Preoperative embolization of hypervascular skull base tumors

The purpose of the present study is to review the results and complications of preoperative embolization of hypervascular skull base tumors at a neurosurgical center with a team of neurosurgeons cross-experienced in the application of both microsurgery and endovascular techniques. One hundred and twenty-eight endovascular approaches were performed in 66 patients treated for skull base meningiomas (n = 41), paragangliomas of the temporal bone (n = 18), and juvenile nasopharyngeal angiofibromas (n = 7). One death and 2 permanent disabilities were attributable to endovascular therapy. These complications occurred early in our experience (1982-1989) and were related to thromboembolic events rather than complications of transcatheter embolization itself. Our current standard is to perform transfemoral superselective embolizations with either finely corpuscular embolizing substances (PVA particles) or cyanoacrylates (NBCA) under local anesthesia. Using this protocol no embolization-related complications have occurred over the last 9 years. We thus conclude that preoperative embolization of hypervascular skull base tumors can be accomplished safely with the endovascular techniques now available.