Carotid artery occlusion and revascularization in the management of meningioma

As the carotid artery courses through the skull base and into the subarachnoid space, it lies in close proximity to regions notorious for meningioma growth. Although infrequent, the growth of these tumors can compromise blood flow through the artery, putting the downstream territory at risk for stroke. In other scenarios, removal of these tumors sometimes requires planning to accomplish both tumor removal and revascularization in the same procedure when then the tumor invades the artery. Since revascularization (bypass surgery) is best performed on a nonemergent basis, it should be given consideration in the preoperative setting. Crisis situations related to intraoperative iatrogenic injury are managed methodically by determining the site of vessel injury and then deciding whether a primary repair or bypass procedure is necessary. The mainstays of revascularization procedures of the carotid artery include flow augmentation and flow replacement, with the superficial temporal artery and external carotid artery being the donor sites, respectively. Although tumor control or cure can be accomplished with surgical, radiosurgical, or combined methods, attention to vascular structures and ensuring blood flow preservation as part of the treatment plan is an important tenet in meningioma surgery.