Mohammed Aref, Katherine E Kunigelis, Alexander Yang, Prem S Subramanian, Vijay R Ramakrishnan, A Samy Youssef

Anterior skull base meningiomas often grow to a large size (≥4cm) prior to 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. Pre-operative ethmoidal arteries ligation has been employed to aid in limiting blood loss. The objective is to assess the effect of pre-operative arterial ligation on the perioperative course of large ((≥4cm) to giant (≥6cm) anterior skull base meningiomas. We retrospectively searched our database for large anterior skull base meningiomas (≥4cm). We analyzed differences in intraoperative blood loss, operative time, intraoperative transfusion, and hematological parameters between patients who did not undergo pre-operative ethmoidal arteries ligation (Group 1) and those who did (Group 2). Average estimated blood loss (EBL) was 825 mL (Group 1) vs. 350 mL (Group 2) (p = 0.42), drop in hemoglobin (Hg) was 4g/dl vs. 3.2g/dl (p = 0.53), drop in hematocrit (HCT) was 12.4% vs. 9.6% (p=0.64) and average operative time was 656 min vs. 598 min (p=0.58). EBL per volume yielded a ratio of 10.6 mL/cm3 vs. 4.1 mL/cm3 (p=0.06). Ethmoidal arteries ligation may have a benefit in large to giant anterior skull base meningiomas surgery. Our results showed a decrease in EBL and less drop in pre- and post-operative haemoglobin and hematocrit levels as compared to cases where no vascular ligation was performed when corrected for tumor volume.