2026 Proffered Presentations
S261: MOTOR IMPROVEMENT AFTER PREOPERATIVE EMBOLIZATION FOR SKULL BASE MENINGIOMA: A RETROSPECTIVE COHORT STUDY
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: Motor deficits in skull base meningioma arise from mass effect edema and involvement of eloquent pathways. Preoperative embolization is used to reduce tumor vascularity and may influence early neurologic recovery. Evidence specific to motor outcomes remains limited.
Methods: We analyzed a cohort of embolized skull base meningioma patients with documented motor deficits and an internal comparison group without motor symptoms. Demographics frailty tumor characteristics, arterial supply and embolization details were abstracted from the curated workbook. Group differences were summarized with standard tests as recorded. Early motor trajectory after embolization was categorized as improved unchanged or worsened. We examined associations between arterial feeders and motor symptoms and explored artery specific improvement rates conditional on embolization. An exploratory modeling analysis evaluated clinical and angiographic features to predict early motor improvement.
Results: 12 embolized patients had motor deficits and 24 served as a non-motor comparison group. Age was higher in the motor group mean 54.25 vs 46.96 years (p=0.106). Sex distribution was similar. Frailty was comparable with similar means (p=0.321). Tumor volume did not differ meaningfully between cohorts median 95.0 for motor vs 90.3 for non-motor with interquartile ranges 54.24 to 191.66 and 57.33 to 148.40. Arterial supply was not significantly associated with the presence of motor symptoms. Examples include extradural internal carotid artery meningeal branches odds ratio 0.85 with p=1.00 and meningeal branches of the middle meningeal or accessory meningeal arteries odds ratio 0.58 with p=0.708 with other vessels similarly non-significant. Early motor response after embolization in the motor cohort was favorable in most patients: improvement occurred in 7/12, stability in 2/12, and worsening in 3/12. The correlation between angiographic blush reduction and motor change was near zero at −0.043 indicating no linear relationship. Artery-specific patterns suggested heterogeneity with small numbers. Embolization of the meningeal middle meningeal or accessory branches was associated with a higher improvement rate 71.4% when embolized versus 40.0% when not embolized with n=7 embolized and n=5 not embolized. Embolization of extradural internal carotid artery meningeal trunks was rare with n=1 and was associated with 0.0% improvement versus 63.6% when not embolized with n=11 not embolized. Exploratory models for predicting improvement yielded a ROC of 0.75 with random forest and gradient boosting while logistic regression performed poorly with test area under the curve 0.25 reflecting the small sample and class imbalance.
Conclusion: In embolized skull base meningioma patients with motor deficits early improvement was observed in more than half while deterioration was less common. Tumor volume and arterial supply were not clearly associated with the presence of motor symptoms and angiographic blush reduction did not track with early motor change. Artery specific signals suggest that embolization of meningeal branches may relate to higher early improvement while extradural internal carotid artery meningeal trunk embolization requires caution due to limited cases. These findings support selective use of preoperative embolization within a multidisciplinary strategy for motor deficits and motivate prospective studies with standardized motor scales perfusion and edema biomarkers and longer follow up to define patient selection mechanism and durability.