Application Analysis of Cerebral Revascularization in the Treatment of Skull Base Tumors Involving Internal Carotid Artery

Objective: To discuss the selection, technical points and therapeutic effect of cerebral revascularization for skull base tumors involving internal carotid artery (ICA).

Methods: A retrospective analysis was conducted on the clinical data of 26 patients with skull base tumors involving ICA admitted to the Department of Neurosurgery of Tianjin Huanhu Hospital from July 2015 to September 2023. There were 22 cases of recurrent meningiomas, 1 case of nasopharyngeal carcinoma endonasal operative bleeding emergency, and 3 case of nasopharyngeal carcinoma. According to the tumor s origin, invasion site, and compensation of collateral circulation, the tumors were removed through Dolenc approach combined with STA-MCA bypass in 3 cases, through extended middle fossa approach combined with Fukushima bypass type I in 17 cases, through extended middle fossa approach combined with Fukushima bypass type II in 2 cases, and through Dolenc approach or extended middle fossa approach combined with direct reconstruction in 4 cases. Postoperative imaging examination was performed to assess the patency of the anastomosed blood vessel, the degree of tumor resection, the presence or absence of cerebral ischemia, and the presence or absence of tumor recurrence.

Results: Intraoperative fluoroscopy in 26 patients showed patency of the anastomotic vessels, all patients underwent digital subtraction angiography (DSA) or CT angiography (CTA) after the operation to confirm that the anastomoses were patent. Total resection was achieved in 16 cases, subtotal resection in 8 cases, partial resection in 1 case, and 1 case of nasopharyngeal carcinoma with ICA rupture and bleeding only underwent vascular bypass surgery without tumor resection. Seven cases of cerebral ischemia improved after medical treatment, 5 cases developed facial numbness and facial paralysis, and recovered after 3 months, 15 cases of meningioma involving bilateral slopes of cavernous sinuses underwent cerebral revascularization combined with endoscopic tumor resection. CSF leakage occured 5 cases but recovered without reoperation.The recovery went smoothly, but 1 patient developed a coma after the second-stage contralateral tumor resection and was discharged at the request of his family. 1 patient died of respiratory failure 15 days after the operation. The follow-up time of 22 patients was 4 to 26 months. The last follow-up showed that none of the patients had new cerebral ischemia. Among them, 16 patients underwent DSA or CTA reexamination, 15 patients showed patency of reconstructed blood vessels, and 1 patient had partial stenosis. One case of malignant recurrent minginggioma recurred 5 months after operation and 1 case of nasopharyngeal carcinoma recurred 1 year after operation.

Conclusion: For skull base tumors involving ICA, different techniques of cerebral revascularization can be selected according to the compensation of cerebral blood flow, tumor location and the degree of ICA involvement, which can reduce the incidence of hemorrhage and cerebral ischemia, and improve the degree of tumor resection.

Publication History

Article published online:
07 February 2025