Tumor embolization via the meningohypophyseal and inferolateral trunk in patients with skull-based tumors by using the distal balloon protection technique

BACKGROUND AND PURPOSE: Tumor embolization through the meningohypophyseal trunk and inferolateral trunk is known to be effective in skull-based tumors; however, microcatheter cannulation into these arteries is difficult, and the number of cases that can be safely embolized is limited. In this study, we present a novel embolization procedure for meningohypophyseal trunk and inferolateral trunk using the distal balloon protection technique and detail its clinical efficacy and complication risks. We developed this procedure to allow safe embolization in patients who cannot be adequately cannulated with microcatheters into these arteries.

MATERIALS AND METHODS: Patients who underwent meningohypophyseal trunk or inferolateral trunk embolization using the distal balloon protection technique for skull-based tumors at our institution between 2010 and 2023 were included. In this procedure, the ICA was temporarily occluded with a balloon at the ophthalmic artery bifurcation, the microcatheter was guided to the meningohypophyseal trunk or inferolateral trunk vicinity, and embolic particles were injected into the arteries. The balloon was deflated after the embolic particles, that had refluxed into the ICA, were aspirated.

RESULTS: A total of 25 meningohypophyseal trunks and inferolateral trunks were embolized during 21 surgeries. Of these 25 arteries, only nine (36.0%) were successfully cannulated with microcatheters. Nevertheless, effective embolization was achieved in all cases. Permanent complications occurred in only one case (4.8%), in which the central retinal artery was occluded during inferolateral trunk embolization, resulting in a visual field defect. No permanent complications resulting from the embolic cerebral infarction were observed. Of 16 cases that underwent MRI within a week after embolization, however, 11 (68.8%) demonstrated embolic cerebral infarctions.

CONCLUSIONS: In patients with skull-based tumors with meningohypophyseal trunk or inferolateal trunk feeders that cannot be catheterized directly, embolization using the distal balloon protection technique for tumor supply can be considered as a salvage technique.

ABBREVIATIONS: MHT = meningohypophyseal trunk; ILT = inferolateral trunk; GC = guide catheter; AC = aspiration catheter; FR = flow reverse