title: Embolization of skull base meningiomas and feeding vessels arising from the internal 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94123, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Waldron
authors.forename: Michael E
authors.initials: ME
authors.lastname: Sughrue
authors.forename: Steven W
authors.initials: SW
authors.lastname: Hetts
authors.forename: Sean P
authors.initials: SP
authors.lastname: Wilson
authors.forename: Steven A
authors.initials: SA
authors.lastname: Mills
authors.forename: Michael W
authors.initials: MW
authors.lastname: McDermott
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Dowd
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Parsa
mesh_terms: D002343:Carotid Artery, Internal / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008577:Meningeal Neoplasms / Q000098:blood supply / Q000601:surgery*; D008579:Meningioma / Q000098:blood supply / Q000601:surgery*; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods*; D019292:Skull Base Neoplasms / Q000098:blood supply / Q000601:surgery*; D016896:Treatment Outcome