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28.02.2023 | Original Article

Preoperative Embolization of Meningiomas Facilitates Reduced Surgical Complications and Improved Clinical Outcomes

A Meta-analysis of Matched Cohort Studies

verfasst von: Derrek Schartz, Taylor Furst, Nathaniel Ellens, Gurkirat Singh Kohli, Redi Rahmani, Sajal Medha K. Akkipeddi, Tyler Schmidt, Tarun Bhalla, Thomas Mattingly, Matthew T. Bender

Erschienen in: Clinical Neuroradiology | Ausgabe 3/2023

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Abstract

Purpose

The utility of preoperative embolization (PE) of intracranial meningiomas is unclear and controversial. The aim of this study was to investigate the effect of PE on meningioma surgical resection by completing a meta-analysis of matched cohort studies.

Methods

A systematic review and meta-analysis of matched cohort studies was completed to evaluate the effect of PE on meningioma resection and outcomes. Outcome measures included: intraoperative blood loss, major surgical complications, total surgical complications including minor ones, total major complications including major surgical and embolization complications, total overall complications, and postoperative functional independence defined as modified Rankin Score (mRS) of 0–2. Pooled odds ratios (OR) were determined via a fixed effects model.

Results

A total of 6 matched cohort studies were identified with 219 embolized and 215 non-embolized meningiomas. There was no significant difference in intraoperative blood loss between the two groups (P = 0.87); however, the embolization group had a significantly lower odds ratio of major surgically related complications (OR: 0.37, 95% confidence interval, CI: 0.21–0.67, P = 0.0009, I² = 0%), but no difference in minor surgical complications (P = 0.86). While there was a significantly lower odds ratio of total overall surgical and PE-related complications in PE cases (OR: 0.64, CI: 0.41–1.0, P = 0.05, I² = 66%), there was no difference in total combined major complications between the groups (OR: 0.57, CI: 0.27–1.18, P = 0.13, I² = 33%). Lastly, PE was associated with a higher odds ratio of functional independence on postoperative follow-up (OR: 2.3, CI: 1.06–5.02, P = 0.04, I² = 0%).

Conclusion

For certain meningiomas, PE facilitates lower overall complications, lower major surgical complications, and improved functional independence. Further research is required to identify the particular subset of meningiomas that benefit from PE.

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Titel: Preoperative Embolization of Meningiomas Facilitates Reduced Surgical Complications and Improved Clinical Outcomes
A Meta-analysis of Matched Cohort Studies
verfasst von: Derrek Schartz
Taylor Furst
Nathaniel Ellens
Gurkirat Singh Kohli
Redi Rahmani
Sajal Medha K. Akkipeddi
Tyler Schmidt
Tarun Bhalla
Thomas Mattingly
Matthew T. Bender
Publikationsdatum: 28.02.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Neuroradiology / Ausgabe 3/2023
Print ISSN: 1869-1439
Elektronische ISSN: 1869-1447
DOI: https://doi.org/10.1007/s00062-023-01272-4

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Preoperative Embolization of Meningiomas Facilitates Reduced Surgical Complications and Improved Clinical Outcomes

A Meta-analysis of Matched Cohort Studies