Preoperative Embolization for Skull Base Meningiomas

Suzuki, Kensuke; Nagaishi, Masaya; Matsumoto, Yoshiyuki; Fujii, Yoshiko; Inoue, Yuki; Sugiura, Yoshiki; Hirata, Koji; Suzuki, Rikako; Kawamura, Yosuke; Nakae, Ryuta; Tanaka, Yoshihiro; Hyodo, Akio

doi:10.1055/s-0037-1598195

Cited by 22 publications

(7 citation statements)

References 16 publications

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“…Judging from these results, such knowledge is very important and useful information not only prior to surgery but also for angiography or preoperative embolization. The advantages of preoperative tumor embolization in meningiomas have been discussed in many reports [8][9][10][11]14,15], and the results of our study also support the efficacy of this option. Among all the arteries investigated in this article, the TA, DMA, APA, and PB potentially provide blood flow to the cranial nerves or form anastomosis with cerebral vessels [16,17].…”

Section: Feeding Arteries In Skull Base Meningiomasupporting

confidence: 84%

“…Although some studies have described dural vessels in normal subjects [6,7], few reports have provided detailed information regarding feeding arteries in meningioma patients [2], and even those articles regarding embolization for meningioma have contained little information about the anatomical characteristics and distributions of feeding arteries in meningioma [8][9][10][11]. In recent years, some studies have pointed out the possibility of the feeding artery as an anatomical land mark of skull base meningioma [2,4], but these tumors are relatively rare so it is usually difficult to evaluate them in large numbers.…”

Section: Introductionmentioning

confidence: 99%

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Angiographic Evaluation of the Feeding Artery in Skull Base Meningioma

Arima,

Watanabe,

Tanoue

et al. 2023

JCM

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To identify the characteristics of feeding arteries in skull base meningioma including location and prevalence, we evaluated the distributions and types of feeding arteries in skull base meningioma by cerebral angiography and assessed relationships to tumor attachment. We enrolled patients with skull base meningioma who underwent MRI and cerebral digital subtraction angiography (DSA), from September 2015 to October 2022. Subjects comprised 115 patients (32 males, 83 females; mean age, 52.7) with 117 meningiomas, showing tumor attachments around the “cavernous sinus to the upper part of the clivus” (Area 1), “lower part of the clivus to foramen magnum” (Area 2), and “tentorium around the petrous bone” (Area 3). Frequent arteries, such as the dorsal meningeal artery (DMA), the ascending pharyngeal artery (APA), the tentorial artery (TA), and the petrosal branch (PB) of the middle meningeal artery (MMA) were analyzed in terms of their associations with tumor attachment to Areas 1–3. Meningiomas with the DMA as a feeding artery correlated with tumor attachment to Area 1 (p < 0.001). Meningiomas with the APA correlated with tumor attachment to Area 2 (p < 0.001). Meningiomas with the TA correlated with tumor attachment to Area 3 (p < 0.001). The PB correlated with Area 3 (p < 0.05). Our study founded that visualization of these arteries correlated well with specific areas. These arteries were also the main feeders in each type of skull base meningioma.

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Section: Feeding Arteries In Skull Base Meningiomasupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Angiographic Evaluation of the Feeding Artery in Skull Base Meningioma

Arima,

Watanabe,

Tanoue

et al. 2023

JCM

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“…Effective embolization has advantages, such as minimizing the loss of blood, making the tumor softer and shortening time of operation, but the controversial aspect deserves careful consideration. [ 9 , 10 ] However, selective embolization may lead to severe stroke. In the patient, the DSA scans indicated collateral circulation between the supplying vessels of left middle meningeal arteries and anterior choroid arteries.…”

Section: Discussionmentioning

confidence: 99%

Extracranial–intracranial bypass in medial sphenoid ridge meningioma associated with severe stenosis of the intracranial segments of the internal carotid artery

Huang

Wang²,

Han³

2018

Medicine

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Rationale:Tumor resection and extracranial-intracranial bypass concerning medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery (ICA) of intracranial segments has been rarely presented. Effective treatment as to the complex lesions may be complicated. Tumor resection and cerebrovascular protection should be both taken into consideration.Patient concerns:We presented one case of medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery of intracranial segments. The patient suffered hyperthyroidism, mirror-image dextrocardia and congenital heart disease atrial septal defect simultaneously.Diagnoses:Before the neurosurgical treatment , the colleagues of department of cardiac surgery, anesthesiology and respiratory medicine agreed on our plan of resecting the tumor following the comprehensive evaluation of basal clinical conditions in the patient. For reducing the bleeding intraoperatively, the interventional branch performed digital subtraction angiography(DSA) and found collateral anastomosis between the supplying vessels of left middle meningeal arteries and anterior choroid arteries. No preoperative interventional embolization was determined considering the risk of cerebral ischemia.Interventions:The following subtotal resection of medial sphenoid ridge meningioma and left extracranial-intracranial bypass were carried out. Additionally, ipsilateral decompressive craniectomy was done. Post-operative imaging Computed tomography (CT), Computed tomography angiography (CTA) and Transcranial Doppler (TCD) indicated subtotal resection of tumor and bypass patency.Outcomes:The patient was discharged with the right limbs of muscle strength of grade IV. The muscle strength of the patient returned to grade V after 6 months of follow-up.Lessons:Comprehensive treatment of tumor resection and extracranial-intracranial bypass concerning medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery of intracranial segments is effective.

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“…Conversely, in particular 3-dimensional DSA reconstructions enable excellent visualization of small feeders and branches arising from posterior circulation arteries that could represent major surgical risks [82]. Conventional DSA should be performed in selected cases of large or giant PCM where there is suspected engulfment of the BA or the ICA [89], to define the dural attachment area, to identify the meningioma feeding arteries and to consequently adapt the surgical approach [2], to study in details venous drainage, and to evaluate the possibility of preoperative embolization [53,95,143]. Preoperative embolization may offer a relatively avascular field, thus reducing the need for bipolar coagulation in the vicinity of critical neurovascular structures and its value should not be underestimated.…”

Section: Neuroradiologymentioning

confidence: 99%

Petroclival meningiomas: update of current treatment and consensus by the EANS skull base section

et al. 2021

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Background The optimal management of petroclival meningiomas (PCMs) continues to be debated along with several controversies that persist. Methods A task force was created by the EANS skull base section along with its members and other renowned experts in the field to generate recommendations for the management of these tumors. To achieve this, the task force reviewed in detail the literature in this field and had formal discussions within the group. Results The constituted task force dealt with the existing definitions and classifications, pre-operative radiological investigations, management of small and asymptomatic PCMs, radiosurgery, optimal surgical strategies, multimodal treatment, decision-making, and patient's counselling. Conclusion This article represents the consensually derived opinion of the task force with respect to the management of PCMs.

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Preoperative Embolization for Skull Base Meningiomas

Cited by 22 publications

References 16 publications

Angiographic Evaluation of the Feeding Artery in Skull Base Meningioma

Angiographic Evaluation of the Feeding Artery in Skull Base Meningioma

Extracranial–intracranial bypass in medial sphenoid ridge meningioma associated with severe stenosis of the intracranial segments of the internal carotid artery

Petroclival meningiomas: update of current treatment and consensus by the EANS skull base section

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