Introduction
Meningiomas, benign tumours that develop in the meninges of the brain and spinal cord, can pose challenges during surgical removal. Preoperative embolization has emerged as a potential technique to facilitate the resection of difficult-to-remove meningiomas.
However, the optimal use and timing of this procedure remain subjects of debate due to concerns about associated morbidity. In this study, the authors utilise a large national database to examine the effects of immediate preoperative embolization on the immediate outcomes of meningioma resection. By investigating the impact of embolization on morbidity, mortality, and nonroutine discharge, the study aims to provide valuable insights into the role and risks associated with this intervention.
Objectives
Preoperative embolization of meningiomas can facilitate their resection when they are difficult to remove. The optimal use and timing of such a procedure remains controversial given the risk of embolization-linked morbidity in select clinical settings. In this work, the authors used a large national database to study the impact of immediate preoperative embolization on the immediate outcomes of meningioma resection.
Methods
The researchers identified meningioma patients who underwent elective resection by analysing the National (Nationwide) Inpatient Sample (NIS) spanning from 2002 to 2014.
Patients who underwent preoperative embolization were then matched using propensity scores to those who did not undergo the procedure, taking into account patient and hospital characteristics. The study investigated the associations between preoperative embolization and various outcomes, including morbidity, mortality, and nonroutine discharge
Results
Among 27,008 admissions that met the inclusion criteria, 633 patients (2.34%) underwent preoperative embolization, while 26,375 (97.66%) did not. The embolization group was characterised by younger age, lower proportion of females, higher Charlson Comorbidity Index, and higher disease severity.
After propensity score matching, a cohort of 413 embolization patients and 413 non embolization patients was analysed. The matched cohort revealed that preoperative embolization was associated with higher rates of cerebral edema, posthemorrhagic anaemia or transfusion, and nonroutine discharge. However, there was no significant difference in mortality between the two groups. Among embolization patients, the timing of resection did not impact the risk of in-hospital complications, suggesting that surgical timing can be determined based on surgeon discretion.
Conclusion
The study findings indicate that meningioma patients who undergo preoperative embolization exhibit higher rates of cerebral edema and nonroutine discharge compared to those who do not undergo embolization during the same admission.
However, the rates of stroke and death did not differ significantly. These results suggest that meningiomas requiring preoperative embolization represent a distinct clinical entity that necessitates prolonged and more complex care. Furthermore, the study suggests that the timing of surgery in embolization patients can be determined according to the surgeon’s judgement, as it does not impact the risk of in-hospital complications. These insights contribute to the ongoing discussion on the utilisation and timing of preoperative embolization in meningioma resection
Reference: Brandel, M.G., Rennert, R.C., Wali, A.R., Santiago-Dieppa, D.R., Steinberg, J.A., Ramos, C.L., Abraham, P., Pannell, J.S. and Khalessi, A.A., 2018. Impact of preoperative endovascular embolization on immediate meningioma resection outcomes. Neurosurgical Focus, 44(4), p.E6.>
Meningiomas, benign tumours that develop in the meninges of the brain and spinal cord, can pose challenges during surgical removal. Preoperative embolization has emerged as a potential technique to facilitate the resection of difficult-to-remove meningiomas.
However, the optimal use and timing of this procedure remain subjects of debate due to concerns about associated morbidity. In this study, the authors utilise a large national database to examine the effects of immediate preoperative embolization on the immediate outcomes of meningioma resection. By investigating the impact of embolization on morbidity, mortality, and nonroutine discharge, the study aims to provide valuable insights into the role and risks associated with this intervention.
Objectives
Preoperative embolization of meningiomas can facilitate their resection when they are difficult to remove. The optimal use and timing of such a procedure remains controversial given the risk of embolization-linked morbidity in select clinical settings. In this work, the authors used a large national database to study the impact of immediate preoperative embolization on the immediate outcomes of meningioma resection.
Methods
The researchers identified meningioma patients who underwent elective resection by analysing the National (Nationwide) Inpatient Sample (NIS) spanning from 2002 to 2014.
Patients who underwent preoperative embolization were then matched using propensity scores to those who did not undergo the procedure, taking into account patient and hospital characteristics. The study investigated the associations between preoperative embolization and various outcomes, including morbidity, mortality, and nonroutine discharge
Results
Among 27,008 admissions that met the inclusion criteria, 633 patients (2.34%) underwent preoperative embolization, while 26,375 (97.66%) did not. The embolization group was characterised by younger age, lower proportion of females, higher Charlson Comorbidity Index, and higher disease severity.
After propensity score matching, a cohort of 413 embolization patients and 413 non embolization patients was analysed. The matched cohort revealed that preoperative embolization was associated with higher rates of cerebral edema, posthemorrhagic anaemia or transfusion, and nonroutine discharge. However, there was no significant difference in mortality between the two groups. Among embolization patients, the timing of resection did not impact the risk of in-hospital complications, suggesting that surgical timing can be determined based on surgeon discretion.
Conclusion
The study findings indicate that meningioma patients who undergo preoperative embolization exhibit higher rates of cerebral edema and nonroutine discharge compared to those who do not undergo embolization during the same admission.
However, the rates of stroke and death did not differ significantly. These results suggest that meningiomas requiring preoperative embolization represent a distinct clinical entity that necessitates prolonged and more complex care. Furthermore, the study suggests that the timing of surgery in embolization patients can be determined according to the surgeon’s judgement, as it does not impact the risk of in-hospital complications. These insights contribute to the ongoing discussion on the utilisation and timing of preoperative embolization in meningioma resection
Reference: Brandel, M.G., Rennert, R.C., Wali, A.R., Santiago-Dieppa, D.R., Steinberg, J.A., Ramos, C.L., Abraham, P., Pannell, J.S. and Khalessi, A.A., 2018. Impact of preoperative endovascular embolization on immediate meningioma resection outcomes. Neurosurgical Focus, 44(4), p.E6.>
