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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

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Abstract

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.

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Funding

There was no funding for this study.

Author information

Authors and Affiliations

  1. Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland

    Hans-Georg Wirsching, Corinne Morel & Michael Weller

  2. Department of Neuroradiology, University Hospital and University of Zurich, Zurich, Switzerland

    Johannes Konstantin Richter & Antonios Valavanis

  3. Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland

    Niklaus Krayenbuehl

  4. Department of Neuropathology, University Hospital and University of Zurich, Zurich, Switzerland

    Elisabeth Jane Rushing

  5. Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany

    Felix Sahm & Andreas von Deimling

  6. Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany

    Felix Sahm & Andreas von Deimling

  7. Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital and University of Bern, Bern, Switzerland

    Johannes Konstantin Richter

Authors
  1. Hans-Georg Wirsching
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Correspondence to Hans-Georg Wirsching.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the regional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. IRB No.: KEK-ZH-2014-0087.

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Wirsching, HG., Richter, J.K., Sahm, F. et al. 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. J Neurooncol 140, 659–667 (2018). https://doi.org/10.1007/s11060-018-2996-0

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  • DOI: https://doi.org/10.1007/s11060-018-2996-0

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