Introduction: Several techniques for reducing blood loss – microsurgical and endoscopic– during resection of olfactory and planum sphenoidale meningiomas, especially when preoperative embolization is risky or not technically feasible do exist but are not well described in the literature. The authors present several examples of an institutional experience employing surgical ligation of the anterior and posterior ethmoid arteries prior to resection of meningiomas of the anterior skull base along with a literature review of extracranial surgical techniques to minimize blood loss in these operations.

Methods: 12 patients who underwent extracranial surgical ligation of ethmoidal arteries through either a transcaruncular or a Lynch approach were identified at our institution. Of these, three patients had giant olfactory groove or planum sphenoidale meningiomas. After IRB approval, we studied the medical records and imaging data of these three patients, with special attention to surgical technique and outcome. The variations of ethmoidal artery foramina pertaining to this surgical approach were studied using preserved human skulls from the Hamann-Todd Osteological Collection at the Museum of Natural History, Cleveland, Ohio.

Results: The extracranial ligation was performed successfully for control of ethmoid arteries prior to resection of all three hypervascular giant anterior skull base meningiomas. A transcaruncular approach was used in one case, while the Lynch incision and approach was used in the other two. Minimal morbidity was observed from these adjuvant operations, and blood loss was less than expected in all three cases.

Conclusions: Extracranial surgical ligation of anterior, and often posterior, ethmoid arteries prior to resection of large olfactory groove or planum sphenoidale meningiomas provides a safe and feasible option for control of these vessels prior to either open or endoscopic resection of non-embolized or partially embolized tumors.

Patient Care: By highlighting evolving strategies to minimize the morbidity of complex skull base approaches and resection of vascular olfactory groove or planum sphenoidale meningiomas.

Learning Objectives: Understand approaches to AEA ligation prior to resection of large vascular meningiomas originating from the olfactory groove or planum sphenoidale.

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