Open Straightening and Direct Puncture of the Superficial Temporal Artery for Tumor Embolization via Transosseous Feeders

Direct access to the superficial temporal artery (STA) has traditionally been performed using an open approach; however, ultrasound-guided percutaneous puncture has recently become widely used in several settings. In meningiomas supplied by transosseous STA feeders, stable navigation of a microcatheter beyond the bony penetration site into the dural tumor feeder is essential. Severe tortuosity and sharp angulation near the cranial entry point may render percutaneous approaches unreliable. To describe an open technique combining STA straightening and a wedged 18-gauge peripheral intravenous catheter (PIVC) used as a sheath substitute to facilitate secure microcatheter passage across the transosseous segment. The STA was exposed through a skin incision and straightened by removing surrounding connective tissue. A PIVC was inserted via subcutaneous tunneling from a puncture site lateral to the incision and wedged at the cranial entry point. A Marathon microcatheter (Medtronic, Minneapolis, MN, USA) was advanced through the PIVC into the dural feeder, and tumor embolization was performed using N-butyl cyanoacrylate (NBCA). The microcatheter successfully traversed the transosseous segment and reached the dural tumor feeder. Effective intratumoral embolization was achieved with 12.5% NBCA (1.09 mL), without reflux into cutaneous branches or skin ischemia. In meningioma embolization requiring reliable use of transosseous feeders, open STA straightening with direct puncture using a wedged PIVC provides secure passage across the cranial entry point and stable catheter control when percutaneous approaches are insufficient, and may be valuable in carefully selected cases.