Safety and Effectiveness of Embolization via the Ophthalmic Artery with N-butyl Cyanoacrylate for Anterior Skull Base Meningiomas.

Anterior skull base meningiomas are often supplied by ethmoidal arteries branching from the ophthalmic artery. Preoperative embolization can reduce intraoperative bleeding and facilitate safer resection; however, its use is limited by the risk of visual complications. This study evaluates the safety, effectiveness, and technical considerations of embolization via the ophthalmic artery using n-butyl-2-cyanoacrylate (n-BCA). This retrospective study included patients with meningiomas who underwent preoperative embolization via the ophthalmic artery between 2017 and 2025. Demographics, clinical characteristics, technical details, surgical outcomes, and complications were analyzed. Five patients (median age of 58 years) underwent embolization. Two meningiomas were at the olfactory groove, two at the planum sphenoidale, and one at the sphenoid ridge (median diameter of 41.9 mm). Unilateral embolization was performed in four patients; one underwent bilateral embolization. The working angle was set at an anterior oblique and cranial position to optimize visualization of the central retinal and ethmoidal arteries. The microcatheter was advanced beyond the central retinal artery to cannulate the ethmoidal artery and to position it near the tumor. N-BCA, heated to 80°C, was used at concentrations ranging from 20% to 33%. All patients showed reduced tumor blush without neurological complications, including vision loss or impairment. Simpson grade II-III resection was achieved in all patients, with a median intraoperative blood loss of 350 mL. One patient demonstrated postoperative improvement in the visual field defects. Embolization via the ophthalmic artery can be safely performed to facilitate the resection of skull base meningiomas using standardized techniques and n-BCA.