BANANA BITES — Preoperative Embolization Sphenoid Wing Meningioma — Both Arteries and Veins are Important

Together with Donato Pacione, MD

Click on this link for BANANA BITES narrated video of this page found on our channel

Note important preservation of important superficial sylvian venous drainage into the cavernous sinus

Cross eye stereos

Some tumor blush here

What is the ECA supply?

Axial cone beam CT images

Stillshots.  Foramen Rotundum Branches (arrows), Accessory Meningeal (dashed arrow), and meningolacrimal branch (arrowhead)

Deep Recurrent Meningeal Artery (arrows) supplying the tumor and contributing to the lateral tentorial arcade (dashed arrows)

All found here… Diagrams and Drawings page

Venous phase cone beam axial MP4

Stillshot views — superficial sylvian (superficial middle cerebral) veins (arrow) drain into a short sphenoparietal / laterocavernous sinus (dashed arrows) and into the cavernous sinus.  There is sometimes a kind of narrowing in this area (arrowhead) where sinus preservation is particularly important.

Anaglyph Stereos

Now, for more academic venous background, click on the image below for link to our recent JNIS article

OK. Now to the embo

Contour 45-150 and 150-250 micrometer particle embo

Towards end

Deeper advancement prior to coil placement may help protect the rotundum network for V2

Middle Meningeal Artery

Meningolacrimal Branch micro

Coil protection of both meningolacrimal and MMA

Foramen Spinosum position

Contour 45-150 and 150-250 micrometer PVA embo

Accessory Meningeal Micro


Post embo ICA


For other preoperative embolizations see Case Library page