Utility and Safety of Preoperative Feeding Arteries Embolization and Tumor Embolization for Skull Base Meningiomas

Background: Preoperative feeding arteries and tumor embolization for meningiomas is considered an effective preoperative treatment for meningiomas because it shortens the operative time by decreasing blood loss and softening the tumor. For skull base meningiomas, tumor feeding arteries from the internal carotid artery are located deep in the surgical field and must be treated after tumor decompression, making preoperative embolization with endovascular treatment useful. On the other hand, perioperative complications from preoperative embolization are known, and its usefulness and safety are controversial.

Methods: Skull base meningiomas supplied with blood flow by the inferior lateral trunk (ILT) or meningohypophyseal trunk (MHT), a branch of the internal carotid artery (ICA), were searched in Osaka Medical and Pharmaceutical University Hospital. The timing of preoperative embolization, embolization material, and perioperative complications were retrospectively investigated.

Results: A total of eight patients underwent preoperative embolization, which was planned approximately within 1 week before craniotomy. Assist balloon catheters were used in all patients to block the internal carotid artery during microcatheter insertion and embolic material injection. The embolization material was mainly n-Butyl cyanoacrylates (NBCA) with coils in each case. 13% NBCA concentration was used. Headache was observed as most common complaint, but improved with time and steroid use. In patients who developed cavernous sinus syndrome after preoperative embolization, craniotomy was temporarily postponed. In both cases, the symptoms were transient, and craniotomy was performed after steroid use was confirmed to have relieved the symptoms.

Discussion and Conclusion: The use of assisted balloon catheters was useful for cannulation of microcatheters into the ILT or MHT and for blocking the internal carotid artery during embolic material injection. Perioperative complications were mainly headache and cavernous sinus syndrome, both of which improved with steroid use and time course. During actual craniotomy, tumor softening associated with tumor necrosis facilitated surgical manipulation, suggesting the usefulness of preoperative feeding arteries embolization and tumor embolization.

Publication History

Article published online:
07 February 2025