Evidence map›Paper›PMID 40916651›Full record

ArticleNeuro-oncology2025

Preoperative embolization improves local control and modulates gene expression in atypical WHO grade 2 meningioma.

Alexander F Haddad, Rithvik Ramesh, Naomi Zakimi, Jia-Shu Chen, Daniel Quintana, Eugene Gil, Aymen S Kabir, Youssef E Sibih, Blanca Morales Lugo, Shubhang Bhalla and 10 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neuro-oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Alexander F HaddadDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Rithvik RameshDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Naomi ZakimiDepartment of Radiology, University of California, San Francisco, San Francisco, CA, USA.
Jia-Shu ChenDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Daniel QuintanaDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Eugene GilDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Aymen S KabirDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Youssef E SibihDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Blanca Morales LugoDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Shubhang BhallaDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
William C ChenDepartment of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA.
Javier E Villanueva-MeyerDepartment of Radiology, University of California, San Francisco, San Francisco, CA, USA.
Kazim H NarsinhDepartment of Radiology, University of California, San Francisco, San Francisco, CA, USA.
Stephen T MagillDepartment of Neurological Surgery, Northwestern University, Chicago, IL, USA.
Ramin A MorshedDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.ORCID 0000-0001-8464-6041
Ethan WinklerDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Philip V TheodosopoulosDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Michael W McDermottDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.ORCID 0000-0001-7944-5181
Manish K AghiDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
David R RaleighDepartment of Pathology, University of California, San Francisco, San Francisco, CA, USA.

Funding

Tissue CoreP50CA097257 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Susan M Chang · 2002 to 2026
$57.4M
Understanding druggable drivers of meningioma tumorigenesisR01CA262311 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI RALEIGH, DAVID R · 2021 to 2025
$2.7M
NCI NIH HHS P50 CA097257NCI NIH HHS R01 CA262311NIH HHS P50 CA097257NIH HHS R01 CA262311Trenchard Family Charitable Fund
6 · The paper itself

Abstract

backgroundPreoperative embolization is hypothesized to reduce blood loss and operative time for meningioma resection, but the impact of preoperative embolization on long-term oncological outcomes and molecular features of meningiomas is incompletely understood. Here, we investigate how preoperative embolization influences perioperative and long-term outcomes as well as molecular features of atypical WHO grade 2 meningiomas.

methodsPatients who underwent resection of WHO grade 2 meningiomas from 1997 to 2021 were retrospectively identified from an institutional database. Univariate and multivariate Cox proportional hazards modeling and propensity matching were used for clinical analyses. Available DNA methylation profiling, bulk RNA sequencing, and targeted gene expression profiling data were used to elucidate how preoperative embolization influences the molecular architecture of atypical WHO grade 2 meningiomas.

resultsA total of 319 patients with atypical WHO grade 2 meningiomas were identified, of which 106 (33.2%) underwent preoperative embolization without significant changes in perioperative outcomes, such as blood loss or operative time, in comparison to patients who did not undergo preoperative embolization. In propensity matched multivariate analyses, preoperative embolization was independently associated with longer recurrence-free survival (RFS, HR 0.55, 95% CI 0.31-0.96, P = .037), particularly in patients with subtotal resection (median RFS 16.2 years vs 5.9 years, P = .045; HR 0.32, 95% CI 0.14-0.70, P = .005). Bioinformatic analyses demonstrated that preoperative embolization led to enrichment of pathways linked to cellular differentiation and hypoxia, and suppression of pathways implicated in mitosis and cell cycle progression, suggesting that improved long-term oncological outcomes may occur through inhibition of the cell cycle in atypical WHO grade 2 meningiomas.

conclusionsPreoperative embolization improves local control and modulates gene expression in atypical WHO grade 2 meningiomas, a subgroup of meningiomas that have intermediate clinical outcomes with standard interventions.

Indexed as

Embolization, TherapeuticGene Expression Regulation, NeoplasticMeningeal NeoplasmsMeningiomaPreoperative CareAdultAgedBiomarkers, TumorFemaleFollow-Up StudiesHumansMaleMiddle AgedNeoplasm GradingPrognosisRetrospective StudiesBiomarkers, TumoratypicaldifferentiationembolizationhypoxiameningiomamitosisrecurrencetranscriptomicsWHO grade 2

Identifiers

PMID40916651
PMCPMC12916727

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.