Skull-base tumors: ethanol embolization of the cavernous carotid artery

Tumors of the skull base frequently have some blood supply from cavernous branches of the internal carotid artery (ICA). Preoperative embolization of such pedicles can expedite the subsequently performed surgery. Sometimes, however, the tumor vessels are multiple and very small so selective catheterizations are not possible, particularly when the tumor invades the cavernous sinus. In eight procedures in seven patients of this type, the tumor was embolized with 100% ethyl alcohol by temporarily occluding the ICA above the feeders while infusing ethanol with a microcatheter as close to the feeders as possible. At fluoroscopy, tumor blush was seen to have decreased markedly in all cases. In one patient, no obvious benefit was gained at surgery. In another patient, a first surgery that was aborted due to blood loss was successfully completed after embolization. The other five patients had much drier surgical fields than expected.