2026 Poster Presentations
P143: COGNITIVE TRAJECTORY AFTER PREOPERATIVE EMBOLIZATION FOR SKULL BASE MENINGIOMA
Hithardhi Duggireddy, MS; Rommi Kashlan, BS; Thomas McCaffery, BS; J. Manuel Revuelta-Barbero, MD, PHD; Karen Salmeron-Moreno, MD; Karthik Papisetty, BA; Gustavo Pradilla, MD; Tomas Garzon-Muvdi, MD, MSc; Emory University
Background: Cognitive impairment in skull base meningioma arises from mass effect, edema, venous congestion, and treatment-related factors. Preoperative embolization is used to devascularize tumors and facilitate resection, yet its relationship to cognitive outcomes is not well defined. We evaluated cognitive trajectories in embolized patients and explored anatomic and procedural correlates.
Methods: We reviewed a cohort of skull base meningioma patients with documented cognitive symptoms who underwent preoperative embolization. Demographics, frailty, comorbidities, tumor volume, arterial supply, and early cognitive status after embolization were abstracted from the dataset. Comparative baselines were summarized against a non-cognitive symptom group. Group differences were tested using standard parametric or nonparametric methods as recorded in the workbook. We assessed associations between specific feeding arteries and the presence of cognitive symptoms and summarized early cognitive response after embolization. Exploratory modeling of cognitive improvement was attempted.
Results: Sixteen embolized patients had cognitive symptoms at baseline and twenty served as a non-cognitive symptoms comparison group. Age did not differ meaningfully between the cognitive and non-cognitive symptom groups, with a mean of 53.6 years versus 45.9 years, p=0.202. Sex distribution was similar with p=0.421. Frailty was comparable, mean mFI approximately 0.88 versus 0.79 with p=0.630. Cognitive symptoms were associated with larger tumor volume. Median volume was 148.4 with an interquartile range of 95.2 to 201.8 in the cognitive group versus 65.6 with an interquartile range of 51.5 to 90.0 in the non-cognitive group, with p=0.003. The presence of individual feeding arteries showed no significant association with cognitive symptoms. Examples include ophthalmic artery odds ratio 1.89 with p=0.742 and extradural internal carotid artery meningeal branches odds ratio 1.29 with p=0.970, with other vessels similarly non-significant. Early cognitive trajectory after embolization was favorable in most patients. Improvement occurred in 13 of 16 patients, which is 81.3%. Stability occurred in 2 of 16, which is 12.5%. Worsening occurred in 1 of 16, which is 6.3%. The correlation between angiographic blush reduction and cognitive change was modest and negative at −0.27, inconsistent with a strong linear relationship. An exploratory logistic model using age, frailty, volume, and arterial features did not discriminate improvement, with the best cross-validated area under the curve approximately 0.50.
Conclusion: In this cohort, most patients with cognitive symptoms improved after preoperative embolization during the early follow-up window, while deterioration was uncommon. Cognitive symptoms clustered among patients with larger tumors, suggesting that disease burden may be a principal driver of impairment and of the observed response. Specific arterial feeders were not predictive of baseline cognitive symptoms, and angiographic blush reduction did not show a clear linear correlation with early cognitive change. These findings support the selective use of preoperative embolization as part of a multidisciplinary strategy for cognitively symptomatic patients with high tumor volumes, while underscoring the need for prospective studies with standardized neuropsychological endpoints, edema and perfusion biomarkers, and longer-term follow-up to define patient selection and the underlying mechanism.