Abstract 441: Transophthalmic Artery Embolization of Anterior Skull Base Meningiomas: Technical Case Series

Introduction/Purpose Preoperative embolization of anterior skull base meningiomas can facilitate surgical resection by reducing tumor vascularity. However, transophthalmic artery embolization carries risks of visual complications. This study aimed to evaluate the safety and efficacy of this technique using modern endovascular tools. Materials and Methods This retrospective study included patients with anterior skull base meningiomas who underwent preoperative transophthalmic artery embolization followed by surgical resection between January 2022 and April 2024. Patient demographics, tumor characteristics, embolization details, surgical outcomes, and complications were analyzed. Results Seven patients (6 male, 1 female; median age 57 years) were included. Tumor locations were planum sphenoidale (58%), olfactory groove (14%), frontal region (14%), and sphenoid wing (14%). Unilateral embolization was performed in 6 patients, with 1 patient receiving bilateral transophthalmic artery embolization. Embolized branches included anterior ethmoidal (38%), posterior ethmoidal (38%), recurrent meningeal (12%), and complete ophthalmic artery occlusion (12%). Embolic agents used were polyvinyl alcohol particles (71%) and coils (29%). Successful angiographic devascularization was achieved in all patients without any endovascular complications or visual deterioration. Gross total resection was achieved in 71% of cases. The median operative blood loss was 427 cc. At a median follow‐up of 9 months, the median modified Rankin Scale score was 1. Conclusion With careful patient selection, advanced microcatheter technology, and meticulous technique, preoperative transophthalmic artery embolization can be safely performed to facilitate resection of anterior skull base meningiomas. These results suggest it is a viable option for well‐selected patients at experienced centers, though larger prospective studies are needed.