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

Abstract

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.

Preoperative Embolization of Intracranial Meningiomas: Efficacy, Technical Considerations, and Complications

“…22,30,31 The technique has been used for lesions in all intracranial locations, including the skull base (Fig 1). 5 Although embolization often makes a subjective difference to the presumed difficulty and duration of a case to the operating surgeon, it may be difficult to demonstrate objective differences in surgical outcomes and operative duration. 32 For example, embolization that leads to a bloodless field during surgery for a tumor in an eloquent location may provide a subjective difference in tumor removal but may not have a significant overall effect on the surgical complications and outcomes.…”

“…1 Meningiomas are commonly supplied by the middle meningeal, accessory meningeal, ascending pharyngeal, or occipital branches of the external carotid artery (ECA), which are easily accessible by selective microcatheterization. 2 Branches of the internal carotid artery and pial feeders supplying the tumor may also be embolized, [3][4][5][6] though these vessels are typically more difficult to access and are associated with a higher risk of parenchymal infarct. In an attempt to change the tumor characteristics to increase the likelihood of a gross total resection and minimize operative morbidity, a variety of embolization materials have been used, including polyvinyl alcohol (PVA) particles, 7,8 large-caliber microspheres, 8,9 ethylene-vinyl alcohol (Onyx; Covidien, Irvine, California), causes changes in protein expression consistent with angiogenesis and promotion of growth, 16 along with cytologic changes, including infiltration of macrophages.…”

Controversies in the role of preoperative embolization in meningioma management

“…Bendszus et al 3 prospectively compared embolized and nonembolized meningiomas and reported that only complete tumor devascularization resulted in significant reduction in blood loss. In another recent retrospective case series, Waldron et al 30 reported good outcomes with preoperative embolization of skull base meningiomas fed by the internal carotid artery circulation, with a low rate of complications. Quiñones-Hinojosa et al…”

“…These include large meningioma size, 10-13 high tumor vascularity, [10][11][12]24 arterial supply that is difficult to reach intraoperatively 10,24 such as in skull base lesions, 10,25 and significant external carotid artery-derived arterial supply. 11,12,19 Only several authors provided a specific algorithm for patient selection 11,30 that explicitly incorporated these factors. In addition, Waldron et al 30 introduced several exclusion criteria such as significant peripheral vascular disease and a history of stroke that can significantly impact the risk-benefit ratio of embolization.…”

“…11,12,19 Only several authors provided a specific algorithm for patient selection 11,30 that explicitly incorporated these factors. In addition, Waldron et al 30 introduced several exclusion criteria such as significant peripheral vascular disease and a history of stroke that can significantly impact the risk-benefit ratio of embolization. Latchaw 16 has defined 5 instances in which preoperative embolization of meningioma can play a significant role.…”