• Mohammed Aref, Katherine E Kunigelis, Alexander Yang, Prem S Subramanian, Vijay R Ramakrishnan, and A Samy Youssef.
• Department of Neurosurgery, University of Colorado Denver, Aurora, Colorado, USA.
• World Neurosurg. 2018 Dec 1; 120: e776-e782.

BackgroundAnterior skull base meningiomas often grow to a large size (≥4 cm) before detection. Their blood supply is mostly provided by the anterior and posterior ethmoidal arteries. Because of their vascularity, intraoperative bleeding can be a challenging prospect that increases the risk of perioperative complications. Preoperative ethmoidal arteries ligation has been used to aid in limiting blood loss. Our objective was to assess the effect of preoperative arterial ligation on the perioperative course of large (≥4 cm) to giant (≥6 cm) anterior skull base meningiomas.MethodsWe retrospectively searched our database for large anterior skull base meningiomas (≥4 cm). We analyzed differences in intraoperative blood loss, operative time, intraoperative transfusion, and hematologic parameters between patients who did not undergo preoperative ethmoidal arteries ligation (Group 1) and those who did (Group 2).ResultsAverage estimated blood loss (EBL) was 825 mL (Group 1) versus 350 mL (Group 2) (P = 0.42), decrease in hemoglobin was 4 g/dL versus 3.2 g/dL (P = 0.53), decrease in hematocrit was 12.4% versus 9.6% (P = 0.64), and average operative time was 656 minutes versus 598 minutes (P = 0.58). EBL per volume yielded a ratio of 10.6 mL/cm3 versus 4.1 mL/cm3 (P = 0.06).ConclusionsEthmoidal arteries ligation may have a benefit in large-to-giant anterior skull base meningiomas surgery. Our results showed a decrease in EBL and lesser decrease in pre- and postoperative hemoglobin and hematocrit levels as compared with cases in which no vascular ligation was performed when corrected for tumor volume.Copyright © 2018 Elsevier Inc. All rights reserved.

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