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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
    CrossrefPubMedSearch in Google Scholar
  • 2 Black P M. Meningiomas.  Neurosurgery. 1993;  32 643-657
    CrossrefPubMedSearch in Google 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
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    Search in 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
    Search in Google Scholar
  • 8 Cushing H. The meningiomas (dural endotheliomas): Their source, and favourite seats of origin.  Brain. 1922;  45 282-316
    PubMedSearch in Google 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
    PubMedSearch in Google 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
    PubMedSearch in Google 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
    PubMedSearch in Google 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
    PubMedSearch in Google 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
    Search in 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
    PubMedSearch in Google 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
    PubMedSearch in Google 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
    Search in 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
    Search in 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
    Search in 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
    Search in 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
    Search in 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
    PubMedSearch in Google 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
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google Scholar
  • 25 Macpherson P. The value of pre-operative embolization of meningioma estimated subjectively and objectively.  Neuroradiology. 1991;  33 334-337
    CrossrefPubMedSearch in Google 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
    PubMedSearch in Google Scholar
  • 27 Manelfe C, Lasjaunias P, Ruscalleda J. Preoperative embolization of intracranial meningiomas.  AJNR Am J Neuroradiol. 1986;  7 963-972
    PubMedSearch in Google Scholar
  • 28 Masters L T, Nelson P K. Preoperative angiography and embolization of petroclival meningiomas.  Intervent Neuroradiol. 1998;  4 209-221
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    Search in 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
    Search in 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
    Search in 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
    PubMedSearch in Google 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
    PubMedSearch in Google Scholar
  • 35 Richling B. Homologous controlled-viscosity fibrin for endovascular embolization.  Acta Neurochir (Wien). 1982;  62 159-170
    CrossrefPubMedSearch in Google Scholar
  • 36 Richter H P, Schachenmayer W. Preoperative embolization of intracranial meningiomas.  Neurosurgery. 1983;  13 261-268
    CrossrefPubMedSearch in Google 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
    PubMedSearch in Google 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
    Search in 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
    Search in 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
    Search in Google Scholar
  • 41 Simpson D. The recurrence of intracranial meningiomas after surgical treatment.  J Neurol Neurosurg Psychiatry. 1957;  20 22-39
    CrossrefPubMedSearch in Google Scholar
  • 42 Terada T, Kinoshita Y, Yokote H. Preoperative embolization of meningiomas fed by ophthalmic branch arteries.  Surg Neurol. 1996;  45 161-166
    CrossrefPubMedSearch in Google 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
    PubMedSearch in Google 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
    PubMedSearch in Google 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