E-071 Preoperative embolization of meningiomas with onyx liquid embolic agent: case series and systematic review of literature. (23rd July 2022)

• Record Type: Journal Article
• Authors: Cappuzzo, J; Monteiro, A; Waqas, M; Ghannam, M; Khawar, W; Khan, A; Siddiqui, A; Levy, E
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A113
• Page End: A114
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.182
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Introduction: Multiple embolic agents have been used for preoperative tumor embolizations. Recently, the liquid embolic agent Onyx (Medtronic), initially designed for arteriovenous malformations, have also been used to perform preoperative embolization of tumors with promising performance. In the current study, we report our experience with the use of Onyx for preoperative embolization of meningiomas, aiming to evaluate its efficacy and safety. We also perform a systematic review of literature on this topic. Methods: We included patients who underwent preoperative embolization with Onyx exclusively. Other embolic agents were excluded. Demographic information, procedural details, complications and outcomes were collected. We performed a comprehensive systematic search of PubMED, EMBASE and MEDLINE databases from their dates of inception to February 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and using keywords combined with Boolean operators to increase search sensitivity and specificity ('meningioma'; 'embolization'; 'onyx'). We included articles reporting embolization of meningiomas with the use of Onyx alone. Results: Twenty-six patients were included: Mean age was 58.1 years (SD± 11.9) and 61.5% were female. Tumor location was parasagittal in 61.5%, parietal convexity in 19.2%, sphenoid wing in 11.5%, and cerebellar convexity in 3.8%. Seventeen (65.4%) meningiomas were >4cm. Seventeen (65.4%) meningiomas were WHO grade I and 9 (34.6%) were WHO grade II. The origin of arterial feeders was the ECA in 96.2% and both ECA and ICA in 3.8%. Target arterial pedicles were the middle meningeal artery (MMA) alone in 80.8%, the occipital artery alone in 3.8%, the internal maxillary artery (IMA) alone in 3.8%, both the IMA and infero-lateral trunk (of the ICA) in 3.8%, and both the IMA and superficial temporal arteries in 7.7%. Onyx 18 was used in 84.6%, Onyx 34 in 11.5%, and a both Onyx 18 and Onyx 34 in 3.8%. All target arterial pedicles were successfully embolized (100%) without any intraprocedural complications. There were no complications between the embolization procedure and surgical resection. Median estimated blood loss volume was 200 mL (IQR 100–350). Gross total resection was achieved in 20 patients (76.9%). Tumor necrosis was observed in 50% of tumors. In our systematic review, only 5 studies were included, comprising 54 patients. The information extracted from these studies is summarized on Table 1 . Conclusions: Preoperative embolization of meningiomas with Onyx alone was successful in all of our cases without any intraprocedural or post-procedural complications. Improved control with this embolic agent, in association with a preference for ECA targets, played major role in the safety achieved in our study. There is limited evidence in literature evaluating Onyx in the preoperative embolization of meningiomas and no direct comparisons with other embolic agents.Disclosures J. Cappuzzo: None. A. Monteiro: None. M. Waqas: None. M. Ghannam: None. W. Khawar: None. A. Khan: None. A. Siddiqui: 2; C; Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus, Cerevatech Medical, Inc., . 4; C; Adona Medical, Inc., Amnis Therapeutics, Bend IT Technologies, Ltd., BlinkTBI, Inc, Buffalo Technology Partners, Inc., Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, Cerevatech Medical, . E. Levy: 2; C; Claret Medical, GLG Consulting, Guidepoint Global, Imperial Care, Medtronic, Rebound, StimMed, Misionix, Mosiac, Clarion, IRRAS.. 4; C; NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, Three Rivers Medical.