The Effect of Preoperative Ligation of Ethmoidal Arteries on the Perioperative Outcomes of Large Anterior Skull Base Meningiomas: A Clinical Study
A.S. Youssef
University of Colorado, Denver, United States
EANS Academy. Youssef A. 10/21/18; 225991; EP4088
Prof. Dr. A Samy Youssef
Prof. Dr. A Samy Youssef
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Anterior skull base meningiomas often grow to a large size (≥4cm) prior to detection owing to their subtle clinical impact. Their blood supply is mostly provided by the anterior and posterior ethmoidal arteries. Because of their vascularity, intraoperative bleeding can be a limiting factor that adds to the length of procedure and increase the risk of perioperative complications. Preoperative ethmoidal arteries ligation has been employed to aid in limiting blood loss. However, endovascular techniques cannot be safely applied in anterior skull base due to the risk of blindness.The objective of this study is to assess the effect of preoperative direct arterial ligation on the perioperative course of large ((≥4cm) to giant (≥6cm) anterior skull base meningiomas.
We retrospectively searched our database for large anterior skull base meningiomas (≥4cm) resected by the senior author using the same technique. Ligation was performed either via an endoscopic endonasal approach or via a trancaruncular approach.
Twelve patients with large anterior skull base meningiomas were studied. Seven underwent surgery without preoperative ethmoidal arteries ligation and five underwent preoperative ligation. There was no significant difference in baseline demographics or postoperative outcomes between the two groups. Average blood loss was less in the patients that underwent ligation group overall and when corrected by tumor volume.

In our small series, the results indicate a decrease in EBL with preoperative direct arterial ligation. Arterial blood supply beyond the ethmoidal arteries limits the benefits of ethmoidal arteries ligation in large anterior skull base meningiomas.
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