Relevance of the Foramen of Vesalius for Preoperative Tumor Embolization in Skull Base Meningioma

Yuyo Maeda; Takafumi Mitsuhara; Kazuya Saeki; Takeshi Hara; Masashi Kuwabara; Kondo Hiroshi; Ishii Daizo; Masaaki Takeda; Nobutaka Horie

doi:10.1016/j.wneu.2024.04.116

Relevance of the Foramen of Vesalius for Preoperative Tumor Embolization in Skull Base Meningioma

World Neurosurg. 2024 Apr 26:S1878-8750(24)00689-2. doi: 10.1016/j.wneu.2024.04.116. Online ahead of print.

Authors

Yuyo Maeda¹, Takafumi Mitsuhara², Kazuya Saeki³, Takeshi Hara², Masashi Kuwabara², Kondo Hiroshi², Ishii Daizo², Masaaki Takeda², Nobutaka Horie²

Affiliations

¹ Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. Electronic address: maedayuyo4.18@gmail.com.
² Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
³ Department of Clinical Laboratory, Hiroshima University Hospital, Hiroshima, Japan.

PMID: 38679376
DOI: 10.1016/j.wneu.2024.04.116

Abstract

Objective: To investigate the role of the foramen of Vesalius (FV) in the pathogenesis of skull base meningioma by analyzing data from various multi-image modalities.

Methods: For this single-center retrospective study, 39 consecutive patients with skull base meningioma who underwent tumor resection between January 2020 and March 2023 were enrolled. The anatomical and pathological characteristics of the FV were evaluated using computed tomography (CT) and three-dimensional (3D)-digital subtraction angiography (DSA). The clinical significance of the FV in tumor hemodynamics and treatment, such as preoperative tumor embolization, was investigated using the 3D-DSA/CT fusion images.

Results: We identified FV in 52% (17/27) of the finally included patients. In 10 (30%) patients, the FV was found bilaterally with no significant variation in appearance between the healthy and tumor-affected sides (p=0.786). The mean FV diameter was significantly larger on the tumor-affected side (p=0.010). No significant anatomical differences, like duplication and partial assimilation with the foramen ovale, were observed between the two sides. The FV was involved in venous skull base perfusion around the tumor in nine cases. In four cases where it was the pathway for tumor feeders, preoperative tumor embolization via the FV resulted in disappearance of the tumor stain. No complications associated with endovascular treatment were observed.

Conclusions: This study elucidated the anatomical asymmetry of the FV and its role in the hemodynamics of skull base meningioma. Our findings highlight the significance of performing anatomical and pathological evaluations of the FV in determining treatment strategies, including preoperative embolization, for skull base lesions.

Keywords: Anatomical variations; Computed tomography; Digital subtraction angiography; Foramen of Vesalius; Preoperative tumor embolization; Skull base tumors; Therapeutic strategies.