Arterial Embolization for Intracranial Meningiomas: A Systematic Review and Meta-analysis

Introduction: The indications and principles governing preoperative embolization of meningiomas remain unclear. Existing evidence primarily comprises retrospective case series, offering valuable insights into procedural guidance and technical considerations. This study systematically reviews the literature on the safety, efficacy, and outcomes of preoperative embolization of meningiomas.

Methods: PubMed and EmBase were queried for studies discussing the embolization of meningiomas in five or more patients. Studies meeting inclusion criteria were extracted for patient demographics, meningioma location, arterial feeders, interval between embolization and resection, and procedural complications. Meta-analysis was carried out for variables reported by ≥3 studies on R version-4.3.2.

Results: Seventy-three studies reporting 4899 patients met the inclusion criteria. The mean age was 56.8 years [55.7-57.9] with 66% [64-68%] female representation. Tumor locations included combined skull base in 12% [8-18%], cortical in 24% [19-31%], tentorial in 3.8% [2.6-5.5%], and parasagittal in 19% [16-22%]. Meningiomas were primary in 98.5% [97.8-98.9%] of cases. Histologically, 75% [69-81%] were WHO Grade I, 20% [15-25%] WHO Grade II, and 4.3% [3.3-5.5%] WHO Grade III. The primary tumor artery was the ECA in 85% [75-92%] of cases. The two most common feeder arteries were the MMA in 62% [53-69%], and the OcA in 7.4% [5.6-9.8%]. Conscious sedation was used in 76% [45-92%] of procedures with femoral access in 98.6% [97.8-99.1%]. Liquid embolics were used in 13% [6-26%] of procedures, particle embolics in 82% [66-91%], and coils in 3.3% [2.1-5.4%]. Procedural success was achieved in 98% [96-99%] of cases. Post-procedural ischemic complications occurred in 1.8% [1.4-2.4%] and hemorrhagic complications in 2.1% [1.6-2.8%]. After embolization, 97% [95-98%] of patients underwent tumor resection, with a mean interval of 3.4 days [3.3-3.5] between procedures. Following resection, ischemic complications occurred in 2.0% [1.4-3.0%] of patients and hemorrhagic complications in 1.8% [1.2-2.7%].

Conclusion : Preoperative embolization of meningiomas is a safe and effective procedure.