Preoperative Embolization of Skull Base Meningiomas: Impact on surgical results

Object There are several surgical techniques for reducing blood loss—open surgical and endoscopic—prior to resection of giant anterior skull base meningiomas, especially when preoperative embolization is risky or not technically feasible. The authors present examples of an institutional experience using surgical ligation of the anterior and posterior ethmoidal arteries producing persistent tumor blush in partially embolized tumors. Methods The authors identified 12 patients who underwent extracranial surgical ligation of ethmoidal arteries through either a transcaruncular or a Lynch approach. Of these, 3 patients had giant olfactory groove or planum sphenoidale meningiomas. After approval from the institution privacy officer, the authors studied the medical records and imaging data of these 3 patients, with special attention to surgical technique and outcome. The variations of ethmoidal artery foramina pertaining to this surgical approach were studied using preserved human skulls from the Hamann-Todd Osteological Collection at the Museum of Natural History, Cleveland, Ohio. Results The extracranial ligation was performed successfully for control of the ethmoidal arteries prior to resection of hypervascular giant anterior skull base meningiomas. The surgical anatomy and landmarks for ethmoidal arteries were reviewed in anthropology specimens and available literature with reference to described surgical techniques. Conclusions Extracranial surgical ligation of anterior, and often posterior, ethmoidal arteries prior to resection of large olfactory groove or planum sphenoidale meningiomas provides a safe and feasible option for control of these vessels prior to either open or endoscopic resection of nonembolized or partially embolized tumors.

Download Full-text

Preoperative embolization of skull base meningiomas: current indications, techniques, and pearls for complication avoidance

Neurosurgical FOCUS ◽

10.3171/2018.1.focus17686 ◽

2018 ◽

Vol 44 (4) ◽

pp. E5 ◽

Cited By ~ 15

Author(s):

Nam Yoon ◽

Aatman Shah ◽

William T. Couldwell ◽

M. Yashar S. Kalani ◽

Min S. Park

Keyword(s):

Blood Loss ◽

Skull Base ◽

Vascular Anatomy ◽

Vascular Supply ◽

Preoperative Embolization ◽

Endovascular Techniques ◽

Potential Benefits ◽

Skull Base Lesions ◽

Skull Base Meningiomas ◽

Decrease Blood Loss

Skull base meningiomas are technically challenging tumors to treat because of their deep vascular supply that can preclude early devascularization during resection. Preoperative embolization of these arterial feeders is thought to decrease blood loss and facilitate resection; however, given the complex and varied anatomy of these skull base lesions, preoperative embolization is not without risk. It is essential for both endovascular and skull base neurosurgeons to understand these risks in light of the potential benefits. The authors review the vascular anatomy of skull base meningiomas, indications for preoperative devascularization, endovascular techniques, and published results regarding embolization of these lesions.

Download Full-text

Pitfalls during the Embolization and Evaluation after the Embolization for the Skull Base Meningiomas

Rivista di Neuroradiologia ◽

10.1177/197140099500800646 ◽

1995 ◽

Vol 8 (6) ◽

pp. 252-257

Author(s):

A. Nishio ◽

K. Ohata ◽

N. Tsuyuguchi ◽

T. Gotoh ◽

T. Ishiguro ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Serum Levels ◽

External Carotid Artery ◽

External Carotid ◽

Preoperative Embolization ◽

Mri Findings ◽

Skull Base Meningiomas

Pitfall during the embolization and evaluation after the embolization for skull base meningiomas supplied by meningeal arteries of internal carotid artery (ICA) are reported. This study includes 15 cases of skull base meningiomas (two males and 13 females) that supplied by meningeal branches of internal carotid artery. The preoperative embolization was performed by these feeders. MRI findings and serum levels of C-reactive protein (CRP) after the embolization were examined. In ten patients among 15 patients the meningeal branches of ICA were dominant feeders. In ten patients out of 15 patients, the embolization from the meningeal branches of ICA was possible. Eight patients out of these ten patients were suffered from high fever and increase of serum level of CRP after the embolization. During the embolization for skull base meningiomas, the existence of collateral pathways between the ICA system and external carotid artery system were identified. The increase of serum levels of CRP might be recognized in the patients that effective embolization were performed.

Download Full-text

Preoperative embolization for skull base meningiomas

Journal of Neuroendovascular Therapy ◽

10.5797/jnet.3.165 ◽

2009 ◽

Vol 3 (3) ◽

pp. 165-173

Author(s):

Akimasa NISHIO ◽

Yutaka MITSUHASHI ◽

Takeo GOTO ◽

Kenichi ISHIBASHI ◽

Tsutomu ICHINOSE ◽

...

