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

Waldron, James S MD*; Sughrue, Michael E MD*; Hetts, Steven W MD†; Wilson, Sean P BA*; Mills, Steven A BFA*; McDermott, Michael W MD*; Dowd, Christopher F MD†; Parsa, Andrew T MD, PhD*

doi: 10.1227/NEU.0b013e3181fe2de9
Research-Human-Clinical Studies

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.

*Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; †Division of Neurointerventional Radiology, University of California, San Francisco, San Francisco, California

Received, January 7, 2010.

Accepted, July 6, 2010.

Correspondence: Andrew T. Parsa, MD, PhD, Associate Professor, Department of Neurological Surgery, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA 94123. E-mail: Parsaa@neurosurg.ucsf.edu

Copyright © by the Congress of Neurological Surgeons