Neurology · Medical Literature
Successful pre-operative endovascular intraventricular meningioma embolization: a systematic review and pediatric case analysis.
Abstract
Intraventricular meningiomas are rare tumors accounting for a small fraction of intracranial meningiomas and are often associated with significant surgical challenges due to their deep location and rich vascular supply. Pre-operative endovascular embolization has been proposed as an adjunct to reduce intraoperative bleeding and facilitate safer resection; however, its role in intraventricular lesions remains poorly defined. We present a case of a 9.5-year-old boy with a highly vascular intraventricular meningioma who underwent pre-operative endovascular embolization followed by surgical resection. Additionally, a systematic review was conducted in accordance with PRISMA guidelines, searching PubMed and Scopus for studies reporting embolization of intraventricular meningiomas. In the presented case, selective embolization of the posterior choroidal artery using a glue-lipiodol mixture was successfully performed without complications, leading to reduced tumor vascularity and enabling gross total resection with minimal blood loss (< 300 mL). The systematic review identified seven cases from six studies. Embolization was successful in six cases, with varying degrees of devascularization. Gross total resection was achieved in all surgically treated patients. Reported intraoperative blood loss ranged from 150 to 1850 mL. Complications occurred in two of seven cases, including postoperative epidural hematoma. Pre-operative endovascular embolization appears to be a technically feasible adjunct in selected cases of intraventricular meningiomas. However, current evidence is limited to case reports and small case series, precluding definitive conclusions regarding its safety or clinical benefit.
Clinical relevance
In patients with highly vascular intraventricular meningiomas, does pre-operative endovascular embolization reduce intraoperative blood loss and facilitate gross total resection compared to direct surgery without embolization? __SNAPSHOT__ {"studyDesign":"Systematic review (PRISMA-compliant) combined with a single pediatric case report","setting":"PubMed and Scopus literature search (institutional setting of index case not reported); International Society for Pediatric Neurosurgery journal","sampleSize":"Index case: n=1 (9.5-year-old male); Systematic review: 7 cases from 6 studies","population":"Patients with intraventricular meningiomas who underwent pre-operative endovascular embolization prior to surgical resection; index case was a pediatric patient (9.5 years old, male) with a highly vascular intraventricular meningioma","intervention":"Pre-operative endovascular embolization of intraventricular meningioma (index case: selective embolization of the posterior choroidal artery using a glue-lipiodol mixture) followed by surgical resection","comparator":"Not applicable — no concurrent control or comparator group; systematic review was descriptive without a non-embolized comparator arm","primaryOutcome":"Technical success of embolization, degree of tumor devascularization, intraoperative blood loss, and extent of surgical resection (gross total resection)","followUp":"Not reported","fundingSource":"Not reported"}
Key findings
In the index pediatric case (9.5-year-old boy), selective embolization of the posterior choroidal artery using a glue-lipiodol mixture was performed without procedural complications, resulting in reduced tumor vascularity. Subsequent surgical resection achieved gross total resection with intraoperative blood loss reported as less than 300 mL (no comparative baseline blood loss without embolization was provided). In the systematic review, seven cases from six studies were identified in the literature. Embolization was reported as technically successful in six of seven cases (success rate: 86%, calculated). The abstract notes varying degrees of devascularization across cases; no pooled quantitative data on blood loss, operative time, extent of resection rates across all reviewed cases, complication rates, p-values, confidence intervals, or effect sizes are reported in the available abstract text. NNT and NNH cannot be calculated from the data provided.
Practice implications
This study provides descriptive, low-certainty evidence that pre-operative endovascular embolization of intraventricular meningiomas is technically feasible and was successful in the majority of the small number of reported cases. The index pediatric case demonstrates that posterior choroidal artery embolization with glue-lipiodol can be performed without immediate neurological or vascular complications and may enable gross total resection with limited blood loss. However, because this study is a case report combined with a PRISMA-compliant systematic review of only 7 total cases from 6 studies — representing one of the rarest subsets of an already rare tumor type — no conclusions about comparative efficacy, superiority over direct surgery, long-term outcomes, or complication rates can be drawn. The evidence base is insufficient to define the benefit-risk profile of this technique in pediatric or adult patients with intraventricular meningiomas. Only the abstract was available for review, which limits assessment of methodological quality, case selection criteria, heterogeneity across the reviewed studies, and completeness of the systematic review. Patients who were not well-represented include adults, females, patients with non-choroidal arterial supply, and those with WHO grade II or III intraventricular meningiomas. __LIMITATIONS__ Extremely small aggregate sample size (n=8 total including index case; n=7 in systematic review) severely limits generalizability and statistical inference.,No comparator group — all cases received embolization; without non-embolized controls, the incremental benefit of embolization over direct surgery cannot be assessed.,Heterogeneity across reviewed cases (varying embolization agents, vascular anatomy, tumor size, patient age, and surgical approaches) precludes meaningful pooled analysis.,Intraventricular meningiomas are an extremely rare tumor subtype; the systematic review identified only 7 previously reported cases, reflecting publication bias toward successful or technically notable cases.,Only the abstract was available; full methodological details of the systematic review (risk of bias assessment, quality appraisal tools, data extraction process) could not be evaluated.,Single index case is a 9.5-year-old male; applicability to adult patients, females, and other age groups is unknown.,No follow-up data reported — tumor recurrence, neurological outcomes, and late embolization-related complications (e.g., ischemia from posterior choroidal artery territory infarct) are not addressed.,Outcome reporting is descriptive and non-standardized across reviewed cases; degree of devascularization and resection extent were variably defined.,Funding source not reported; potential conflicts of interest cannot be assessed.,The study design (case report plus systematic review without meta-analysis) represents the lowest tier of comparative evidence. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ Pre-operative endovascular embolization of intraventricular meningiomas appears technically feasible based on a PRISMA-compliant systematic review of 7 published cases and a single pediatric index case, with a reported technical success rate of 6/7 (86%, calculated) and no procedural complications in the index case. However, the aggregate evidence base is extremely limited, no comparative data exist, and long-term outcomes are unreported — this technique should be considered investigational and applied only at high-volume centers with multidisciplinary neurovascular expertise on a highly individualized basis. Practice should not change on the basis of this study alone; prospective registries or comparative cohort studies are needed.