Contralateral meningeal artery supply of paramedian meningiomas

When resecting at falcine or parasagittal portion of paramedian meningiomas, intraoperative hemostasis often is difficult despite effective management of ipsilateral meningeal arteries. We attribute such difficulties to meningeal artery blood supply from the contralateral side. We retrospectively studied feeding arteries from both sides in case of paramedian meningioma in terms of patient and tumor characteristics.

Forty-three patients with paramedian meningiomas underwent selective internal and external carotid angiography. We investigated how contralateral meningeal arterial feeders related to patient profiles and imaging, histopathologic, and immunohistochemical findings.

Contralateral meningeal supply existed for 14 of 25 falcine meningiomas and 6 of 18 parasagittal meningiomas. Patients with contralateral feeders were 8.5 years younger than the others (P=.027) and were more likely to have larger tumors (P=.028). These were histopathologically malignant (P=.048), while showing more proliferation followed by monoclonal antibody against the Ki-67 antigen index (P=.012) and angiogenetic potential associated with vascular endothelial growth factor expression (P=.0085).

Contralateral meningeal supply may reflect strong angiogenetic recruitment from rapid tumor growth followed by high expression of vascular endothelial growth factor. This angiographical feature may predict the aggressive growth of paramedian meningiomas.