Embosphere

https://www.merit.com/peripheral-intervention/embolotherapy/microspheres/embosphere-microspheres/

Embosphere Microspheres are the most clinically studied and clinically proven round embolic, providing consistent and predictable results for effective embolization.


A study aimed to evaluate the efficacy of tumor embolization using Embosphere® microspheres for skull base meningiomas and analyze post-embolization plain computed tomography (CT) and magnetic resonance imaging (MRI) scans to identify findings that could potentially predict treatment response.

Methods: Between April 2014 and April 2020, 80 patients with skull base meningiomas presenting at our medical center underwent embolization with Embosphere® microspheres. The effects of tumor embolization were evaluated through a comparison of post-embolization plain CT and contrast-enhanced MRI.

Results: A total of 143 vessels (102/108 external carotid artery branches; 41/65 internal carotid artery branches) from 80 skull base meningiomas were embolized with Embosphere® microspheres. Microspheres 100-300 μm in size were used in two cases, microspheres 300-500 μm in size were used in 12 cases, and microspheres 500-700 μm in size were used in 66 cases. Post-embolization contrast-enhanced MRI showed reductions in enhancing lesions within the tumor in 55/80 cases. Post-embolization plain CT scans showed high-density lesions within the tumor in 41/55 cases. Thus, reductions in enhancing lesions on post-embolization contrast-enhanced MRI were statistically significantly associated with the presence of high-density lesions on post-embolization plain CT (P<0.001). Embolization-related neurological complications occurred in three cases.

Conclusions: Embosphere® microspheres are user-friendly and effective embolization agents for skull base meningiomas. Post-embolization contrast-enhanced MRI and plain CT findings may be useful for evaluating the effects of tumor embolization 1).


Seventeen consecutive patients (average age, 76.4 years; 12 men [71%]) underwent MMA embolization of CSDH from January 2014 to July 2017. Earlier interventions included embolization using N-butyl-2-cyanoacrylate (although trisacryl gelatin microspheres were used in recent cases), followed by burr-hole craniotomy and irrigation in all cases. None of the patients experienced perioperative complications or postoperative recurrence. The modified Rankin Scale scores, which were unfavorable at admission, improved significantly at discharge but were comparable to those at the time of hospitalization when measured during the follow-up period. Although the patients required rehospitalization at other departments for unrelated causes, none required rehospitalization in our department.

Conclusions: Despite the known unfavorable outcomes of patients with intractable CSDHs, MMA embolization was not associated with recurrent CSDH or rehospitalization in our department in the current case series. MMA embolization should be considered a preferred therapeutic option for intractable CSDHs 2).


3: Arai S, Shimizu K, Yamochi T, Mizutani T, Okumura H, Nakajo T, Matsumoto M. Preoperative Embolization of Meningiomas: Differences in Surgical Operability and Histopathologic Changes Between Embosphere and N-butyl 2-cyanoacrylate. World Neurosurg. 2018 Mar;111:e113-e119. doi: 10.1016/j.wneu.2017.12.003. Epub 2017 Dec 12. PMID: 29246879.

4: Katsumori T, Miura H, Arima H, Hino A, Tsuji Y, Masuda Y, Nishimura T. Tris- acryl gelatin microspheres versus gelatin sponge particles in uterine artery embolization for leiomyoma. Acta Radiol. 2017 Jul;58(7):834-841. doi: 10.1177/0284185116674499. Epub 2016 Oct 31. PMID: 27799569.

5: Shimoda Y, Osanai T, Terasaka S, Kobayashi H, Yamaguchi S, Endo S, Hatanaka K, Houkin K. [Efficiency of Embosphere in the Pre-Operative Embolization of Meningioma:Clinical Experience]. No Shinkei Geka. 2016 Jul;44(7):555-60. Japanese. doi: 10.11477/mf.1436203330. PMID: 27384115.

6: Ghobrial GM, Chalouhi N, Harrop J, Dalyai RT, Tjoumakaris S, Gonzalez LF, Hasan D, Rosenwasser RH, Jabbour P. Preoperative spinal tumor embolization: an institutional experience with Onyx. Clin Neurol Neurosurg. 2013 Dec;115(12):2457-63. doi: 10.1016/j.clineuro.2013.09.033. Epub 2013 Oct 12. PMID: 24169150.

7: Wang HH, Luo CB, Guo WY, Wu HM, Lirng JF, Wong TT, Lu YH, Chang FC. Preoperative embolization of hypervascular pediatric brain tumors: evaluation of technical safety and outcome. Childs Nerv Syst. 2013 Nov;29(11):2043-9. doi: 10.1007/s00381-013-2128-2. Epub 2013 May 4. PMID: 23644575.

8: Jankowitz BT, Vora N, Jovin T, Horowitz M. Treatment of pediatric intracranial vascular malformations using Onyx-18. J Neurosurg Pediatr. 2008 Sep;2(3):171-6. doi: 10.3171/PED/2008/2/9/171. PMID: 18759597.

9: Cornelius JF, Saint-Maurice JP, Bresson D, George B, Houdart E. Hemorrhage after particle embolization of hemangioblastomas: comparison of outcomes in spinal and cerebellar lesions. J Neurosurg. 2007 Jun;106(6):994-8. doi: 10.3171/jns.2007.106.6.994. PMID: 17564170.

10: Rodiek SO, Stölzle A, Lumenta ChB. Preoperative embolization of intracranial meningiomas with Embosphere microspheres. Minim Invasive Neurosurg. 2004 Oct;47(5):299-305. doi: 10.1055/s-2004-830069. PMID: 15578344.


1)
Okada H, Hashimoto T, Tanaka Y, Sakamoto H, Kohno M. Embolization of Skull Base Meningiomas with Embosphere® Microspheres: Factors Predicting Treatment Response and Evaluation of Complications. World Neurosurg. 2022 Mar 2:S1878-8750(22)00265-0. doi: 10.1016/j.wneu.2022.02.118. Epub ahead of print. PMID: 35247619.
2)
Okuma Y, Hirotsune N, Sato Y, Tanabe T, Muraoka K, Nishino S. Midterm Follow- Up of Patients with Middle Meningeal Artery Embolization in Intractable Chronic Subdural Hematoma. World Neurosurg. 2019 Jun;126:e671-e678. doi: 10.1016/j.wneu.2019.02.121. Epub 2019 Mar 4. PMID: 30844521.
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