Surgical Anatomy for Control of Ethmoidal Arteries During Extended Endoscopic Endonasal or Microsurgical Resection of Vascular Anterior Skull Base Meningiomas

Abstract

eningiomas represent about 13%e20% of brain tumors; skull base meningiomas represent about 44%. M Anterior skull base meningiomas are supplied from anterior or posterior ethmoidal arteries (branches of the ophthalmic artery), as in olfactory groove (10%) and tuberculum sellae and planum sphenoidale (13%) meningiomas, or middle meningeal arteries, as in sphenoid ridge meningiomas 17% (9, 13, 23). In addition to anastomosis between the middle meningeal artery and the ophthalmic artery, the middle meningeal artery may arise from the ophthalmic artery, or the ophthalmic artery may arise from the middle meningeal artery in rare cases (11, 12, 15, 33). Collaterals from the meningeal branches of the internal carotid arteries, frontal or sphenoid branches of the middle meningeal arteries, and the sphenopalatine branch of the distal maxillary artery may share in the secondary arterial supply of midline anterior skull base meningiomas (olfactory groove, planum sphenoidale, and tuberculum sellae). This rich arterial network predisposes anterior skull base lesions to high vascularity in many cases, especially meningiomas and arteriovenous malformations.