Preoperative embolization of meningiomas: Comparison of superselective and subselective techniques

We retrospectively compared the efficacy of preoperative superselective and subselective embolization for intracranial meningiomas. Between January and December 1996, 22 patients (7 men, 15 men, mean age 51 ± 15.5 yr) underwent superselective embolization with 45 to 150 mm polyvinyl alcohol particles after superselective catheterization of the feeding vessels with a microcatheter system. Another 30 patients (12 men, 18 women, mean age 50 ± 12.9 yr) underwent subselective embolization between January and December 1995 with 150 to 300 mm Gelfoam particles after catheterization of the terminal external carotid artery just proximal to the orifice of the maxillary artery with a 4- or 5-F angiocatheter. The mean intraoperative blood loss (918 versus 1450 mL, p < 0.05), amount of blood transfused (4.9 versus 7.5 units, p = 0.09), and surgical resection time (422 versus 529 min, p < 0.05) were all lower in the superselective group than in the subselective group, while the occurrence of fresh ischemic necrosis (59% versus 53%, p = 0.68), hemorrhage (77% versus 60%, p = 0.19), and embolic material (55% versus 13%, p < 0.05) on pathologic examination were higher in the superselective group. No procedure-related complications occurred in the superselective group, whereas two patients in the subselective group had postoperative scalp necrosis. Our findings show that superselective embolization is more effective than subselective embolization for preoperative endovascular devascularization of meningiomas, with significant reductions in intraoperative blood loss and surgery time. Preoperative embolization of meningiomas, if indicated, should be done with the superselective technique whenever feasible.