2026 Poster Presentations
P155: CLINICAL AND VASCULAR PREDICTORS OF VISUAL OUTCOMES IN SKULL BASE MENINGIOMAS TREATED WITH PREOPERATIVE EMBOLIZATION
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: Visual impairment is among the most debilitating presenting symptoms of skull base meningiomas. Compression of the optic nerve, chiasm, and related pathways often leads to reduced acuity, field defects, or diplopia, significantly impairing quality of life. Preoperative embolization is increasingly used to decrease tumor vascularity, reduce intraoperative blood loss, and improve surgical safety, yet its impact on visual outcomes remains uncertain. This study analyzed visual outcomes after embolization in a single-center cohort, integrating clinical characteristics, vascular anatomy, and postoperative results.
Methods: Thirty-six patients undergoing preoperative embolization for skull base meningiomas were retrospectively reviewed. Patients were stratified by the presence of visual symptoms. Tumor volume, vascular supply, and histologic grade were recorded. Feeding vessels were categorized as ophthalmic, anterior cerebral artery (ACA), middle cerebral artery (MCA), extradural ICA, and meningeal branches. Visual outcomes were classified as improved, unchanged, or worsened at 12 months following surgery. Logistic regression modeling identified features predictive of postoperative change.
Results: Visual symptoms were present in 15 patients (42%) and absent in 21 (58%). Median tumor volume in the visual group was 78.8 cm³ (IQR 57.4–105.0), compared with 95.1 cm³ (IQR 55.7–206.9) in the non-visual group (p = 0.45). Distribution across WHO grades included both grade I and II tumors without significant difference between groups. Feeding vessel analysis demonstrated heterogeneity in vascular supply. Ophthalmic artery feeders were present in 7 cases and strongly associated with visual symptoms (71% vs 34% without feeders, OR 4.75, p = 0.18). ACA feeders were seen in 2 cases with a 50% symptom rate compared to 41% without (OR 1.43, p = 1.0). MCA feeders were observed in 3 cases with a 33% rate compared to 42% without (OR 0.68, p = 1.0). Extradural ICA feeders were common (19 cases), with a 42% symptom rate, nearly identical to patients without such supply (OR 1.04, p = 1.0). Meningeal feeders (24 cases) were associated with a 42% symptom rate, identical to those without (OR 1.0, p = 1.0). No vascular territory reached statistical significance. Among the 15 patients with visual symptoms, 7 (47%) improved, 2 (13%) remained unchanged, and 6 (40%) worsened after surgery. Overall improvement rate was 47%. Embolization blush reduction correlated moderately with visual outcomes (r=0.54). Logistic regression modeling identified clinical and angiographic features predictive of visual response, with the best-performing model achieving an AUC of 0.83 using 12 features, suggesting potential for predictive stratification.
Conclusion: In this cohort, nearly half of patients with preoperative visual symptoms experienced improvement after embolization and resection, while 40% worsened. Ophthalmic artery supply showed a trend toward higher visual morbidity, although not statistically significant. Tumor volume did not differ significantly between visual and non-visual groups. Embolization was safe and achieved effective devascularization without procedure-related injury, but its direct role in visual recovery remains unclear. Predictive modeling demonstrated promising accuracy and may guide risk stratification in future practice. Larger multicenter studies are needed to validate predictive features and clarify whether targeted embolization strategies can optimize visual outcomes in skull base meningioma patients.