Post-operative cardiovascular complications and time to recurrence in meningioma patients treated with versus without pre-operative embolization: a retrospective cohort study of 741 patients.

Wirsching, Hans-Georg; Richter, Johannes Konstantin; Sahm, Felix; Morel, Corinne; Krayenbuehl, Niklaus; Rushing, Elisabeth Jane; von Deimling, Andreas; Valavanis, Antonios; Weller, Michael (2018). Post-operative cardiovascular complications and time to recurrence in meningioma patients treated with versus without pre-operative embolization: a retrospective cohort study of 741 patients. Journal of neuro-oncology, 140(3), pp. 659-667. Springer 10.1007/s11060-018-2996-0

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PURPOSE Preoperative embolization of radiographically suspected meningiomas is often performed to facilitate tumor resection. Its effects on the subsequent disease course of meningioma patients have not been studied in detail and randomized trials are lacking. The purpose of this study was to explore associations of preoperative meningioma embolization with postoperative outcome. PATIENTS AND METHODS Patients undergoing resection of an intracranial meningioma at the University Hospital Zurich 2000-2013 (N = 741) were reviewed for the inclusion of pre-operative embolization in the management strategy. Annotations included demographics, radiographic, surgical, histological and hematological parameters, cardiovascular risk factors, pre- and postoperative neurological function and gene methylation-based classification. Binary regression and Cox proportional hazards models were applied to determine factors associated with outcome. RESULTS Pre-operative embolization was performed in 337 patients (42%). Cardiovascular events after surgery comprised mostly deep vein thrombosis (N = 39) and pulmonary embolisms (N = 64). On multivariate analyses of post-operative cardiovascular adverse events controlling for established risk factors, there were associations with embolization (OR 2.38, 95% CI 1.37-4.00), and with female gender (OR 2.18, 95% CI 1.17-4.08). Recurrence-free survival (RFS) of embolized patients was less favorable among patients with WHO grade II or grade III meningiomas (median RFS: 4.3 vs. 7.0 years, P = 0.029) or in patients with intermediate or malignant gene methylation subtype meningiomas (median RFS: 2.0 vs. 8.2 years, P = 0.005). CONCLUSION Pre-operative meningioma embolization may cause adverse outcomes. Randomized trials to determine benefit-risk ratios are warranted to clarify the role of pre-operative embolization for the treatment of meningioma patients.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Richter, Johannes Konstantin

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0167-594X

Publisher:

Springer

Language:

English

Submitter:

Santa Bertina Schiaroli

Date Deposited:

15 Nov 2018 13:30

Last Modified:

01 Dec 2018 01:32

Publisher DOI:

10.1007/s11060-018-2996-0

PubMed ID:

30196368

Uncontrolled Keywords:

Embolism Embolization Meningioma Post-operative Recurrence Thrombosis

BORIS DOI:

10.7892/boris.121258

URI:

https://boris.unibe.ch/id/eprint/121258

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