Preoperative embolization versus direct surgery of meningiomas: A meta-analysis

Abstract Background Preoperative embolization (POE) of meningioma has been established to facilitate surgical resection, which may reduce intraoperative blood loss and surgical time. However, no consensus has been achieved in meningioma treatment and no meta-analysis has been conducted. The purpose of this study was to perform a systematic review and meta-analysis and provide evidence of the efficacy of meningioma treatment with POE and direct surgery. Methods This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A systematic search was performed using PubMed and EMBASE. Meta-analysis was performed using the risk ratio (RR) of overall complication, mean difference (MD) of blood loss, surgical time. The I 2 statistic was used to assess the heterogeneity. Results Eight studies (one RCT and seven non-RCTs) were included, in which 510 patients met the inclusion criteria. We found that preoperative embolization for meningioma patients cannot increase the overall complication rate (RR = 0.92, 95% CI: 0.61 to 1.38) and can significantly reduce intraoperative blood loss (MD = –65.10, 95% CI: –124.76 to –20.82) and surgical time (MD = –38.48, 95% CI: –64.03 to –12.93) compared with the control patients. No significant publication bias was observed. Conclusions This meta-analysis supports the hypothesis that POE of meningioma is a useful adjunct in meningioma treatment. This technique helps reduce blood loss and surgical time during meningioma resection.