title: Extracranial ligation of ethmoidal arteries before resection of giant olfactory groove or planum sphenoidale meningiomas: 3 illustrative cases with a review of the literature on surgical techniques.
abstract: OBJECTIVE
  There are several surgical techniques for reducing blood loss-open surgical and endoscopic-prior to resection of giant anterior skull base meningiomas, especially when preoperative embolization is risky or not technically feasible. The authors present examples of an institutional experience using surgical ligation of the anterior and posterior ethmoidal arteries producing persistent tumor blush in partially embolized tumors.
  
  
  METHODS
  The authors identified 12 patients who underwent extracranial surgical ligation of ethmoidal arteries through either a transcaruncular or a Lynch approach. Of these, 3 patients had giant olfactory groove or planum sphenoidale meningiomas. After approval from the institution privacy officer, the authors studied the medical records and imaging data of these 3 patients, with special attention to surgical technique and outcome. The variations of ethmoidal artery foramina pertaining to this surgical approach were studied using preserved human skulls from the Hamann-Todd Osteological Collection at the Museum of Natural History, Cleveland, Ohio.
  
  
  RESULTS
  The extracranial ligation was performed successfully for control of the ethmoidal arteries prior to resection of hypervascular giant anterior skull base meningiomas. The surgical anatomy and landmarks for ethmoidal arteries were reviewed in anthropology specimens and available literature with reference to described surgical techniques.
  
  
  CONCLUSIONS
  Extracranial surgical ligation of anterior, and often posterior, ethmoidal arteries prior to resection of large olfactory groove or planum sphenoidale meningiomas provides a safe and feasible option for control of these vessels prior to either open or endoscopic resection of nonembolized or partially embolized tumors.
authors.affiliation: Departments of Neurosurgery and.
authors.forename: Sunil
authors.initials: S
authors.lastname: Manjila
authors.forename: Efrem M
authors.initials: EM
authors.lastname: Cox
authors.forename: Gabriel A
authors.initials: GA
authors.lastname: Smith
authors.forename: Mark
authors.initials: M
authors.lastname: Corriveau
authors.forename: Nipun
authors.initials: N
authors.lastname: Chhabra
authors.forename: Freedom
authors.initials: F
authors.lastname: Johnson
authors.forename: Robert T
authors.initials: RT
authors.lastname: Geertman
mesh_terms: D001158:Arteries / Q000601:surgery*; D002490:Central Nervous System; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D008026:Ligation; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000628:therapy*; D008579:Meningioma / Q000628:therapy*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D019292:Skull Base Neoplasms / Q000601:surgery*; D013100:Sphenoid Bone / Q000473:pathology; D015898:Tomography Scanners, X-Ray Computed