Preoperative embolization of skull base meningiomas: A systematic review

•Preoperative embolization may facilitate resection of skull base meningiomas.•Based on pooled data, Simpson grade I-III resection was achieved in 74% of cases.•Pooled rates of major complication and mortality were 6% and 0.2%, respectively. Neoadjuvant endovascular embolization of skull base meningiomas may facilitate surgical resection, thereby potentially decreasing operative morbidity. However, due to variation in the reported efficacy and complication rates, the utility of embolization remains incompletely defined. The aim of this systematic review is to assess the outcomes of preoperative embolization for skull base meningiomas. A literature review was performed to identify studies reporting outcomes of patients with skull base meningiomas who underwent preoperative embolization. Baseline, treatment, and outcomes data were analyzed. Major complications included death, new cranial neuropathy, retinal artery ischemia, permanent neurologic deficit, or intracerebral hemorrhage. The pooled analysis consisted of 15 studies, comprising a total of 403 patients with skull base meningiomas treated with preoperative embolization. The most common locations were the sphenoid wing (34%, 87/256 cases), petroclival region (31%, 80/256 cases), and cavernous sinus (12%, 31/256 cases). The median tumor size ranged from 5.0 to 8.0 cm. Based on pooled data, angiographic absence of tumor blush was achieved in 17% (13/79 cases). The median estimated blood loss (EBL) ranged from 225 to 580 mL. Simpson grade I-III resection was achieved in 74% (40/54) of patients. The overall complication, major complication, and mortality rates were 12% (47/403 patients), 6% (21/328 patients), and 0.2% (1/403 patients), respectively. Preoperative embolization is a reasonable adjunct to resection for appropriately selected skull base meningiomas. Future comparative analyses are necessary to ascertain the benefits of preoperative embolization of skull base meningiomas with respect to extent of resection, operative duration, operative blood loss, and surgical morbidity.