scholarly journals The technique of superselective ophthalmic artery chemotherapy for retinoblastoma: The Garrahan Hospital experience

2017 ◽  
Vol 24 (1) ◽  
pp. 93-99 ◽  
Author(s):  
Flavio Requejo ◽  
Juan Marelli ◽  
Agustin Ruiz Johnson ◽  
Claudia Sampor ◽  
Guillermo Chantada
Keyword(s):  
Femoral Artery ◽  
Ophthalmic Artery ◽  
Middle Meningeal Artery ◽  
Retinal Hemorrhage ◽  
External Carotid Artery ◽  
Morbidity Rate ◽  
External Carotid ◽  
Safe Technique ◽  
Tandem Therapy ◽  
Effects Of Radiation

Background Superselective ophthalmic artery chemotherapy (SOAC) is a proven therapy for the treatment of retinoblastomas. We describe the technique, results and complications of SOAC performed in our hospital. Objective The aim of this article is to demonstrate that a seemingly complex technique can be carried out with a low morbidity rate. Methods A retrospective analysis of patients receiving SOAC in our department from November 2014 to April 2017 was performed. Data collected were age, gender, number of procedures, arteries approached, bilaterality of treatment, and complications. The procedure was performed using a 3F sheath and a flow-dependent 1.5F microcatheter that was navigated from the femoral artery to the ostium of the ophthalmic artery (OA). When the OA was too small or a stable position could not be achieved, the microcatheter was navigated in the external carotid artery to reach an anastomotic ramus (AR) of the middle meningeal artery (MMA) to the OA. The drugs were then injected through the microcatheter in a pulsatile way. Results Forty-one patients underwent SOAC. A total of 248 procedures were performed in 45 eyes, and 248 arteries were approached (205 OAs and 43 MMAs). Four patients underwent tandem therapy (both eyes treated in the same procedure). Complications were: hypotension and bradycardia during the procedure (five cases), transient thrombosis of the femoral artery (two cases), retinal hemorrhage (one case), alopecia (one case), and anaphylactic shock to carboplatin (one case). No patient showed adverse effects of radiation or ischemic stroke. Conclusion SOAC is a safe technique with a very low complication rate.

Middle Meningeal Origin of the Ophthalmic Artery

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 401-407 ◽  
Author(s):  
Qingliang Liu ◽  
Albert L. Rhoton
Keyword(s):  
Ophthalmic Artery ◽  
Middle Meningeal Artery ◽  
External Carotid Artery ◽  
External Carotid ◽  
Microsurgical Anatomy ◽  
Superior Orbital Fissure ◽  
Anatomic Dissection ◽  
Retinal Artery ◽  
Arteries And Veins ◽  
Meningeal Artery

Abstract OBJECTIVE To examine the microsurgical anatomy and clinical significance of an anomalous origin of the ophthalmic artery from the middle meningeal artery. METHODS In the course of an anatomic study of the cavernous sinus, an anomalous ophthalmic artery arising from the middle meningeal artery was found. To further define the anatomy of the region, five additional skulls, in which the arteries and veins were injected with colored latex, were dissected using 3× to 40× magnification. RESULTS The anomalous ophthalmic artery arose from the frontal branch of the middle meningeal artery, passed through the superior orbital fissure, and supplied the entire contents of the orbit, as well as giving rise to the central retinal artery. This study provides the first display of this anomaly in an anatomic dissection. CONCLUSION The ophthalmic artery may infrequently arise from the middle meningeal artery. This anomaly places the ophthalmic artery at risk during procedures in which the dura is elevated from the greater and lesser wings of the sphenoid or when the sphenoid ridge is removed and during embolization procedures involving the branches of the external carotid artery.

