Comparative benefits of particle embolization versus liquid agents in preoperative management of meningiomas: A Systematic Review and Meta-analysis

Introduction Preoperative embolization reduces intraoperative blood loss (IBL) in meningioma treatment, but the optimal embolic material remains uncertain. This systematic review and meta-analysis compares the effectiveness and safety of particle versus liquid embolic agents in the preoperative embolization of meningiomas. Methods PubMed, Cochrane, Embase, and Scopus were searched for studies comparing particles and liquid embolic agents in patients undergoing preoperative embolization of meningiomas. Primary outcomes included the degree of devascularization, IBL, ischemic events, and overall complications. The risk of bias was assessed using the ROBINS-I. Statistical analyses were conducted using R. Results The analysis included four studies, covering a total of 1827 patients. Particles were associated with a significantly lower incidence of operative complications (OR = 0.35; 95% CI 0.20–0.62; p < 0.001; I 2 = 0.0%). The other outcomes did not differ between groups. Regarding IBL, no significant difference was observed between particulate and liquid embolic agents (MD = −65.01 mL; 95% CI −237.01–107.00; p = 0.46; I 2 = 77.8%). Conclusion Our systematic review and meta-analysis indicate no significant differences between particulate and embolic agents; however, particulate agents were associated with a lower incidence of overall complications, suggesting a potential advantage in perioperative safety.