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Minim Invasive Neurosurg 2000; 43(1): 18-29
DOI: 10.1055/s-2000-8812
ORIGINAL PAPER
Georg Thieme Verlag Stuttgart · New York

Preoperative Embolization of Intracranial Meningiomas:A 17-Years Single Center Experience

A. Gruber1 , M. Killer1 , P. Mazal 2 , G. Bavinzski1 , B. Richling1
  • 1 Department of Neurosurgery, University of Vienna Medical School, Vienna, Austria
  • 2 Institute of Neurology, University of Vienna Medical School, Vienna, Austria
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Publication History

Publication Date:
31 December 2000 (online)

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The purpose of the present report is to review the evolution of endovascular therapy at our center as utilized for the preoperative embolization of intracranial meningiomas over a 17-years period (1982 - 1998). This study is based upon a consecutive series of 63 patients who underwent preoperative embolization of intracranial meningiomas. Total or subtotal angiographic devascularization of the tumor parenchyma was accomplished in 38 patients (60.3 %) who had tumors with either an external carotid artery supply only (n = 30) or with contributions from the cavernous carotid artery, ophthalmic artery, vertebral artery, or pial feeders which were feasible for selective embolization (n = 8). Partial tumor embolizations were attained in the remaining 25 patients (39.7 %) because

  1. the remanent feeders were considered easily accessible to surgical control in the early stages of dissection,

  2. the feeding branches were inaccessible for a microcatheter approach, or

  3. superselective microcatheter positions allowing for safe embolization without reflux of embolic material into physiological branches were not achieved.

Overall, 97 of 126 tumor feeders identified angiographically were catheterized to selective embolization (77 %). Three embolization related complications occurred early in our experience (1982 - 1989) using techniques which no longer meet standards of treatment. In light of the remarkable evolution of endovascular techniques over the 17-years study period, however, we conclude that preoperative embolization of intracranial meningiomas can be performed safely with the endovascular tools currently available.

Key words:

