Outcomes of Preoperative Transophthalmic Artery Embolization of Meningiomas: A Systematic Review with a Focus on Embolization Agent.

Background: Transophthalmic artery embolization of intracranial meningiomas is thought to be associated with a high complication risk.

Purpose: With advances in endovascular techniques, we systematically reviewed the current literature to improve our understanding of the safety and efficacy of transophthalmic artery embolization of intracranial meningiomas.

Data sources: We performed a systematic search using PubMed from inception until August 3, 2022.

Study selection: Twelve studies with 28 patients with intracranial meningiomas embolized through the transophthalmic artery were included.

Data analysis: Baseline and technical characteristics and clinical and safety outcomes were collected. No statistical analysis was conducted.

Data synthesis: The average age of 27 patients was 49.5 (SD, 13) years. Eighteen (69%) meningiomas were located in the anterior cranial fossa, and 8 (31%), in the sphenoid ridge/wing. Polyvinyl alcohol particles were most commonly (n = 8, 31%) used to preoperatively embolize meningiomas, followed by n-BCA in 6 (23%), Onyx in 6 (23%), Gelfoam in 5 (19%), and coils in 1 patient (4%). Complete embolization of the target meningioma feeders was reported in 8 (47%) of 17 patients; partial embolization, in 6 (32%); and suboptimal embolization, in 3 (18%). The endovascular complication rate was 16% (4 of 25), which included visual impairment in 3 (12%) patients.

Limitations: Selection and publication biases were limitations.

Conclusions: Transophthalmic artery embolization of intracranial meningiomas is feasible but is associated with a non-negligible complication rate.