085 Bilateral abducens nerve palsies following bilateral middle meningeal artery embolisation for chronic subdural haemorrhage

Abstract Purpose The close topographic relationship between vascular and osseous structures in the condylar and subcondylar region and marked variability in the arterial course has been revealed by both imaging and cadaveric studies. This study aimed to verify the previously published information in a large sample and to determine a safe surgical region. Methods We analyzed the three-dimensional time-of-flight magnetic resonance angiography images of 300 individuals. Results The mean distance between the middle meningeal artery and the apex of the condyle or the most medial point of the condyle was 18.8 mm (range: 11.2–25.9 mm) or 14.5 mm (range: 8.8–22.9 mm) respectively. The course of the maxillary artery relative to the lateral pterygoid muscle was medial in 45.7% of cases and lateral in 54.3%. An asymmetric course was evident in 66 patients (22%). The mean distance between the maxillary artery and condylar process at the deepest point of the mandibular notch was 6.2 mm in sides exhibiting a medial course (range: 3.7–9.8 mm) and 6.6 mm in sides exhibiting a lateral course (range: 3.9–10.4 mm). The distances were significantly influenced by age, gender, and the course of the maxillary artery. Conclusion Our study emphasizes the marked inter- and intra-individual variability of the maxillary and middle meningeal arterial courses. We confirmed the proximity of the arteries to the condylar process. Extensive surgical experience and thorough preparation for each individual case are essential to prevent iatrogenic vascular injury.

Download Full-text

Retrograde Approach for Intra-arterial Chemotherapy Delivery in Retinoblastoma

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0041-1727584 ◽

2021 ◽

Author(s):

Giancarlo Saal-Zapata ◽

Walter Durand ◽

Alfredo Ramos ◽

Raúl Cordero ◽

Rodolfo Rodríguez

Keyword(s):

Internal Carotid ◽

Middle Meningeal Artery ◽

Posterior Circulation ◽

Alternative Form ◽

Chemotherapeutic Drugs ◽

Retrograde Approach ◽

First Line ◽

The Third ◽

Cure Rates ◽

Meningeal Artery

AbstractIntra-arterial chemotherapy (IAC) is currently, the first-line treatment for retinoblastomas with successful cure rates. In difficult access or unsuccessful catheterization of the ophthalmic artery (OA), the middle meningeal artery is a second alternative followed by the Japanese technique using balloon. Nevertheless, when a well-developed posterior communicating artery is present, a retrograde approach to the OA through this vessel can be performed to deliver the chemotherapeutic drugs.We present a case of an unsuccessful catheterization of the OA through the internal carotid artery due to a challenging configuration of the OA/carotid siphon angle and describe an alternative form of navigation and catheterization through the posterior circulation.To our knowledge, this is the third report of a successful retrograde catheterization of the OA for IAC and constitutes an alternative route to deliver chemotherapy.

Download Full-text

Recurrence and Coniglobus Volumetric Resolution of Subacute and Chronic Subdural Hematoma Post-Middle Meningeal Artery Embolization

Diagnostics ◽

10.3390/diagnostics11020257 ◽

2021 ◽

Vol 11 (2) ◽

pp. 257

Author(s):

Ambooj Tiwari ◽

Adam A. Dmytriw ◽

Ryan Bo ◽

Nathan Farkas ◽

Phillip Ye ◽

...

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Volumetric Analysis ◽

Primary Therapy ◽

Curative Therapy ◽

Complete Obliteration ◽

Embolization Treatment ◽

Long Term Follow Up ◽

Meningeal Artery

Objective: To study the efficacy of middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematoma (SDH) and characterize its post-embolization volumetric resolution. Methods: Ten patients diagnosed with 13 cSDH underwent MMA embolization. SDH volumes were measured from time of initial discovery on imaging to pre-operative, post-operative, short-term and long-term follow-up. Time between procedure to obliteration was also measured. Volumetric analysis was done using the coniglobus formula, and recurrence rate as well as resolution timeline was defined using best-fit models. Results: Out of 10 patients, five were recurrent lesions, three were bilateral and seven unilateral cSDH. Average and median pre-operative volumes were 105.3 cc and 97.4 cc, respectively. Embolization on average was performed 21 days after discovery. Sixty percent of patients had concurrent antiplatelets or anticoagulation use. Forty percent underwent embolization treatment as the primary therapy. Recurrence was not seen in any patients treated with embolization. There were no peri- or post-operative complications. Five patients experienced complete or near-complete obliteration, while those with partial resolution showed a composite average of 75% volumetric reduction in 45 days. Post-embolization, the volumetric resolution followed an exponential decay curve over time and was independent of initial volume. Conclusion: MMA embolization contributed to a marked reduction in SDH volume post-operatively and can be used as a curative therapy for primary or recurrent chronic SDH.

Download Full-text

E-111 Chronic subdural hematoma recurrence due to contralateral neovascularization following middle meningeal artery embolization

10.1136/neurintsurg-2021-snis.206 ◽

2021 ◽

Author(s):

Z Hubbard ◽

S Al Kasab ◽

G Porto ◽

M Sattur ◽

A Spiotta

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Artery Embolization ◽

Meningeal Artery

Download Full-text

Response to “Some observations over the article “Evaluation of the anastomoses between the ophthalmic artery and the middle meningeal artery by superselective angiography””

Surgical and Radiologic Anatomy ◽

10.1007/s00276-020-02624-2 ◽

2021 ◽

Author(s):

Hilal Akdemir Aktaş ◽

Kadriye Mine Ergun ◽

İlkan Tatar ◽

Anıl Arat ◽

Kadir Mutlu Hayran

Keyword(s):

Ophthalmic Artery ◽

Middle Meningeal Artery ◽

Superselective Angiography ◽

Meningeal Artery

Download Full-text

Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016798 ◽

2021 ◽

pp. neurintsurg-2020-016798

Author(s):

Maksim Shapiro ◽

Melanie Walker ◽

Kate T Carroll ◽

Michael R Levitt ◽

Eytan Raz ◽

...

Keyword(s):

Subdural Hematoma ◽

Ex Vivo ◽

Vascular Anatomy ◽

Middle Meningeal Artery ◽

Artery Embolization ◽

Strategic Approach ◽

Fundamental Understanding ◽

Endovascular Approach ◽

Meningeal Artery

Adoption of middle meningeal artery embolization in the management of chronic subdural hematomas has led to a renewed interest in dural vascular anatomy. The readily identifiable major dural arteries and potential hazards associated with their embolization are well described. Less emphasized are several levels of intrinsic dural angioarchitecture, despite their more direct relationship to dural based diseases, such as subdural hematoma and dural fistula. Fortunately, microvascular aspects of dural anatomy, previously limited to ex vivo investigations, are becoming increasingly accessible to in vivo visualization, setting the stage for synthesis of the old and the new, and providing a rationale for the endovascular approach to subdural collections in particular. In contrast with traditional anatomical didactics, where descriptions advance from larger trunks to smaller pedicles, we present a strategic approach that proceeds from a fundamental understanding of the dural microvasculature and its relationship to larger vessels.

Download Full-text