Embolization of meningiomas: comparison of safety between calibrated microspheres and polyvinyl-alcohol particles as embolic agents

• Published in: American journal of neuroradiology : AJNR 2013-04, Vol.34 (4), p.727-729
• Main Authors: Sluzewski, M, van Rooij, W J, Lohle, P N, Beute, G N, Peluso, J P
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Brain Ischemia - prevention & control; Calibration; Cerebral Hemorrhage - prevention & control; Cohort Studies; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Female; Humans; Male; Meningeal Neoplasms - therapy; Meningioma - therapy; Microspheres; Middle Aged; Particle Size; Patient Safety; Polyvinyl Alcohol - therapeutic use
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a3311

During embolization of meningiomas, intratumoral hemorrhagic complications may occur, especially with the use of small particle sizes. We compared the rate of hemorrhagic complications in 55 patients embolized with 400-μm calibrated microspheres (Embozene) with a historical cohort of 198 patients embolized with smaller PVA particles. Between September 2009 and February 2012, fifty-five patients with 55 meningiomas were embolized with 400-μm calibrated microspheres. Indications for embolization were preoperative in 47 and before radiosurgery in 2 patients; and in 6 patients, embolization was offered as sole therapy. There were 35 women and 20 men with a mean age of 60.3 years. Mean meningioma diameter was 53 mm (range, 23-97 mm). Hemorrhagic complications were recorded. There were no hemorrhagic complications in the 55 embolized patients (0%; 95% CI, 0.0%-7.8%). The difference in complication rates between 400-μm calibrated microspheres in this study (0 of 55, 0%) and small PVA particles (45-150 μm) in the historical cohort (9 of 108, 8.3%) was just short of significance (P=.066). The difference in complication rates between 400-μm calibrated microspheres (0 of 55, 0%) and larger PVA particles (150-250 μm) in the historical cohort (1 of 93, 1.1%) was not significant (P=.8). In this series, embolization of meningiomas by using large (400-μm) calibrated microspheres did not result in any hemorrhagic complications.