Endovascular management of arterial-encasing meningiomas: A case report and review of treatment strategies

Skull base meningiomas pose significant surgical challenges due to their proximity to and encasement of critical neurovascular structures, particularly the internal carotid artery (ICA). While surgical resection remains the standard of care, complete excision may be limited by the risk of vascular injury. Endovascular approaches such as stenting and angioplasty have emerged as potential adjuncts to mitigate ischemic complications. A review using Scopus, Medline, and Web of Science was conducted according to PRISMA guidelines to evaluate the use of endovascular stenting and angioplasty in patients with intracranial meningiomas encasing arteries. Inclusion criteria targeted cases with symptomatic encasement treated with endovascular procedures. Among 114 studies, three patients presented with skull base meningiomas involving the ICA, with symptoms including hemiparesis, aphasia, proptosis, and visual deficits. Endovascular strategies included: (1) ICA stenting for high-grade stenosis with favorable long-term patency; (2) preoperative angioplasty to reduce perioperative ischemic risk; and (3) postoperative stenting for vasospasm due to vessel kinking. Additionally, we report the case of a 71-year-old woman with a meningioma encasing the ICA, managed with endovascular stenting and radiotherapy. No ischemic events or tumor progression were observed at 12-month follow-up. The reviewed cases highlight the potential of endovascular strategies to maintain vascular integrity and prevent ischemia in tumors with arterial encasement. This strategy may reduce intraoperative complications and expand resection options. Current evidence is limited to isolated reports, underscoring the need for prospective studies to validate efficacy and safety.