Embolization of Skull Base Meningiomas and Feeding Vessels Arising From the Internal Carotid Circulation

• Published in: Neurosurgery Vol. 68; no. 1; pp. 162 - 169
• Main Authors: Waldron, James S., Sughrue, Michael E., Hetts, Steven W., Wilson, Sean P., Mills, Steven A., McDermott, Michael W., Dowd, Christopher F., Parsa, Andrew T.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Oxford University Press 01.01.2011; Lippincott Williams & Wilkins; Wolters Kluwer Health, Inc
• Subjects: Biological and medical sciences; Brain cancer; Carotid arteries; Carotid Artery, Internal - surgery; Clinical decision making; Decision making; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Humans; Medical sciences; Meningeal Neoplasms - blood supply; Meningeal Neoplasms - surgery; Meningioma - blood supply; Meningioma - surgery; Middle Aged; Neoadjuvant Therapy - adverse effects; Neoadjuvant Therapy - methods; Neurosurgery; Skull Base Neoplasms - blood supply; Skull Base Neoplasms - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Veins & arteries; Endovascular therapy; Tumor embolization; Skull base; Internal carotid artery; Meningioma; Internal carotid; Nervous system diseases; Endovascular route; Treatment; Surgery; Skull; Embolization; Benign neoplasm
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0b013e3181fe2de9

Abstract BACKGROUND: Practice patterns regarding the preoperative embolization of skull base tumors vary widely among institutions and are driven by surgeon preference and concerns about safety. OBJECTIVE: We present a recent experience at our institution with a specific focus on procedural decision-making, embolization of vessels arising from the internal carotid circulation, and complication rates. METHODS: During a 7.5-year period, 262 meningiomas were referred for embolization. of which 119 (45%) originated from the skull base. Tumors were categorized by location, feeding artery origin, and arteries embolized. Complication rates were reviewed. RESULTS: Sixty-four of 119 patients with skull base tumors (54%) underwent embolization of at least 1 feeding artery. Feeding arteries arose from the external carotid artery (ECA) circulation in 26 (22%), the internal carotid artery (ICA) circulation in 30 (25%), a combination of ECA/ICA/Vert in 54 (45%), and had only pial supply in 10 (8%). In total, 15 of 85 (18%) ICA feeding vessels were embolized. This included 9 of 28 vessels from the meningohypopheseal trunk, 3 of 4 vessels from the anterior temporal artery, 1 of 35 vessels from the ophthalmic artery, 1 of 8 vessels directly from the ICA, and 1 of 5 vessels from the inferolateral trunk. Complete devascularization occurred in 6 of 64 patients; subtotal devascularization was seen in 58 of 64. The overall angiographic complication rate for all meningiomas embolized in the study period was 2.5% (5/199). None of the complications occurred in the skull base group. CONCLUSION: Preoperative embolization of skull base meningiomas and ICA feeding vessels can be done with low complication rates when intraprocedural decision-making favors complication avoidance over complete devascularization.