Another case for CBCT role in preop evaluation of complex meningiomas — often more important than embo

Presentation is with several years of complete blindness, presumably due to intracranial hypertension

Not very vascular

Where is the precentral vein?

Describe supply to tumor

Only with SMALL particles can an embolization be performed from such a faraway, proximal position. Large particles are useless here. What is the importance of having the catheter beyond the foramen?

Note how saturated the dura is. Is this a strategy for addressing posterior fossa subdurals?

What supplies the superior left parasagittal portion of the unembolized tumor?

OK, and now lets see what in-depth analysis can do

Fusion venous phase DYNA. What is the important deep venous system variation here?

Better appreciated below. Right side is purple, left is blue. By what pathways does each side drain?

Fusion venous phase ICA and subselective tumor supply (what is supplying tumor?)

Look at the proximity of three important structures: Straight sinus, Supply to Mening, and Basal Vein Tentorial Sinus in lower image pairs

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