Abstract
Vascular supply plays a significant role in the management of skull base tumors. The diagnosis is aided by contrast-enhanced imaging and angiographic techniques, and embolization procedures are used to devascularize certain lesions. The degree of surgical technical difficulty is strongly influenced by the degree of tumor vascularity. Although the importance of this blood supply is clearly understood, the mechanism involved in developing a system of tumor-perfusing vessels is yet to be defined. The development of a vascular network, or angiogenesis, is an important event in allowing tumor proliferation to progress beyond small clusters of cells. Basic fibroblastic growth factor (bFGF) is an especially attractive candidate as an angiogenic growth factor because of its ability to stimulate processes that are characteristic of angiogenesis in vitro. Tumors that involve the meninges may have the ability to liberate normally stored bFGF, which may, in turn, induce new vessel formation for continued tumor proliferation. An immunohistochemical analysis of rodent and bovine meninges to study this phenomenon is described. The dura, arachnoid, and their associated vessels are shown clearly to contain this growth factor. Ultimately, an adjuvant therapy based on the inhibition of angiogenesis may provide a reasonable alternative to aggressive surgical approaches in skull base tumors that are incompletely resectable.