Pre-Operative Embolisation of an Aberrant Pharyngeal Arterial Branch Arising From the Internal Carotid Artery and Contributing Significantly to the Supply of a Large Juvenile Nasopharyngeal Angiofibroma

2021 ◽  
pp. 153857442110287
Author(s):  
Steven G. Dolan ◽  
Pavol Surda ◽  
Tarun Sabharwal
Keyword(s):  
Carotid Artery ◽  
Blood Loss ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Neurological Complications ◽  
External Carotid ◽  
Intraoperative Blood Loss ◽  
Nasopharyngeal Angiofibroma ◽  
Pharyngeal Branch ◽  
Arterial Branch

Preoperative embolisation of juvenile nasopharyngeal angiofibromas (JNAs) is a well-established treatment that reduces intraoperative blood loss and improves surgical outcomes. While the bulk of arterial supply to the tumour is derived from the external carotid system, some degree of contribution from the internal carotid artery (ICA) is common. ICA branch embolisation in this setting has previously been avoided due to concerns over ischaemic neurological complications, possibly contributing to the increased intraoperative blood loss observed in patients with tumours with ICA supply. There is a marked paucity of reports of embolisation of ICA branches supplying JNA in the medical literature. We present a case of successful embolisation of an aberrant pharyngeal branch of the ascending pharyngeal artery arising from the proximal cervical ICA, which was making a significant contribution to tumour blood supply in a male adolescent with a very large JNA.

Retromandibular Fossa Approach to the High Cervical Internal Carotid Artery: An Anatomic Study

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS363-ONS370 ◽  
Author(s):  
Yusuf Izci ◽  
Roham Moftakhar ◽  
Mark Pyle ◽  
Mustafa K. Basşkaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Average Length ◽  
Cranial Nerves ◽  
External Carotid Artery ◽  
External Carotid ◽  
Digastric Muscle ◽  
High Cervical ◽  
Cervical Internal Carotid Artery

Abstract Objective: Access to the high cervical internal carotid artery (ICA) is technically challenging for the treatment of lesions in and around this region. The aims of this study were to analyze the efficacy of approaching the high cervical ICA through the retromandibular fossa and to compare preauricular and postauricular incisions. In addition, the relevant neural and vascular structures of this region are demonstrated in cadaveric dissections. Methods: The retromandibular fossa approach was performed in four arterial and venous latex-injected cadaveric heads and necks (eight sides) via preauricular and postauricular incisions. This approach included three steps: 1) sternocleidomastoid muscle dissection; 2) transparotid dissection; and 3) removal of the styloid apparatus and opening of the retromandibular fossa to expose the cervical ICA with the internal jugular vein along with Cranial Nerves X, XI, and XII. Results: The posterior belly of the digastric muscle and the styloid muscles were the main obstacles to reaching the high cervical ICA. The high cervical ICA was successfully exposed through the retromandibular fossa in all specimens. In all specimens, the cervical ICA exhibited an S-shaped curve in the retromandibular fossa. The external carotid artery was located more superficially than the ICA in all specimens. The average length of the ICA in the retromandibular fossa was 6.8 cm. Conclusion: The entire cervical ICA can be exposed via the retromandibular fossa approach without neural and vascular injury by use of meticulous dissection and good anatomic knowledge. Mandibulotomy is not necessary for adequate visualization of the high cervical ICA.

scholarly journals Preoperative Embolization of Brain Tumor with Pial Artery or Dural Branch of Internal Carotid Artery as Feeding Artery

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 246-251 ◽  
Author(s):  
M Hirohata ◽  
T Abe ◽  
N Fujimura ◽  
Y Takeuchi ◽  
M Shigemori
Keyword(s):  
Brain Tumor ◽  
Carotid Artery ◽  
Blood Loss ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Tumor Resection ◽  
Preoperative Embolization ◽  
Digital Subtraction ◽  
Feeding Artery ◽  
Pial Artery

