The role of interventional neuroradiology in the management of skull base tumours and related surgical complications.

The management of hypervascular skull base tumours is complex and requires a multidisciplinary approach. Skull base surgery may be challenging because of the risk of serious intra-operative bleeding and of potential injuries to lower cranial nerves and/or large cervical vessels. Over the last four decades, advances in neuro-interventional procedures have produced a range of adjunctive endovascular techniques in addition to conventional surgery. Digital subtraction angiography (DSA) allows for a better understanding of tumour vascularisation and its relationship with Surrounding vessels. Tumoural devascularisation and the occlusion of feeding arteries is a useful adjunct to surgery because it allows for the reduction of intra-operative blood loss and induces ischaemic necrosis of the tumour. Finally, surgery-related iatrogenic vascular lesions may be successfully treated with endovascular techniques. Nevertheless, endovascular procedures in the head and neck region are associated with infrequent but potentially serious complications. An extensive and comprehensive knowledge of head and neck vascular anatomy is therefore necessary. This article provides a review of the indications for, and results of, diagnostic, pre-operative and therapeutic endovascular procedures for the management of skull base tumours and related surgical complications.