Meningioma - Microsurgery - Preoperative embolization

References

  • 1 Adegbite R A, Kahn M I, Paine K W. et al . The recurrence of intracranial meningiomas after surgical treatment.  J Neurosurg. 1983;  58 51-56
    CrossrefPubMedGoogle Scholar
  • 2 Black P M. Meningiomas.  Neurosurgery. 1993;  32 643-657
    CrossrefPubMedGoogle Scholar
  • 3 Brothers M F, Kaufmann J CE, Fox A J, Deveikis J P. n-Butyl 2-cyanoacrylate-substitute for IBCA in interventional neuroradiology: histopathologic and polymerization time studies.  AJNR Am J Neuroradiol. 1989;  10 777-786
    PubMedGoogle Scholar
  • 4 Capo H, Kuppersmith M J, Berenstein A, Choi I S, Diamond G A. The clinical importance of the inferolateral trunk of the internal carotid artery.  Neurosurgery. 1991;  28 733-738
    CrossrefPubMedGoogle Scholar
  • 5 Chan R C, Thompson G B. Morbidity, mortality and quality of life following surgery for intracranial meningiomas: A retrospective study in 257 cases.  J Neurosurg. 1984;  60 52-60
    CrossrefPubMedGoogle Scholar
  • 6 Chen T C, Rabb C, Apuzzo M LJ. Complex technical methodologies and their applications in the surgery of intracranial meningiomas. In: Winn, RH et al (eds) Neurosurgery Clinics of North America. W.B. Saunders Company 1994 Vol 5 (2): 261-281
    Google Scholar
  • 7 Cushing H, Eisenhardt L. In: Springfield, I Meningiomas. Their classification, regional behavior, life history, and surgical results. Charles C. Thomas 1938 11
    Google Scholar
  • 8 Cushing H. The meningiomas (dural endotheliomas): Their source, and favourite seats of origin.  Brain. 1922;  45 282-316
    PubMedGoogle Scholar
  • 9 Dean B L, Flom R A, Wallace R C, Khayata M H, Obuchowski N A, Hodak J A, Zabramski J M, Spetzler R F. Efficacy of endovascular treatment of meningiomas: evaluation with matched samples.  AJNR Am J Neuroradiol. 1994;  15 1675-1680
    PubMedGoogle Scholar
  • 10 Gruber A, Mazal P R, Bavinzski G, Killer M, Budka H, Richling B. Repermeation of partially embolized cerebral arteriovenous malformations: a clinical, radiologic, and histologic study.  AJNR Am J Neuroradiol. 1996;  17 1323-1331
    PubMedGoogle Scholar
  • 11 Gruber A, Bavinzski G, Killer M, Richling B. Preoperative embolization of hypervascular skull base tumors. Minim Invas Neurosurg (MIN) (accepted)
  • 12 Jaaskelainen J. Seemingly complete removal of histologically benign intracranial meningioma: Late recurrence rate and factors predicting recurrence in 657 patients.  Surg Neurol. 1986;  26 461-469
    PubMedGoogle Scholar
  • 13 Kaufman S L, Strandberg J D, Barth K H, White Jr R I. Transcatheter embolization with microfibrillar collagen in swine.  Invest Radiol. 1978;  13 200-204
    PubMedGoogle Scholar
  • 14 Kleihues P, Burger P C, Scheithauer B W. Histological typing of tumours of the central nervous system. World Health Organization International Histological Classification of Tumours. 2nd edition. Springer Verlag 1993
    Google Scholar
  • 15 Kolles H, Niedermayer I, Schmitt C, Henn W, Feld R, Steudel W I, Zang K D, Feiden W. Triple approach for diagnosis and grading of meningiomas: histology, morphometry of Ki-67/Feulgen stainings, and cytogenetics.  Acta Neurochir (Wien). 1995;  137 174-181
    PubMedGoogle Scholar
  • 16 Kumar A J, Kaufman S L, Patt J, Posey J B, Maxwell D D, White Jr R I. Preoperative embolization of hypervascular head and neck neoplasms using microfibrillar collagen.  AJNR Am J Neuroradiol. 1982;  3 163-168
    PubMedGoogle Scholar
  • 17 Lasjaunias P, Brugge K T, Chiu M, Ibor L L. Embolization and balloon occlusion techniques in the management of cranial base tumours. In: Shekar, LN, Schramm Jr, VL (eds) Tumors of the cranial base. Diagnosis and treatment. New York; Futura Publishing Company Inc 1987: 95-104
    Google Scholar
  • 18 Lasjaunias P, Berenstein A. The transosseous peripheral nervous system arterial supply. In: Lasjaunias, P, Berenstein, A (eds) Surgical Neuroangiography, part 1, functional anatomy of craniofacial arteries. Wien New York; Springer 1987: 221-237
    Google Scholar
  • 19 Lasjaunias P, Berenstein A. Dangerous vessels. In: Lasjaunias, P, Berenstein, A (eds) Surgical Neuroangiography, part 1, functional anatomy of craniofacial arteries. Springer Wien New York; 1987: 239-244
    Google Scholar
  • 20 Lasjaunias P, Berenstein A. Dural and bony tumours. In: Lasjaunias, P, Berenstein, A (eds) Surgical Neuroangiography, part 2, endovascular treatment of craniofacial lesions. Wien New York; Springer 1987: 57-99
    Google Scholar
  • 21 Lasjaunias P, Berenstein A. Technical aspects of surgical neuroangiography. In: Lasjaunias, P, Berenstein, A (eds) Surgical Neuroangiography, part 2, endovascular treatment of craniofacial lesions. Wien New York; Springer 1987: 1-56
    Google Scholar
  • 22 Latchaw R E, Gold L A. Polyvinyl foam embolization of vascular and neoplastic lesions of the head, neck, and spine.  Radiology. 1979;  131 669-679
    PubMedGoogle Scholar
