Comprehensive analysis of the distribution of dural artery-derived tumor-feeding arteries in intracranial meningiomas

Objective: Knowledge of the location of tumor-feeding arteries is necessary for the safe surgery of intracranial meningiomas. Hence, this retrospective study aimed to comprehensively analyze the distribution of tumor-feeding arteries. Methods: Patients who underwent intracranial meningioma surgery at our institution between 2015 and 2023 were included in this study. The tumor attachment sites and tumor-feeding arteries were evaluated based on the results of preoperative examinations. The tumor attachment sites were classified as non-skull bases (convexity, parasagittal, and falx) or skull bases (anterior skull base, sphenoid ridge, sphenopetroclival, petrous, tentorial, cerebellar convexity, and foramen magnum). These tumors were further subdivided according to their attachment areas. Results: Among the 180 patients included, the tumor-feeding arteries were identified in 177 patients (98.3%). In 67 patients with non-skull base meningiomas, the middle meningeal artery primarily functioned as a tumor-feeding artery in the anterior and middle regions (78 of 108 feeding arteries, 72.2%), while the extracranial artery served as a tumor-feeding artery in the posterior region (20 of 37 feeding arteries, 54.1%). Conversely, skull base meningiomas exhibited a higher frequency of having tumor-feeding arteries derived from the internal carotid artery (132 of 278 feeding arteries; 47.5%); these tumor-feeding arteries are often found at the deepest part of the surgical field during tumor resection and require careful intraoperative handling. Conclusions: Tumor-feeding arteries originate from different dural arteries depending on the tumor attachment site. These findings could help enhance surgical safety, especially in patients with meningiomas who have not undergone preoperative angiography.