Preoperative embolization versus no embolization for WHO grade I intracranial meningioma: a retrospective matched cohort study
| Autor: | Nader Sanai, Jacob F Baranoski, Andrew F. Ducruet, Leandro Borba Moreira, Felipe C. Albuquerque, Kristina Chapple, Peter Nakaji, Kaith K. Almefty, Xiaochun Zhao, Colin J. Przybylowski, Andrew S. Little, Sirin Gandhi |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment World Health Organization Cohort Studies Meningioma 03 medical and health sciences Postoperative Complications 0302 clinical medicine Modified Rankin Scale medicine.artery Preoperative Care medicine Humans Dimethyl Sulfoxide Embolization Propensity Score Aged Brain Neoplasms business.industry General Medicine Perioperative Middle Aged medicine.disease Embolization Therapeutic Surgery Treatment Outcome 030220 oncology & carcinogenesis Middle cerebral artery Propensity score matching Female Polyvinyls Internal carotid artery Intracranial meningioma business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Journal of Neurosurgery. 134:693-700 |
| ISSN: | 1933-0693 0022-3085 |
| DOI: | 10.3171/2020.1.jns19788 |
| Popis: | OBJECTIVEThe controversy continues over the clinical utility of preoperative embolization for reducing tumor vascularity of intracranial meningiomas prior to resection. Previous studies comparing embolization and nonembolization patients have not controlled for detailed tumor parameters before assessing outcomes.METHODSThe authors reviewed the cases of all patients who underwent resection of a WHO grade I intracranial meningioma at their institution from 2008 to 2016. Propensity score matching was used to generate embolization and nonembolization cohorts of 52 patients each, and a retrospective review of clinical and radiological outcomes was performed.RESULTSIn total, 52 consecutive patients who underwent embolization (mean follow-up 34.8 ± 31.5 months) were compared to 52 patients who did not undergo embolization (mean follow-up 32.8 ± 28.7 months; p = 0.63). Variables controlled for included patient age (p = 0.82), tumor laterality (p > 0.99), tumor location (p > 0.99), tumor diameter (p = 0.07), tumor invasion into a major dural sinus (p > 0.99), and tumor encasement around the internal carotid artery or middle cerebral artery (p > 0.99). The embolization and nonembolization cohorts did not differ in terms of estimated blood loss during surgery (660.4 ± 637.1 ml vs 509.2 ± 422.0 ml; p = 0.17), Simpson grade IV resection (32.7% vs 25.0%; p = 0.39), perioperative procedural complications (26.9% vs 19.2%; p = 0.35), development of permanent new neurological deficits (5.8% vs 7.7%; p = 0.70), or favorable modified Rankin Scale (mRS) score (a score of 0–2) at last follow-up (96.0% vs 92.3%; p = 0.43), respectively. When comparing the final mRS score to the preoperative mRS score, patients in the embolization group were more likely than patients in the nonembolization group to have an improvement in mRS score (50.0% vs 28.8%; p = 0.03).CONCLUSIONSAfter controlling for patient age, tumor size, tumor laterality, tumor location, tumor invasion into a major dural sinus, and tumor encasement of the internal carotid artery or middle cerebral artery, preoperative meningioma embolization intended to decrease tumor vascularity did not improve the surgical outcomes of patients with WHO grade I intracranial meningiomas, but it did lead to a greater chance of clinical improvement compared to patients not treated with embolization. |
| Databáze: | OpenAIRE |
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