Evaluating the effectiveness of preoperative embolization for meningioma with pial feeders: Analysis of perfusion magnetic resonance imaging.

Background and purposeMeningiomas often contain a pial supply, and devascularization through preoperative transarterial embolization (TAE) is useful. However, the efficacy indicators of TAE for meningiomas with pial feeders remain unclear owing to their challenging quantification. Therefore, we propose a practical and quantitative intratumoral cerebral blood volume (CBV) from the pial supply, called pial-nCBV. This study aimed to identify the efficacy indicators of TAE against meningiomas in pial feeders using pial-nCBV.Materials and methodsBetween 2015 and 2021, 25 patients who underwent preoperative TAE and perfusion magnetic resonance imaging (MRI) for meningiomas with pial feeders were included in the study. We set 5 mm diameter round Region Of Interests as many as possible within the tumor at the border with the brain parenchyma, and calculated the intratumoral CBV from pial supply. The reduction rate was defined as primary outcome, termed Δ pial-nCBV. Additionally, we collected data on the injection behavior of the n-Butyl-Cyanoacrylate (n-BCA), including intratumoral embolization (IE) and feeder occlusion. We then analyzed the association between each variable and Δ pial-nCBV.ResultsThe median Δ pial-nCBV was 25%. The n-BCA was applied in 22 (88%) cases, of which nine (36%) cases were injected into pial feeders. The use of n-BCA (p = .037), treatment with pial feeders (p = .002), and IE in meningeal feeders (p = .049) were associated with an increase in Δ pial-nCBV.ConclusionWe proposed a practical indicator, pial-nCBV, and increasing Δ pial-nCBV was associated with treating pial feeder using n-BCA.