This study evaluated the clinical usefulness of preoperative embolization of the pial artery or dural branch of the internal carotid artery (ICA) for brain tumor. Subjects comprised 17 patients with large hypervascular brain tumors who underwent preoperative selective embolization. Micro-catheters (2- or 1.7-F) and shapeable hydrophilic micro-guide wires were used for pial artery (branching from the posterior or anterior cerebral artery) or ICA dural branch embolization. Embolization was performed under digital subtraction fluoroscopy with Polyvinyl alcohol (PVA) particles (150–250 mm) and/or liquid coil. Tumor resection was performed immediately or the day after embolization. Digital subtraction angiography (DSA) before and after endovascular devascularization, blood loss during tumor resection, and clinical outcome were evaluated. All endovascular procedures were technically successful. Post-embolization DSA revealed either a disappearance or a marked decrease of the tumor stain in all cases. Control of intraoperative bleeding was easily accomplished, and intraoperative blood loss was low. Preoperative particle embolization of the feeding artery from the cortical artery or ICA dural branch is safe and effective as adjuvant therapy before tumor resection.

Dynamic Computed Tomography Angiography in Suspected Brain Death: A Noninvasive Biomarker

2014 ◽  
Vol 65 (4) ◽  
pp. 352-359 ◽  
Author(s):  
Santanu Chakraborty ◽  
Reem A. Adas
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Brain Death ◽  
Internal Carotid ◽  
External Carotid Artery ◽  
External Carotid ◽  
Ancillary Test ◽  
Organ Harvesting

Purpose Neurologic determination of death or brain death is primarily a clinical diagnosis. This must respect all guarantees required by law and should be determined early to avoid unnecessary treatment and allow organ harvesting for transplantation. Ancillary testing is used in situations in which clinical assessment is impossible or confounded by other factors. Our purpose is to determine the utility of dynamic computed tomographic angiography (dCTA) as an ancillary test for diagnosis of brain death. Materials and Methods We retrospectively reviewed 13 consecutive patients with suspected brain death in the intensive care unit who had dCTA. Contrast appearance timings recorded from the dCTA data were compared to findings from 15 controls selected from patients who presented with symptoms of acute stroke but showed no stroke in follow-up imaging. Results The dCTA allows us to reliably assess cerebral blood flow and to record time of individual cerebral vessels opacification. It also helps us to assess the intracranial flow qualitatively against the flow in extracranial vessels as a reference. We compared the time difference between enhancement of the external and internal carotid arteries and branches. In all patients who were brain dead, internal carotid artery enhancement was delayed, which occurred after external carotid artery branches were opacified. Conclusion In patients with suspected brain death, dCTA reliably demonstrated the lack of cerebral blood flow, with extracranial circulation as an internal reference. Our initial results suggest that inversion of time of contrast appearance between internal carotid artery and external carotid artery branches at the skull base could predict a lack of distal intracranial flow.

Blister Aneurysms of the Internal Carotid Artery: Microsurgical Results and Management Strategy

Neurosurgery ◽  
2017 ◽  
Vol 80 (2) ◽  
pp. 235-247 ◽  
Author(s):  
Christopher M. Owen ◽  
Nicola Montemurro ◽  
Michael T. Lawton
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Treatment Strategy ◽  
Internal Carotid ◽  
Artery Bypass ◽  
External Carotid ◽  
Parent Artery ◽  
Intraoperative Rupture

Abstract BACKGROUND: Blister aneurysms of the supraclinoid internal carotid artery (ICA) are challenging lesions with high intraoperative rupture rates and significant morbidity. An optimal treatment strategy for these aneurysms has not been established. OBJECTIVE: To analyze treatment strategy, operative techniques, and outcomes in a consecutive 17-year series of ICA blister aneurysms treated microsurgically. METHODS: Seventeen patients underwent blister aneurysm treatment with direct clipping, bypass and trapping, or clip-reinforced wrapping. RESULTS: Twelve aneurysms (71%) were treated with direct surgical clipping. Three patients required bypass: 1 superficial temporal artery to middle cerebral artery bypass, 1 external carotid artery to middle cerebral artery bypass, and 1 ICA to middle cerebral artery bypass. One patient was treated with clip-reinforced wrapping. Initial treatment strategy was enacted 71% of the time. Intraoperative rupture occurred in 7 patients (41%), doubling the rate of a poor outcome (57% vs 30% for patients with and without intraoperative rupture, respectively). Severe vasospasm developed in 9 of 16 patients (56%). Twelve patients (65%) were improved or unchanged after treatment, and 10 patients (59%) had good outcomes (modified Rankin Scale scores of 1 or 2). CONCLUSION: ICA blister aneurysms can be cautiously explored and treated with direct clipping as the first-line technique in the majority of cases. Complete trapping of the parent artery with temporary clips and placing permanent clip blades along normal arterial walls enables clipping that avoids intraoperative aneurysm rupture. Trapping/bypass is used as the second-line treatment, maintaining a low threshold for bypass with extensive or friable pathology of the carotid wall and in patients with incomplete circles of Willis.

