Preoperative embolization of intracranial meningiomas: efficacy, technical considerations, and complications.

BACKGROUND AND PURPOSE: Preoperative embolization for intracranial meningiomas offers potential advantages for safer and more effective surgery. However, this treatment strategy has not been examined in a large comparative series. The purpose of this study was to review our experience using preoperative embolization to understand the efficacy, technical considerations and complications of this technique. MATERIALS AND METHODS: We performed a retrospective review of patients undergoing intracranial meningioma resection at our institution (March 2001 to December 2012). Comparisons were made between embolized and nonembolized patients, including patient and tumor characteristics, embolization method, operative blood loss, complications, and extent of resection. Logistic regression analyses were used to identify factors predictive of operative blood loss and extent of resection. RESULTS: Preoperatively, 224 patients were referred for embolization, of which 177 received embolization. No complications were seen in 97.1%. There were no significant differences in operative duration, extent of resection, or complications. Estimated blood loss was higher in the embolized group (410 versus 315 mL, P=.0074), but history of embolization was not a predictor of blood loss in multivariate analysis. Independent predictors of blood loss included decreasing degree of tumor embolization (P=.037), skull base location (P=.005), and male sex (P=.034). Embolization was not an independent predictor of gross total resection. CONCLUSIONS: Preoperative embolization is a safe option for selected meningiomas. In our series, embolization did not alter the operative duration, complications, or degree of resection, but the degree of embolization was an independent predictor of decreased operative blood loss.

This article has been retracted and is available online only: Religion, culture and male involvement in the use of family planning: evidence from Enugu and Katsina States of Nigeria.

The following article from the International Nursing Review, 'Religion, culture and male involvement in the use of family planning: evidence from Enugu and Katsina States of Nigeria', by C. Ujuju, J. Anyanti, S.B. Adebayo, F. Muhammad, O. Oluigbo and A. Gofwan, published online on 6 September 2010 on Wiley Online Library (http://wileyonlinelibrary.com) has been retracted by agreement between the authors, the journal Editor in Chief, Jane J.A. Robinson and Blackwell Publishing Ltd. The retraction has been agreed as not all copyright permissions had been cleared. Jane J.A Robinson Editor International Nursing Review.

Bilateral intracavernous carotid artery pseudoaneurysms as a result of sellar reconstruction during the transsphenoidal resection of a pituitary macroadenoma: case report.

OBJECTIVE AND IMPORTANCE: Transsphenoidal surgery is considered to be a safe, relatively low risk procedure for the resection of pituitary lesions. Although rare, injury to the internal carotid artery is a potentially devastating complication associated with the transsphenoidal approach. The authors report a unique case in which the patient developed mirror pseudoaneurysms of the cavernous carotid arteries after an apparently uneventful transsphenoidal procedure, a complication attributed to the reconstruction of the sellar floor. CLINICAL PRESENTATION: The patient is a 55-year-old gentleman who presented to the emergency room with severe epistaxis nearly 4 weeks after undergoing an uncomplicated transsphenoidal resection of a pituitary adenoma. An emergency cerebral angiogram was performed which demonstrated bilateral cavernous carotid artery pseudoaneurysms, a complication attributed to the placement of a synthetic implant in the sellar floor. While on the angiography table, the patient again developed massive epistaxis, with enlargement of the left-sided pseudoaneurysm from 3.4 x 2.5 x 2.1 mm to 4.5 x 3.7 x 3 mm. INTERVENTION: The left cavernous carotid artery was occluded using 8 coils. The right-sided pseudoaneurysm was not treated at the time of the angiogram, and was managed conservatively. The patient subsequently developed an expressive aphasia, with an MRI revealing multiple areas of diffusion-weighted abnormalities. Within several days the patient's speech returned to normal, and he was discharged home eleven days after presenting to the emergency room. Follow-up imaging 6 weeks later showed complete obliteration of the left cavernous carotid artery with distal reconstitution, and a decrease in size of the right-sided pseudoaneurysm. CONCLUSION: While considered to be a relatively safe procedure, the transsphenoidal approach for resection of pituitary lesions is not without risks. Injury to the internal carotid artery is arguably the most catastrophic complication seen with pituitary surgery. Although it typically occurs during the dural opening, or during tumor removal, this case illustrates that the neurosurgeon must be conscious of this risk throughout every aspect of the case. For cases when sellar reconstruction is performed, specific attention should be paid to ensuring that an appropriately sized graft is used.