gms | German Medical Science

Objective: Meningiomas are often vascularized lesions and resection can be facilitated by preoperative embolization. This proof of concept study assesses application and benefit of direct intraoperative intratumoral Glubran® injection.

Methods: Eight patients (4 female, 4 male, mean age 63.5y, SD 17.4y) with suspected meningiomas were referred to surgery and simultaneous intraoperative embolization with intratumoral injection of Glubran®2. Written informed consent was obtained in advance in all cases. Dispersion of the glue was controlled with intraoperative fluoroscopy and/or ultrasonography. The postoperative CT scans were analyzed for extravasation of the glue and associated sequelae.

Results: Mean tumour volume was 79.4ccm (SD51.5ccm). Simpson I-II could be achieved in 7/8 patients. No patient needed blood transfusion. Postoperative Hb control showed a mean decrease of 2.3 g/dl. The glue could be applied via direct puncture of the lesion in all cases. There were no application associated side effects or adverse events. Extravasations were recorded on all postoperative CT scans without any associated neurological deficits or ischemic events.

One patient died 3 weeks postoperatively due to a fulminant ischemic stroke of the contralateral MCA unrelated to the tumor embolization.

Conclusion: Intraoperative intratumoral Glubran®2 injection is safe without additional risks or adverse events. Compared to preoperative transarterial tumour embolization direct intraoperative embolization only needs single anesthesia without further catheter interventions. Further studies are warranted to assess the effectiveness with respect to control intraoperative blood-loss in a large collective.