery in 2 cases (7%), and the posterior auricular, ophthalmic, occipital, and anterior cerebral arteries in 1 case each (4%). The embolysates used were Onyx alone in 20 cases (71%), n-butyl cyanoacrylate alone in 3 cases (11%), coils/particles and Onyx/n-butyl cyanoacrylate in 2 cases each (7%), and Onyx and coils in 1 case (4%). The median degree of tumor devascularization was 60%. Significant neurologic morbidity occurred in 1 patient (4%) who developed symptomatic peritumoral edema after Onyx embolization. Conclusions: For appropriately selected skull base meningiomas supplied by dura mater–based arterial pedicles without distal cranial nerve supply, preoperative embolization with current embolysate technology affords substantial tumor devascularization with a low complication rate.

Publication Date

2018

Publication Title

World Neurosurgery

ISSN

1878-8750

Volume

116

First Page

e371

Last Page

e379

Digital Object Identifier (DOI)

10.1016/j.wneu.2018.04.208

Recommended Citation

Przybylowski, Colin J.; Baranoski, Jacob F.; See, Alfred P.; Flores, Bruno C.; Almefty, Rami O.; Ding, Dale; Chapple, Kristina M.; Sanai, Nader; Ducruet, Andrew F.; and Albuquerque, Felipe C., "Preoperative Embolization of Skull Base Meningiomas: Outcomes in the Onyx Era" (2018). Neurosurgery. 336.
https://scholar.barrowneuro.org/neurosurgery/336