{
  "abstract": "Background Meningiomas are typically managed with surgery or radiotherapy, but recurrent or surgically inaccessible tumors present a persistent therapeutic gap, particularly for progressive higher grade disease. Intra-arterial yttrium-90 (90Y) transarterial radioembolization (TARE) is well established for hepatocellular carcinoma to deliver high dose, short range β-brachytherapy in the form of 20-60µm radioactive microspheres. This technology could plausibly be adapted to meningiomas, exploiting their dominant dural arterial supply.Methods We performed systematic searches of PubMed and Google Scholar for literature directly addressing intracranial TARE planning or delivery, supplemented by a scoping review of adjacent fields: meningioma radionuclide therapy, peptide receptor radionuclide therapy (PRRT), hepatic TARE, bland meningioma embolization, and the radiobiology relevant to meningioma vascular behavior, dosimetry, hypoxia, and imaging.Results Five studies and one ongoing clinical trial directly addressed intracranial TARE or its planning. Seventy-four supporting studies informed synthesis across meningioma embolization, vascular anatomy, hepatic TARE dosimetry and device characteristics, and foundational radiobiology. Currently two TARE platforms exist (glass and resin), with differences in dose-per sphere and physical density which may impact deliverability. The compartmentalized dural arterial supply of most meningiomas supports catheter-based access and may permit single-compartment dosimetry modeling, with generally low-to-moderate arterial shunting risk. The established but incomplete efficacy of radioligand therapies provides a biologic rationale for TARE, while underscoring the need for higher tumor radiation delivery, which early dosimetry work suggests may be achievable with TARE.Conclusions TARE is a plausible treatment for recurrent and inoperable meningiomas due to their compartmentalized vascular supply. Four considerations should anchor early phase trial design: (1) microsphere platform selection between glass and resin spheres, with their differing embolic burden and dosimetric profiles; (2) whether to limit treatment to external carotid artery territories or include internal carotid artery supplied tumor; (3) compartmental dosimetric planning calibrated to meningioma angiosomes; and (4) a structured safety framework non-target deposition, peri-procedural risks, and delayed radiation necrosis.",
  "authors": [
    {
      "affiliations": [
        "Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA"
      ],
      "name": "Aaron Daniel Brake"
    },
    {
      "affiliations": [
        "Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA"
      ],
      "name": "Kevin John"
    },
    {
      "affiliations": [
        "Department of Nuclear Medicine, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Sanchay Jain"
    },
    {
      "affiliations": [
        "Department of Radiation Oncology, Renown Health, Reno, Nevada, USA"
      ],
      "name": "Garrett Green"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA"
      ],
      "name": "Adnan H Siddiqui"
    },
    {
      "affiliations": [
        "Department of Interventional Radiology, Northwestern University, Evanston, Illinois, USA"
      ],
      "name": "Riad Salem"
    },
    {
      "affiliations": [
        "Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Ammar Sarwar"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Montefiore Einstein Medical Center, New York, New York, USA"
      ],
      "name": "David Altschul"
    },
    {
      "affiliations": [
        "Neuroloy, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA"
      ],
      "name": "Santiago Ortega-Gutierrez"
    },
    {
      "affiliations": [
        "Department of Interventional Radiology, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Sandeep Laroia"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Mario Zanaty"
    }
  ],
  "title": "Yttrium-90 Radioembolization for Recurrent Meningioma: Rationale and Roadmap for Neurointerventional Translation",
  "uid": "a755e4d1-fcf5-512c-a8a5-1c0d673b4e2e"
}