Embolization of Intracranial and Skull Base Tumors

Abstract

Embolization is now recognized as an established endovascular interventional neuroradiologic technique for the preoperative devascularization of vascular neoplasms of the intracranial space and of the skull base (Lasjaunias and Berenstein 1987b; Valavanis 1990; Halbach et al. 1992). The goal of embolization in cases of intracranial and skull base tumors is selective obliteration of the pathologic intratumoral vasculature while preserving the normal supply to surrounding tissues. In the majority of cases, selective obliteration of the intratumoral vasculature by appropriate embolic materials facilitates subsequent surgical tumor removal by improving the intraoperative conditions in terms of blood loss, almost bloodless tumor exposure, and easy identification of surgically important structures such as cranial nerves (Valavanis 1990). In conjunction with these advantages, embolization of intracranial and skull base tumors contributes to shortening of the operation time, increasing the rate of radical tumor removal, reducing the surgical complication rate, and possibly reducing the incidence of recurrence. In addition to embolization, the technique of permanent balloon occlusion of the internal carotid artery (ICA) in extensive tumors of the skull base with an intimate relationship to the ICA allows identification and resection of pericarotid tumor extensions without the fear of uncontrollable hemorrhage from the ICA and has thus contributed to safe and radical removal of skull base tumors previously regarded as inoperable (Fisch and Mattox 1988).