scholarly journals Carotid artery stenting for patients with occipital–vertebral anastomosis

2018 ◽  
Vol 25 (2) ◽  
pp. 212-218
Author(s):  
Ryuichiro Kajikawa ◽  
Toshiyuki Fujinaka ◽  
Hajime Nakamura ◽  
Manabu Kinoshita ◽  
Takeo Nishida ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Vertebral Artery ◽  
High Intensity ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
External Carotid ◽  
Occipital Artery ◽  
Protection Method ◽  
Distal Internal Carotid Artery

Background and purpose We report the outcomes of carotid artery stenting for patients with angiographically visible occipital artery–vertebral artery anastomosis. Methods Among 47 consecutive patients who underwent carotid artery stenting from January 2007 to December 2010, seven patients for whom cerebral angiograms clearly showed occipital artery–vertebral artery anastomosis were selected. Four different protection methods were used: distal internal carotid artery protection; carotid flow reversal; seatbelt and airbag technique; and double protection method of protecting both the external and internal carotid artery. Results One patient with distal internal carotid artery protection showed a high-intensity lesion at the border of the upper thalamus, internal capsule and lateral ventricle wall after carotid artery stenting. The other patient with the double protection method did not show any high-intensity lesions on postoperative diffusion-weighted imaging in the vertebrobasilar territory. All seven patients with visible occipital artery–vertebral artery anastomosis showed ipsilateral vertebral artery severe stenosis or occlusion. Conclusion Large occipital artery–vertebral artery anastomosis may be a pathway for embolic materials during carotid artery stenting. External carotid artery protection is recommended for carotid artery stenting in such patients.

Orbital Vascular And Lymphatic Systems

2012 ◽  
Author(s):  
David Jordan ◽  
Louise Mawn ◽  
Richard L. Anderson
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
External Carotid Artery ◽  
External Carotid ◽  
Sympathetic Nerve Fibers ◽  
Carotid Canal ◽  
Cervical Ganglion

The anatomy of the orbital vascular bed is complex, with tremendous individual variation. The main arterial supply to the orbit is from the ophthalmic artery, a branch of the internal carotid artery. The external carotid artery normally contributes only to a small extent. However, there are a number of orbital branches of the ophthalmic artery that anastomose with adjacent branches from the external carotid artery, creating important anastomotic communications between the internal and external carotid arterial systems. The venous drainage of the orbit occurs mainly via two ophthalmic veins (superior and inferior) that extend to the cavernous sinus, but there are also connections with the pterygoid plexus of veins, as well as some more anteriorly through the angular vein and the infraorbital vein to the facial vein. A working knowledge of the orbital vasculature and lymphatic systems is important during orbital, extraocular, or ocular surgery. Knowing the anatomy of the blood supply helps one avoid injury to the arteries and veins during operative procedures within the orbit or the eyelid. Inadvertent injury to the vasculature not only distorts the anatomy and disrupts a landmark but also prolongs the surgery and might compromise blood flow to an important orbital or ocular structure. Upon entering the cranium, the internal carotid artery passes through the petrous portion of the temporal bone in the carotid canal and enters the cavernous sinus and middle cranial fossa through the superior part of the forame lacerum . It proceeds forward in the cavernous sinus with the abducens nerve along its side. There it is surrounded by sympathetic nerve fibers (the carotid plexus ) derived from the superior cervical ganglion. It then makes an upward S-shaped turn to form the carotid siphon , passing just medial to the oculomotor, trochlear, and ophthalmic nerves (V1). After turning superiorly in the anterior cavernous sinus, the carotid artery perforates the dura at the medial aspect of the anterior clinoid process and turns posteriorly, inferior to the optic nerve.

Sign in / Sign up

Export Citation Format

Share Document