Vascular issues in intracranial meningiomas: A pictorial review with clues for surgical management

Abstract: Meningiomas are mostly benign tumors arising from the meninges enveloping the brain. Although being benign, they might produce relevant consequences and often require surgical intervention. In this review, the main arterial and venous issues in cranial meningiomas were addressed from a pathophysiological point of view, starting from the main angiographic findings and their impact on treatment choices. The arterial supply of meningioma with its several sources is detailed, considering catheter angiography as the main investigation, and the venous involvement and architecture are broadly and deeply proposed due to its impact on surgical complications and postsurgical venous infarction. Meningiomas are highly vascularized tumors, and vascular issues are of paramount importance for growth pattern and for planning of surgical treatment to maximize the beneficial effects and minimize the complications. Both the arterial supply and the venous drainage or invasion are fundamental to know for defining the surgical strategy and avoid both excessive bleeding during surgery and postoperative infarction from damage to venous structures. A thorough knowledge of arterial and venous issues can help to define the best surgical plan and to reduce complications.