Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
Clin Neuroradiol. 2023 Sep;33(3):755-762. doi: 10.1007/s00062-023-01272-4. Epub 2023 Feb 28.
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.
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.
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, I = 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, I = 66%), there was no difference in total combined major complications between the groups (OR: 0.57, CI: 0.27-1.18, P = 0.13, I = 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, I = 0%).
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.
术前栓塞（PE）治疗颅内脑膜瘤的效果尚不清楚，存在争议。本研究旨在通过对匹配队列研究进行荟萃分析来探讨 PE 对脑膜瘤手术切除的影响。
对匹配队列研究进行系统评价和荟萃分析，以评估 PE 对脑膜瘤切除和结局的影响。结局指标包括术中出血量、主要手术并发症、包括轻微并发症在内的总手术并发症、包括主要手术和栓塞并发症在内的总主要并发症、总总体并发症和术后功能独立性定义为改良 Rankin 量表（mRS）评分 0-2。通过固定效应模型确定汇总比值比（OR）。
共确定了 6 项匹配队列研究，其中 219 例接受栓塞治疗，215 例未接受栓塞治疗。两组患者术中出血量无显著差异（P=0.87）；然而，栓塞组主要手术相关并发症的发生风险显著降低（OR：0.37，95%置信区间，CI：0.21-0.67，P=0.0009，I=0%），但手术轻微并发症发生率无差异（P=0.86）。虽然栓塞病例的总手术和 PE 相关并发症总发生率的发生风险显著降低（OR：0.64，CI：0.41-1.0，P=0.05，I=66%），但两组总主要并发症发生率无差异（OR：0.57，CI：0.27-1.18，P=0.13，I=33%）。最后，PE 与术后随访时功能独立性的发生风险增加相关（OR：2.3，CI：1.06-5.02，P=0.04，I=0%）。
对于某些脑膜瘤，PE 可降低总并发症、降低主要手术并发症发生率，并提高功能独立性。需要进一步研究来确定从 PE 中受益的特定脑膜瘤亚组。
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