Keyword(s):

Skull Base ◽

Preoperative Embolization ◽

Skull Base Meningiomas

Download Full-text

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

Neurosurgery ◽

10.1227/neu.0b013e3181fe2de9 ◽

2011 ◽

Vol 68 (1) ◽

pp. 162-169 ◽

Cited By ~ 37

Author(s):

James S. Waldron ◽

Michael E. Sughrue ◽

Steven W. Hetts ◽

Sean P. Wilson ◽

Steven A. Mills ◽

...

Keyword(s):

Decision Making ◽

Skull Base ◽

Internal Carotid ◽

Preoperative Embolization ◽

Complication Rates ◽

Feeding Artery ◽

Skull Base Tumors ◽

Feeding Vessels ◽

Skull Base Meningiomas ◽

Carotid Circulation

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.

Download Full-text

Preoperative Embolization of Skull Base Meningiomas: Outcomes in the Onyx Era

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1633349 ◽

2018 ◽

Vol 79 (S 01) ◽

pp. S1-S188

Author(s):

Colin Przybylowski ◽

Jacob Baranoski ◽

Alfred See ◽

Rami Almefty ◽

Dale Ding ◽

...

Keyword(s):

Skull Base ◽

Preoperative Embolization ◽

Skull Base Meningiomas

Download Full-text

Pitfalls during the Embolization and Evaluation after the Embolization for the Skull Base Meningiomas

Interventional Neuroradiology ◽

10.1177/15910199060120s146 ◽

2006 ◽

Vol 12 (1_suppl) ◽

pp. 252-257

Author(s):

A. Nishio ◽

K. Ohata ◽

N. Tsuyuguchi ◽

T. Gotoh ◽

T. Ishiguro ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Serum Levels ◽

External Carotid Artery ◽

External Carotid ◽

Preoperative Embolization ◽

Mri Findings ◽

Skull Base Meningiomas

Pitfall during the embolization and evaluation after the embolization for skull base meningiomas supplied by meningeal arteries of internal carotid artery (ICA) are reported. This study includes 15 cases of skull base meningiomas (two males and 13 females) that supplied by meningeal branches of internal carotid artery. The preoperative embolization was performed by these feeders. MRI findings and serum levels of C-reactive protein (CRP) after the embolization were examined. In ten patients among 15 patients the meningeal branches of ICA were dominant feeders. In ten patients out of 15 patients, the embolization from the meningeal branches of ICA was possible. Eight patients out of these ten patients were suffered from high fever and increase of serum level of CRP after the embolization. During the embolization for skull base meningiomas, the existence of collateral pathways between the ICA system and external carotid artery system were identified. The increase of serum levels of CRP might be recognized in the patients that effective embolization were performed.

Download Full-text

Preoperative Embolization for Skull Base Meningiomas

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1598195 ◽

2017 ◽

Vol 78 (04) ◽

pp. 308-314 ◽

Cited By ~ 11

Author(s):

Masaya Nagaishi ◽

Yoshiyuki Matsumoto ◽

Yoshiko Fujii ◽

Yuki Inoue ◽

Yoshiki Sugiura ◽

...

Keyword(s):

Skull Base ◽

Treatment Time ◽

Preoperative Embolization ◽

Large Tumor ◽

Embolic Material ◽

Medial Side ◽

Simpson Grade ◽

Embolic Materials ◽

Skull Base Meningiomas ◽

Excision Rate

AbstractThe results of preoperative embolization for skull base meningiomas were retrospectively evaluated to confirm the efficacy of this procedure. Skull base meningiomas that were treated with preoperative embolization were evaluated in 20 patients. The occluded arteries, embolic materials, treatment time, excision rate, neurologic manifestations, and complications were analyzed. The embolic material was 80% liquid, 30% coils, and 15% particles. The surgery was normally completed within 3 to 5 hours. Blood loss was normally approximately 250 mL, excluding four patients having the following conditions: malignant meningioma, a large tumor located on the medial side of the sphenoidal ridge, the petroclival tumor, and infiltrated tumor into the sigmoid sinus. The mean excision rate was 90%, achieving a Simpson grade III, but 10% were graded as Simpson grade IV. No permanent complications due to the preoperative embolization occurred. No neurologic symptoms occurred after excision. Current cerebral endovascular treatment is sophisticated, and the complication rate has markedly decreased. Although it was impossible to compare directly with or without operative embolization, preoperative embolization should be actively used as part of the treatment for this benign tumor, with better understanding of dangerous anastomosis.

Download Full-text