A microsurgical study of the anatomy and course of the ophthalmic artery and its possibly dangerous anastomoses

2007 ◽  
Vol 106 (1) ◽  
pp. 142-150 ◽  
Author(s):  
Paolo Perrini ◽  
Andrea Cardia ◽  
Kenneth Fraser ◽  
Giuseppe Lanzino
Keyword(s):  
Optic Nerve ◽  
Ophthalmic Artery ◽  
Endovascular Procedures ◽  
Middle Meningeal Artery ◽  
External Carotid Artery ◽  
External Carotid ◽  
Detailed Knowledge ◽  
Microsurgical Anatomy ◽  
Retinal Artery ◽  
Meningeal Artery

Object The authors studied the microsurgical anatomy of the ophthalmic artery (OphA), paying particular attention to its possibly dangerous anastomoses with the middle meningeal artery (MMA). Methods The microsurgical anatomy of the OphA and its anastomoses with the MMA were studied in 14 vessels from seven adult cadaveric heads. The origination order of the OphA branches varies in relation to whether the artery, along its intraorbital course, crosses above or below the optic nerve (ON). The central retinal artery is the first branch to course from the OphA when it crosses over the ON, and it is the second branch to course from the OphA when the artery crosses under the ON. Anastomoses between branches of the MMA and the OphA were present in the majority of the specimens examined. Conclusions Detailed knowledge of the microanatomy of the OphA and recognition of anastomoses between the external carotid artery and the OphA are critically important in avoiding disastrous complications during endovascular procedures.

scholarly journals Effect of Stellate Ganglion Block on the Cerebrovascular System

2010 ◽  
Vol 113 (4) ◽  
pp. 936-944 ◽  
Author(s):  
Chang-Ki Kang ◽  
Seung-Taek Oh ◽  
Rack Kyung Chung ◽  
Hyon Lee ◽  
Chan-A Park ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Carotid Artery ◽  
Signal Intensity ◽  
Ophthalmic Artery ◽  
Stellate Ganglion ◽  
Stellate Ganglion Block ◽  
External Carotid Artery ◽  
External Carotid ◽  
Ganglion Block

Background Several studies have shown that stellate ganglion block (SGB) is an effective treatment for certain cerebrovascular related diseases; however, the direct effect of SGB on the cerebral vasculature is still unknown. The present study investigated the effect of SGB on the cerebral vascular system using magnetic resonance angiography. Methods Time-of-flight magnetic resonance angiography images of 19 healthy female volunteers (mean ages of 46.4 ± 8.9 yr) were obtained before and after SGB with 1.5-T magnetic resonance imaging. The authors determined successful interruption of sympathetic innervation to the head with the appearance of Horner syndrome and conjunctival injection. We measured changes in the average signal intensity and diameter of the major intracranial and extracranial arteries and their branches, which were presented with mean (±SE). Results The signal intensity changes were observed mainly in the ipsilateral extracranial vessels; the external carotid artery (11.2%, P < 0.001) and its downstream branches, such as the occipital artery (9.5%, P < 0.001) and superficial temporal artery (14.1%, P < 0.001). In contrast, the intensities of the intracranial arteries did not change with the exception of the ipsilateral ophthalmic artery, which increased significantly (10.0%, P = 0.008). After SGB, only the diameter of the ipsilateral external carotid artery was significantly increased (26.5%, P < 0.001). Conclusions We were able to observe significant changes in the extracranial vessels, whereas the intracranial vessels were relatively unaffected (except for the ophthalmic artery), demonstrating that both perivascular nerve control and sympathetic nerve control mechanisms may contribute to the control of intracranial and extracranial blood vessels, respectively, after SGB.

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.

scholarly journals Retinal Embolization and Cerebellar Asymptomatic Embolization after Carotid Stenting Using Distal Balloon Protection

2003 ◽  
Vol 9 (3) ◽  
pp. 311-314 ◽  
Author(s):  
S. Islam ◽  
H. Manabe ◽  
S. Hasegawa ◽  
A. Takemura ◽  
M. Nagahata ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Ophthalmic Artery ◽  
Carotid Stenting ◽  
External Carotid Artery ◽  
External Carotid ◽  
Occipital Artery ◽  
Cerebral Embolization ◽  
Intracranial Arteries ◽  
Balloon Protection ◽  
Meningeal Artery

We describe a rare case of having both symptomatic ipsilateral retinal embolization and asymptomatic cerebellar embolization occurring after carotid stenting with use of distal protect device. In this case, external carotid angiograms revealed accessory meningeal artery-ophthalmic artery and occipital artery-vertebral artery anastomoses. This case suggested that the protection for external carotid artery should be considered during carotid stenting to avoid retinal embolization and cerebellar or cerebral embolization in cases showing angiographical anastomoses between external carotid artery and ophthalmic artery or intracranial arteries.

