{
  "abstract": "Background Preoperative embolization has been used for intracranial meningiomas for nearly 40 years with varying preferences for embolic materials and limited comparative data on their efficacy.Methods Consecutively treated patients from 2013 until 2023 who underwent preoperative embolization for meningioma from 12 centers across North America and Europe were included and classified by embolic material: (1) particles, (2) Onyx, and (3) coils. Primary outcomes included estimated blood loss (EBL), procedural complications, surgery duration, gross total resection (GTR), unplanned rescue surgery, modified Rankin Scale (mRS), and mortality. After unmatched analysis. Propensity score matching (PSM) subgroup analyses compared each pair of embolic materials, controlling for age, sex, body mass index, smoking, comorbidities, prior surgery, pre-treatment antithrombotics, WHO grade, tumor location, maximal diameter, and baseline mRS.Results A total of 275 patients (median age 47 years, 62.9% female) underwent preoperative embolization for meningioma. The mean maximum tumor diameter was 32.9±10.1 mm, with 61.1% classified as WHO I. Onyx was most frequently used 117 (42.5%), followed by particles 107 (38.9%), and coils (18.5%). Unmatched analysis revealed that Onyx was significantly associated with reduced EBL, surgery duration, and increased GTR, while decreasing unplanned rescue surgeries compared to particles and coils. PSM produced 89, 48, and 44 matched pairs for Onyx vs. Particles, Particles vs. Coils, and Onyx vs. Coils, respectively. Onyx demonstrated significant reductions against Particles in EBL (250 mL vs. 350 mL, P = 0.011) and surgical time (291 min vs. 403 min, P < 0.001), and against Coils in EBL (250 mL vs. 400 mL, P = 0.012) and surgical time (255 min vs. 347 min, P = 0.002). Onyx also showed higher rates of gross total resection compared to Particles (80.9% vs. 56.2%, P = 0.021) and Coils (88.6% vs. 56.8%, P = 0.002). No significant differences were observed in blood transfusion requirements, embolization-related complications mRS, or mortality rates across all comparisons.Conclusions Onyx, a liquid embolic agent, reduces EBL which may explain the shorter surgery duration, higher GTR rates, and lower retreatment rates. Procedural risks and patient selection require further investigation.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Julio Isidor"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Rahim Abo Kasem"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Mohammad-Mahdi Sowlat"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Conor Cunningham"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA"
      ],
      "name": "Michael Levitt"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA"
      ],
      "name": "Margaret McGrath"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Christopher S Ogilvy"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Omar Alwakaa"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Albany Medical College, Albany, New York, USA"
      ],
      "name": "Alexandra R Paul"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Albany Medical College, Albany, New York, USA"
      ],
      "name": "Matthew Cullen"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA"
      ],
      "name": "Isaac Josh Abecassis"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA"
      ],
      "name": "Ahmad Alhourani"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal"
      ],
      "name": "Isabel Fragata"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal"
      ],
      "name": "Mariana Baptista"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Illinois System, Urbana, Illinois, USA"
      ],
      "name": "Ali Alaraj"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Illinois System, Urbana, Illinois, USA"
      ],
      "name": "Mpuekela Tshibangu"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Michigan Health-West, Wyoming, Michigan, USA"
      ],
      "name": "Fazeel Siddiqui"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Michigan Health-West, Wyoming, Michigan, USA"
      ],
      "name": "Elyza Larson"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Marios-Nikos Psychogios"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Aikaterini Anastasiou"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Ramesh Grandhi"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Santiago Gomez-Paz"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA"
      ],
      "name": "Clemens Schirmer"
    },
    {
      "affiliations": [
        "Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA"
      ],
      "name": "Prateeka Koul"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Saskatchewan, Saskatoon, South Saskatchewan, Canada"
      ],
      "name": "Syed Uzair Ahmed"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Saskatchewan, Saskatoon, South Saskatchewan, Canada"
      ],
      "name": "Jack Su"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences, College of Medicine, University of Houston, Houston, Texas, USA",
        "Neuroendovascular surgery, HCA Houston, Houston, Texas, USA"
      ],
      "name": "Mohamad Ezzeldin"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Alejandro M Spiotta"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Ben A Strickland"
    }
  ],
  "title": "Comparison of embolic agents in preoperative embolization for intracranial meningiomas: multicenter adjusted analysis of 275 cases",
  "uid": "a36c911a-0091-5303-88a5-5ccb1e0d5292"
}