Comparing Liquid and Particle Embolic Agents for Meningioma Surgery Outcomes

Introduction Preoperative embolization of meningiomas (PrEM) traditionally performed with particle embolic agents (PEA) has resulted in inconsistent benefits compared with no embolization. Lower‐viscosity formulations and improved catheter trackability have made liquid embolic agents (LEA) an increasingly appealing alternative, particularly due to the lower risk of non‐target embolization. We present a propensity score‐matched (PSM) study comparing patient and intracranial meningioma‐related outcomes between PEA and LEA PreM. Materials/Methods A retrospective review of multicenter databases was conducted to identify adults who underwent PrEM between January 2015 and January 2025. We included LEA cases from three LEA‐experienced centers and PEA cases from one PEA‐experienced center to compare outcomes between experienced LEA and PEA users, reducing heterogeneity and maximizing the potential performance achievable with each modality. Propensity scores were generated from significant confounders identified via multivariable regression predicting gross total resection (GTR) likelihood and matched within a 0.1 threshold using fuzzy matching on SPSS Statistics (IBM Corp.). Results We included 150 patients (mean age, 58.9±13.5 years; women, 66.7%; PEA=60, LEA=90). Skull base location (adjusted odds ratio [aOR]:0.388; p=0.047), higher number of feeders (aOR:0.634; p=0.014), and fewer percentage of feeders embolized (aOR:1.017; p=0.032) were significant predictors of incomplete resection. After PSM (25 patients per cohort), surgical (454.5±115 vs 258.2±87.7 minutes, p<0.01) and anesthesia (469±111.9 vs 344.1±111.7 minutes, p<0.01) durations were significantly shorter in the LEA cohort. Combined GTR and near‐total resection rates (64% vs 92%, p=0.02) were significantly higher for LEA. Higher rates of adjuvant radiosurgery with LEA (16% vs 60%, p<0.01) reflected the higher proportion of high‐grade meningiomas among tumors where GTR could not be achieved. Recurrence rates were significantly higher in the PEA cohort (36% vs. 12%, p=0.04). Conclusions Optimizing LEA‐based PrEM bears potential to confer consistent surgical benefit during meningioma resection, including superior resection rates and reduced operative and anesthesia durations.