Pre-operative embolization of skull base meningiomas

Area of Science:

• Neurosurgery
• Interventional Radiology
• Vascular Neurology

Background:

• Skull base meningiomas present significant surgical challenges due to their deep location and complex vascular supply.
• Tumor vascularity arises from internal/external carotid arteries and posterior circulation, potentially involving cranial nerves.
• Pre-operative embolization is considered to facilitate resection, but its indications and outcomes vary widely.

Purpose of the Study:

• To review indications and outcomes of pre-operative embolization for skull base meningiomas.
• To discuss embolic materials, their risks, and benefits.
• To review relevant vascular anatomy supplying these tumors.

Main Methods:

• Literature review of pre-operative embolization for skull base meningiomas.
• Analysis of indications, outcomes, embolic materials, and vascular anatomy.
• Synthesis of current evidence and recommendations.

Main Results:

• Pre-operative embolization may be beneficial in select cases, particularly for hypervascular tumors.
• Vascular supply is complex, involving multiple arterial sources.
• Embolic material choice and technique influence outcomes and risks.

Conclusions:

• Selective pre-operative embolization is recommended for hypervascular skull base meningiomas.
• Embolization is advised when surgical approaches hinder early devascularization.
• Careful patient selection and technique are crucial for optimizing outcomes.