  • 23 Latchaw R E. Preoperative intracranial meningioma embolization: technical considerations affecting the risk-to-benefit ratio.  AJNR Am J Neuroradiol. 1993;  14 583-586
    PubMedGoogle Scholar
  • 24 Lylyk P, Vinuela F, Vinters H V, Dion J, Duckwiler C, Lin T. Use of a new mixture for embolization of intracranial vascular malformations.  Neuroradiology. 1990;  32 304-310
    CrossrefPubMedGoogle Scholar
  • 25 Macpherson P. The value of pre-operative embolization of meningioma estimated subjectively and objectively.  Neuroradiology. 1991;  33 334-337
    CrossrefPubMedGoogle Scholar
  • 26 Maier H, Ofner D, Hittmair A, Kitz K, Budka H. Classic, atypical, and anaplastic meningioma: three histopathological subtypes of clinical relevance.  J Neurosurg. 1992;  77 616-623
    PubMedGoogle Scholar
  • 27 Manelfe C, Lasjaunias P, Ruscalleda J. Preoperative embolization of intracranial meningiomas.  AJNR Am J Neuroradiol. 1986;  7 963-972
    PubMedGoogle Scholar
  • 28 Masters L T, Nelson P K. Preoperative angiography and embolization of petroclival meningiomas.  Intervent Neuroradiol. 1998;  4 209-221
    PubMedGoogle Scholar
  • 29 McDermott M W, Rootman J, Durity F A. Subperiosteal, subperiorbital dissection and division of the anterior and posterior ethmoidal arteries for meningiomas of the cribriform plate and planum sphenoidale: technical note.  Neurosurgery. 1995;  36 1215-1219
    CrossrefPubMedGoogle Scholar
  • 30 Miller D C. Predicting recurrence of intracranial meningiomas: a multivariate clinicopathologic model - interim report of the New York University Medical Center meningioma project. In: Winn, RH et al (eds) Neurosurgery Clinics of North America. W. B. Saunders Company 1994 Vol 5 (2): 193-200
    Google Scholar
  • 31 Nelson P K, Setton A, Choi I S, Ransohoff J, Berenstein A. Current status of interventional neuroradiology in the management of meningiomas. In: Winn, RH et al (eds) Neurosurgery Clinics of North America. W. B. Saunders Company 1994 Vol 5 (2): 235-259
    Google Scholar
  • 32 Ojemann R G, Swann K W. Meningiomas of the anterior cranial base. In: Shekar, LN, Schramm Jr, VL (eds) Tumors of the cranial base. Diagnosis and treatment. Futura Publishing Company Inc. New York; 1987: 279-294
    Google Scholar
  • 33 Porstman W, Wiemy L, Warnke H. Catheter closure of patent ductus arteriosus: 62 cases treated without thoracotomy.  Radiol Clin North Am. 1971;  9 203-218
    PubMedGoogle Scholar
  • 34 Reisch R, Vutskits L, Patonay L, Fries G. The meningohypophyseal trunk and its blood supply to different intracranial structures.  Minim Invas Neurosurg (MIN). 1996;  39 78-81
    PubMedGoogle Scholar
  • 35 Richling B. Homologous controlled-viscosity fibrin for endovascular embolization.  Acta Neurochir (Wien). 1982;  62 159-170
    CrossrefPubMedGoogle Scholar
  • 36 Richter H P, Schachenmayer W. Preoperative embolization of intracranial meningiomas.  Neurosurgery. 1983;  13 261-268
    CrossrefPubMedGoogle Scholar
  • 37 Salamon G, Guerinel G, Combalbert A, Faure J J, Giudicelli G. Etude arteriographique des meningimes intracraniens. Correlations radio-anatomiques.  Ann Radiol (Paris). 1969;  12 661-679
    PubMedGoogle Scholar
  • 38 Shekar L N, Babu R P, Wright D C. Surgical resection of cranial base meningiomas. In: Winn, RH et al (eds) Neurosurgery Clinics of North America. WB Saunders Company 1994 Vol 5 (2): 299-330
    Google Scholar
  • 39 Shekar L N. The exposure, preservation, and reconstruction of cerebral arteries and veins during the resection of cranial base tumours. In: Shekar, LN, Schramm Jr., VL (eds) Tumors of the cranial base. Diagnosis and treatment. New York; Futura Publishing Company Inc 1987: 213-226
    Google Scholar
  • 40 Shekar L N. Preservation and reconstruction of cranial nerves during removal of cranial base neoplasms. In: Shekar, LN, Schramm Jr., VL (eds) Tumors of the cranial base. Diagnosis and treatment. New York; Futura Publishing Company Inc 1987: 213-226
    Google Scholar
  • 41 Simpson D. The recurrence of intracranial meningiomas after surgical treatment.  J Neurol Neurosurg Psychiatry. 1957;  20 22-39
    CrossrefPubMedGoogle Scholar
  • 42 Terada T, Kinoshita Y, Yokote H. Preoperative embolization of meningiomas fed by ophthalmic branch arteries.  Surg Neurol. 1996;  45 161-166
    CrossrefPubMedGoogle Scholar
  • 43 van Halbach V, Higashida R T, Hieshima G B, Hardin C W. Embolization of branches arising from the cavernous portion of the internal carotid artery.  AJNR Am J Neuroradiol. 1989;  10 143-150
    PubMedGoogle Scholar
  • 44 Wakhloo A K, Juengling F D, van Velthoven V, Schumacher M, Henning J, Schwechheimer K. Extended preoperative polyvinyl alcohol microembolization of intracranial meningiomas: assessment of two different embolization techniques.  AJNR Am J Neuroradiol. 1993;  14 571-582
    PubMedGoogle Scholar

Corresponding Author

C. M. Andreas Gruber

Department of Neurosurgery University of Vienna Medical School

Waehringer Guer18-20

A-1090 Vienna

Austria

Phone: +43-1-40400-4560

Fax: +43-1-40400-4566