Strategies for embolization of the internal carotid artery for cavernous sinus tumors

Skull base tumors, in addition to blood supply from the external carotid artery, frequently receive a portion of their blood supply from the cavernous portion of the internal carotid artery, especially when the cavernous sinus is invaded by tumor. Preoperative embolization routinely includes obliteration of the supply to the tumor from the external carotid system. However, a variety of strategies are available that enable preoperative embolization of supply from the internal carotid artery as well. These include direct catheterization of cavernous branches of the internal carotid artery, temporary occlusion of the internal carotid artery during external carotid embolization, embolization of the internal carotid artery supply during temporary or permanent occlusion of the internal carotid artery, and internal carotid artery sacrifice. The angiographic anatomy in any particular case dictates these options.