Contralateral catheterization of the ophthalmic artery to deliver intra-arterial chemotherapy in retinoblastoma

2021 ◽  
pp. 197140092110246
Author(s):  
Giancarlo Saal-Zapata ◽  
Rodolfo Rodríguez ◽  
Aaron Rodriguez-Calienes ◽  
Raúl Cordero
Keyword(s):  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Pediatric Population ◽  
Anterior Communicating Artery ◽  
Chemotherapeutic Drugs ◽  
First Line ◽  
Chemotherapy Administration ◽  
Class D ◽  
Severity Of The Disease ◽  
Cure Rates

Retinoblastoma is the most frequent ocular malignancy in the pediatric population and intra-arterial chemotherapy has emerged as the first-line treatment of this entity with cure rates ranging from 33–100%, depending on the severity of the disease. We present the case of an advanced retinoblastoma in a pediatric patient who underwent intra-arterial chemotherapy through a contralateral route due to unsuccessful catheterization of the ophthalmic artery. The patient was diagnosed with a class D retinoblastoma which underwent the catheterization of the ophthalmic artery through the contralateral internal carotid and through the anterior communicating artery. In this case, intra-arterial chemotherapy administration was successfully delivered without complications. Contralateral routes for intra-arterial chemotherapy are safe and allow adequate penetration of the chemotherapeutic drugs in cases where a well-developed anterior communicating artery is present.

scholarly journals Retrograde Approach for Intra-arterial Chemotherapy Delivery in Retinoblastoma

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.

Carotid-anterior cerebral artery anastomosis

1976 ◽  
Vol 44 (3) ◽  
pp. 378-382 ◽  
Author(s):  
Stephen Nutik ◽  
Domenico Dilenge
Keyword(s):  
Optic Nerve ◽  
Cerebral Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Optic Chiasm ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Anatomical Features ◽  
Fine Print

✓ The angiographic and anatomical features of an anomalous communication between the intradural internal carotid artery and the anterior cerebral artery are described. Essential features of the anastomosis include an origin at, or close to, the origin of the ophthalmic artery, a course ventral to the ipsilateral optic nerve and anterior to the optic chiasm, and a termination near the anterior communicating artery. Although rare, the condition should be considered as an entity. The incidence of associated berry aneurysm and other congenital vascular anomalies is high.

Treatment of an anterior communicating artery aneurysm through an anomalous anastomosis from the cavernous internal carotid artery

2002 ◽  
Vol 97 (6) ◽  
pp. 1432-1435 ◽  
Author(s):  
Virany Huynh Hillard ◽  
Kiran Musunuru ◽  
Chiedozie Nwagwu ◽  
Kaushik Das ◽  
Raj Murali ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Surgical Clipping ◽  
Content Type ◽  
Endovascular Approach

✓ Cavernous internal carotid artery (ICA)—anterior cerebral artery (ACA) anastomoses are unusual anomalies in which a duplicated A1 segment of the ACA arises from the infraoptic ICA. The authors report on a 30-year-old woman who presented with subarachnoid hemorrhage from an anterior communicating artery (ACoA) aneurysm associated with an extremely rare variant of this anastomosis. The extra A1 segment emerged from the ICA within the cavernous sinus rather than at or above the level of the ophthalmic artery. The presence of the anomalous vessel provided a straightforward endovascular approach to the ACoA and allowed the use of coil placement rather than surgical clipping to treat the aneurysm successfully.

Hypoplastic internal carotid artery ending as an ophthalmic artery with multiple cerebral aneurysms, fenestrated Acom and triple A2

2021 ◽  
Vol 14 (7) ◽  
pp. e243520
Author(s):  
Yaşar Türk ◽  
Atakan Küskün
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Hemisphere ◽  
Rare Case ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Cerebral Atrophy ◽  
Anterior Communicating Artery ◽  
Watershed Infarcts

A rare case of a hypoplastic internal carotid artery (ICA) terminating in the ophthalmic artery with multiple intracranial saccular aneurysms in the contralateral ICA, anterior communicating artery fenestration and triple A2 was identified. The aetiology and pathogenesis of ICA hypoplasia are subjected to certain hypotheses. Developing several collaterals to preserve the blood supply of the ipsilateral cerebral hemisphere could result in aneurysm formation due to flow overload on the contralateral vasculature, but it could also result in hemicranial hypoplasia, cerebral atrophy and deep watershed infarcts, as in our case.

Anomalous branch of the internal carotid artery supplying circulation of the anterior cerebral artery

1983 ◽  
Vol 58 (6) ◽  
pp. 941-946 ◽  
Author(s):  
Shunichiro Fujimoto ◽  
Masao Murakami
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysms ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
The Right ◽  
Anomalous Branch

✓ Angiographic and operative investigations revealed an anomalous branch of the internal carotid artery (ICA) in a patient with an anterior communicating artery (ACoA) aneurysm. The anomalous vessel originated from the right ICA at the level of the ophthalmic artery, and pursued an infraoptic and prechiasmatic path to supply both pericallosal arteries. The clinical features and possible genesis of this anomaly are discussed. This irregularity is frequently associated with intracranial aneurysms, especially those of the ACoA, and with other anomalies.