scholarly journals Acute retinal hemorrhage after Pipeline embolization device placement for treatment of ophthalmic segment aneurysm: A case report

2018 ◽  
Vol 24 (4) ◽  
pp. 383-386
Author(s):  
Nimer Adeeb ◽  
Justin Moore ◽  
Christoph J Griessenauer ◽  
Raghav Gupta ◽  
Ahad A Fazelat ◽  
...  
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Ophthalmic Artery ◽  
Artery Aneurysm ◽  
Retinal Hemorrhage ◽  
External Carotid ◽  
Anterior Communicating Artery ◽  
Small Subset ◽  
Pipeline Embolization Device ◽  
Ophthalmic Segment Aneurysms

Introduction Ophthalmic segment aneurysms may present with visual symptoms due to direct compression of the optic nerve. Treatment of these aneurysms with the Pipeline embolization device (PED) often results in visual improvement. Flow diversion, however, has also been associated with occlusion of the ophthalmic artery and visual deficits in a small subset of cases. Case report A 49-year-old Caucasian female presented with subarachnoid hemorrhage due to a ruptured anterior communicating artery aneurysm. On follow-up imaging, the patient was found to have a right asymptomatic ophthalmic segment aneurysm. Due to the irregular shape of the aneurysm and history of aneurysmal subarachnoid hemorrhage, the decision was made to treat the aneurysm with a PED. Postoperatively, the patient complained of floaters in the right eye. Detailed ophthalmologic examination showed retinal hemorrhage and cotton-wool spots on the macula. Such complication after PED placement has never been reported in the literature. Conclusion Visual complications after PED placement for treatment of ophthalmic segment aneurysms are rare. It is thought that even in cases where the ophthalmic artery occludes, patients remain asymptomatic due to the rich collateral supply from the external carotid artery branches. Here we report a patient who developed an acute retinal hemorrhage after PED placement.

scholarly journals Ophthalmic artery occlusion following neuro-embolization of the external carotid artery, a case report

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Ng Wei Loon ◽  
Balwant Singh Gendeh ◽  
Rozman Zakaria ◽  
Jemaima Che Hamzah ◽  
Norshamsiah Md Din
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Ophthalmic Artery ◽  
Artery Occlusion ◽  
External Carotid Artery ◽  
External Carotid

Transarterial N-Butyl-2-cyanoacrylate Embolization of an Intraosseous Dural Arteriovenous Fistula Associated With Acute Epidural Hematoma: Technical Case Report

2015 ◽  
Vol 11 (3) ◽  
pp. E468-E471 ◽  
Author(s):  
Shotaro Yoshioka ◽  
Kazuyuki Kuwayama ◽  
Junichiro Satomi ◽  
Shinji Nagahiro
Keyword(s):  
Epidural Hematoma ◽  
Clinical Presentation ◽  
Middle Meningeal Artery ◽  
Endovascular Embolization ◽  
External Carotid Artery ◽  
External Carotid ◽  
Maxillary Artery ◽  
Microsurgical Anatomy ◽  
The Right ◽  
Acute Epidural Hematoma

Abstract BACKGROUND AND IMPORTANCE Intraosseous dural arteriovenous fistulae (DAVF) are rare, especially those with drainage into the diploic venous system. The clinical presentation depends on the location of the lesion. This is the first report of an intraosseous DAVF associated with acute epidural hematoma. CLINICAL PRESENTATION A 25-year-old man presented with headache and nausea. Imaging of the brain revealed abnormal signals indicative of acute epidural hematoma in the right frontal convexity. Angiography demonstrated a DAVF in the region of the frontal bone. Right external carotid artery angiography showed that the DAVF was fed mainly by the right middle meningeal artery with drainage into diploic veins. Immediately after embolization of the middle meningeal and the distal internal maxillary artery with 17% N-butyl-2-cyanoacrylate, the shunt was completely occluded. The patient was discharged 4 days later without clinical complications. CONCLUSION Intraosseous DAVF can be treated by surgical resection or endovascular embolization. Curative treatment requires careful inspection of the angiographic architecture and microsurgical anatomy.

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