Definitive embolization of meningiomas: a 20-year updated systematic review

BACKGROUND: To systematically review published reports of standalone bland embolization for intracranial meningioma and summarize clinical, radiographic, and safety outcomes. METHODS: A systematic PubMed search was performed from inception through December 2025 in accordance with PRISMA guidelines. Eligible studies included intracranial meningiomas treated with embolization as the primary therapy without planned immediate surgery or radiation. Data on patient characteristics, tumor features, embolic materials, complications, and longitudinal outcomes were extracted and synthesized descriptively. RESULTS: Twelve studies comprising 30 patients met inclusion criteria. Patients were typically older or high-risk surgical candidates, and tumors were most commonly convexity or parasagittal with predominant external carotid artery supply. The middle meningeal artery was embolized in 27/30 cases. Particles (polyvinyl alcohol or tris-acryl gelatin microspheres) were the most commonly used embolic agents, with multiple studies also reporting liquid embolics. Quantitative volumetric follow-up was available in 18 patients and demonstrated a mean tumor volume reduction of 37% over a mean follow-up of 13 months. Durable symptomatic improvement was reported in all cases with available clinical follow-up. Treatment-related complications included two patients with transient edema, one requiring steroids. Two patients underwent delayed additional tumor-directed therapy. CONCLUSIONS: This review is limited by low-quality evidence of the existing literature. Nevertheless, the evidence suggests that standalone bland embolization appears technically feasible and may provide symptom improvement and moderate tumor control in selected intracranial meningiomas, without precluding subsequent surgery or radiation. These findings provibaseline outcome data, establish a precedent for possible pragmatic trials, and may inform the design and interpretation of future endovascular therapy studies for meningioma.