Purpose To assess the feasibility and safety of cone-beam computed tomography (CBCT) advanced navigation for optimizing intra-arterial chemotherapy infusion (IACI) in patients with skull base tumors.

Materials and Methods Retrospective review on 10 consecutive IACI procedures performed in five patients (four women, 1 man) over a 1-year period. The median age of the patients was 71 years (interquartile range: 34–74). During the procedures, a CBCT-based navigation software was employed to evaluate tumor perfusion and guide the infusion methods. Catheterization of the primary tumor feeding vessel was performed in seven cases when it originated from the external carotid artery, whereas a temporary balloon-assisted occlusion technique was utilized in the remaining three cases where the tumor was primarily fed by the internal carotid artery. Carboplatin, topotecan, and melphalan were injected over a 10-minute period. Fluoroscopy time, reference dose, and Kerma area product, which estimates effective dose, were analyzed.

Results The technical success rate was 100%, with a median procedure length of 82 minutes (79–90). The median fluoroscopy time was 11.3 minutes (9.4–16.9), reference dose was 93.5 mGy (62–256.5), and Kerma area product was 11.6 Gy.cm² (9.5–25.4). The median effective dose was 3.8 mSv (1.5–5.1). The median follow-up duration was 233.5 days (186.3–432). One severe adverse event was reported, involving a right brachial hematoma and brachiocephalic artery dissection related to catheterization through a type III aortic arch. Three patients exhibited disease progression, but two patients showed stable disease.

Conclusion IACI for skull base tumors guided by CBCT navigation is both feasible and safe.

目的 评估锥束计算机断层扫描 (CBCT) 高级导航优化颅底肿瘤患者动脉内化疗输注 (IACI) 的可行性和安全性。

材料和方法 对 1 年内对 5 名患者（4 名女性，1 名男性）进行的 10 次连续 IACI 手术进行回顾性审查。患者的中位年龄为 71 岁（四分位数范围：34-74）。手术过程中，采用基于 CBCT 的导航软件来评估肿瘤灌注并指导输注方法。当肿瘤起源于颈外动脉时，对原发肿瘤供血血管进行了导管插入术，而对于肿瘤主要由颈内动脉供血的其余三例，则采用了临时球囊辅助闭塞技术。卡铂、托泊替康和马法兰在 10 分钟内注射。分析了透视时间、参考剂量和估计有效剂量的比释动面积积。

结果 技术成功率为100%，中位手术时间为82分钟（79-90）。中位透视时间为11.3分钟（9.4-16.9），参考剂量为93.5 mG​​y（62-256.5），比释动能面积乘积为11.6 Gy.cm ²（9.5-25.4）。中位有效剂量为 3.8 mSv (1.5–5.1)。中位随访时间为 233.5 天 (186.3–432)。报告了一项严重不良事件，涉及与通过 III 型主动脉弓插入导管相关的右臂血肿和头臂动脉夹层。三名患者表现出疾病进展，但两名患者表现出疾病稳定。

结论 CBCT导航引导下IACI治疗颅底肿瘤既可行又安全。