2026 Poster Presentations
P145: PREOPERATIVE EMBOLIZATION FOR SKULL BASE MENINGIOMA: VESTIBULOCOCHLEAR OUTCOMES AND PREDICTORS
Rommi Kashlan, BS; Hithardhi Duggireddy, MS; 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: Skull base meningiomas typically arise from deep, highly vascularized regions, increasing the risk of intraoperative bleeding and limiting surgical visibility during resection. Preoperative embolization is a technique utilized to devascularize the tumor and facilitate maximal safe resection. Vestibulocochlear symptoms, including hearing loss, tinnitus, vertigo, and imbalance, are common in this patient population and may influence recovery. However, there is limited literature on the effect of embolization on vestibulocochlear outcomes.
Objective: To characterize vestibulocochlear outcomes following preoperative embolization and evaluate clinical and angiographic predictors of early improvement at 3 months follow-up.
Methods: We analyzed a curated retrospective cohort of embolized skull base meningioma patients with documented vestibulocochlear symptoms (n=27) and an internal asymptomatic comparison group. Demographics, frailty (mFI-5), tumor characteristics, arterial supply, and embolization details were obtained. Post-embolization symptom course was categorized as improved, unchanged, or worsened and was measured over 3 months follow-up. We delineated feeding artery-specific improvement rates conditional on embolization of the middle/accessory meningeal, ascending pharyngeal, and occipital arteries. The association between angiographic blush reduction and symptom change was quantified. An exploratory supervised learning model assessed the prediction capability of clinical and angiographic features on symptomatic early improvement.
Results: Among symptomatic patients, early improvement occurred in 16/27 (59.3%), persistence in 9/27 (33.3%), and worsening in 2/27 (7.4%). Baseline differences between symptomatic and comparison groups were small: age (p=0.891), frailty (p=0.145), sex (p=1.000), and tumor volume (p=0.789) were not significantly different. Angiographic blush reduction showed no linear relationship with symptom change (r=0.0068). Analyses of feeding arteries did not demonstrate a consistent benefit of embolizing specific external carotid territories: improvement when the middle/accessory meningeal branches were embolized was 56.3% (9/16) versus 63.6% (7/11) when not embolized; for the ascending pharyngeal, 40.0% (2/5) versus 63.6% (14/22); for the occipital, 25.0% (1/4) versus 65.2% (15/23). These vessel-specific estimates likely reflect confounding by indication and small sample sizes. Exploratory modeling achieved a best test AUC of 0.70 for predicting symptomatic early improvement, indicating moderate discrimination, underscoring the need for larger datasets and standardized features.
Conclusion: Most patients with vestibulocochlear symptoms experienced early improvement after preoperative embolization, with deterioration being uncommon. Embolization of individual external carotid territories nor angiographic tumor blush reduction robustly predicted early improvement. Clinically, our findings indicate that preoperative embolization should be chosen to improve operative conditions, but not as a reliable means to restore vestibulocochlear function.