Hans-Georg Wirsching1, Johannes Konstantin Richter2,3, Felix Sahm4,5, Corinne Morel6, Niklaus Krayenbuehl7, Elisabeth Jane Rushing8, Andreas von Deimling4,5, Antonios Valavanis2, Michael Weller6. 1. Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland. hans-georg.wirsching@usz.ch. 2. Department of Neuroradiology, University Hospital and University of Zurich, Zurich, Switzerland. 3. Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital and University of Bern, Bern, Switzerland. 4. Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany. 5. Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany. 6. Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland. 7. Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland. 8. Department of Neuropathology, University Hospital and University of Zurich, Zurich, Switzerland.
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.
PURPOSE: Preoperative embolization of radiographically suspected meningiomas is often performed to facilitate tumor resection. Its effects on the subsequent disease course of meningiomapatients 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 embolizedpatients 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 meningiomapatients.
Authors: Felix Sahm; Daniel Schrimpf; Damian Stichel; David T W Jones; Thomas Hielscher; Sebastian Schefzyk; Konstantin Okonechnikov; Christian Koelsche; David E Reuss; David Capper; Dominik Sturm; Hans-Georg Wirsching; Anna Sophie Berghoff; Peter Baumgarten; Annekathrin Kratz; Kristin Huang; Annika K Wefers; Volker Hovestadt; Martin Sill; Hayley P Ellis; Kathreena M Kurian; Ali Fuat Okuducu; Christine Jungk; Katharina Drueschler; Matthias Schick; Melanie Bewerunge-Hudler; Christian Mawrin; Marcel Seiz-Rosenhagen; Ralf Ketter; Matthias Simon; Manfred Westphal; Katrin Lamszus; Albert Becker; Arend Koch; Jens Schittenhelm; Elisabeth J Rushing; V Peter Collins; Stefanie Brehmer; Lukas Chavez; Michael Platten; Daniel Hänggi; Andreas Unterberg; Werner Paulus; Wolfgang Wick; Stefan M Pfister; Michel Mittelbronn; Matthias Preusser; Christel Herold-Mende; Michael Weller; Andreas von Deimling Journal: Lancet Oncol Date: 2017-03-15 Impact factor: 41.316
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Authors: Christian Valentin Eisenring; Marian Christoph Neidert; Daniel Sabanés Bové; Leonhard Held; Johannes Sarnthein; Niklaus Krayenbühl Journal: PLoS One Date: 2013-11-14 Impact factor: 3.240
Authors: Roland Goldbrunner; Pantelis Stavrinou; Michael D Jenkinson; Felix Sahm; Christian Mawrin; Damien C Weber; Matthias Preusser; Giuseppe Minniti; Morten Lund-Johansen; Florence Lefranc; Emanuel Houdart; Kita Sallabanda; Emilie Le Rhun; David Nieuwenhuizen; Ghazaleh Tabatabai; Riccardo Soffietti; Michael Weller Journal: Neuro Oncol Date: 2021-11-02 Impact factor: 13.029