Combination of mitotane and locoregional treatments in low-volume metastatic adrenocortical carcinoma

2021 ◽  
Author(s):  
Alice Boileve ◽  
Elise Mathy ◽  
Charles Roux ◽  
Matthieu Faron ◽  
Julien Hadoux ◽  
...  
Keyword(s):  
Adrenocortical Carcinoma ◽  
Stage Iv ◽  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Complete Response ◽  
Tumor Burden ◽  
Interquartile Range ◽  
First Line ◽  
Chemotherapy Administration ◽  
Metastatic Sites

Abstract Purpose European and French guidelines for ENSAT stage IV low tumor burden or indolent adrenocortical carcinoma (ACC) recommend combination of mitotane and locoregional treatments (LRT) in first-line. Nevertheless, the benefit of LRT combination with mitotane has never been evaluated in this selected group of patients. Methods A retrospective chart review was performed from 2003-2018 of patients with stage IV ACC with ≤2 tumoral organs who received mitotane in our center. Primary endpoint was the delay between mitotane initiation and first systemic chemotherapy. Secondary endpoints were progression-free survival (PFS) and overall survival (OS) from mitotane initiation. Adjusted analyses were performed on the main prognostic factors. Results Out of 79 included patients, 48 (61%) patients were female and median age at stage IVA diagnosis was 49.8 years (interquartile-range:38.8-60.0). Metastatic sites were mainly lungs (76%) and liver (48%). Fifty-eight (73%) patients received LRT including adrenal bed radiotherapy (14 patients, 18%), surgery (37 patients, 47%) and/or interventional radiology n(35,44%). Median time between mitotane initiation and first chemotherapy administration was 9 months (Interquartile-range:4-18). Median PFS1 (first tumor-progression) was 6.0 months (CI95%:4.5-8.6). Median OS was 46 months (CI95%:41-68). PFS1, PFS2 and OS were statistically longer in the mitotane plus LRT group compared to the mitotane-only group (Hazard ratio (HR)=0.39 (CI95%:0.22-0.68), HR=0.35 (CI95%:0.20-0.63) and HR=0.27 (CI95%:0.14-0.50) respectively). Ten (13%) patients achieved complete response, all from mitotane plus LRT group. Conclusion Our results endorse European and French guidelines for stage IV ACC with ≤2 tumor-organs and favor the combination of mitotane and LRT as first-line treatment. For the first time, a significant number of complete responses were observed. Prospective studies are expected to confirm these findings.

Bilateral Internal Carotid to Anterior Cerebral Artery Anastomosis with Anterior Communicating Artery Aneurysm: Technical Case Report

2005 ◽  
Vol 57 (suppl_4) ◽  
pp. ONS-E400-ONS-E400 ◽  
Author(s):  
Kaya Kılıç ◽  
Metin Orakdöğen ◽  
Aram Bakırcı ◽  
Zafer Berkman
Keyword(s):  
Case Report ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery

Abstract OBJECTIVE AND IMPORTANCE: The present case report is the first one to report a bilateral anastomotic artery between the internal carotid artery and the anterior communicating artery in the presence of a bilateral A1 segment, fenestrated anterior communicating artery (AComA), and associated aneurysm of the AComA, which was discovered by magnetic resonance angiography and treated surgically. CLINICAL PRESENTATION: A 38-year-old man who was previously in good health experienced a sudden onset of nuchal headache, vomiting, and confusion. Computed tomography revealed a subarachnoid hemorrhage. Magnetic resonance angiography and four-vessel angiography documented an aneurysm of the AComA and two anastomotic vessels of common origin with the ophthalmic artery, between the internal carotid artery and AComA. INTERVENTION: A fenestrated clip, introduced by a left pterional craniotomy, leaving in its loop the left A1 segment, sparing the perforating and hypothalamic arteries, excluded the aneurysm. CONCLUSION: The postoperative course was uneventful, with complete recovery. Follow-up angiograms documented the successful exclusion of the aneurysm. Defining this particular internal carotid-anterior cerebral artery anastomosis as an infraoptic anterior cerebral artery is not appropriate because there is already an A1 segment in its habitual localization. Therefore, it is also thought that, embryologically, this anomaly is not a misplaced A1 segment but the persistence of an embryological vessel such as the variation of the primitive prechiasmatic arterial anastomosis. The favorable outcome for our patient suggests that surgical treatment may be appropriate for many patients with this anomaly because it provides a complete and definitive occlusion of the aneurysm.

Cervical ICA pseudo-occlusion on single phase CTA in patients with acute terminal ICA occlusion: what is the mechanism and can delayed CTA aid diagnosis?

2018 ◽  
Vol 10 (10) ◽  
pp. 983-987 ◽  
Author(s):  
James Wareham ◽  
Robert Crossley ◽  
Sarah Barr ◽  
Alex Mortimer
Keyword(s):  
Ophthalmic Artery ◽  
Single Phase ◽  
Internal Carotid ◽  
Posterior Communicating Artery ◽  
Digital Subtraction ◽  
Delayed Imaging ◽  
Stroke Imaging ◽  
Cervical Segment ◽  
Digital Subtraction Angiographic ◽  
Delayed Phase

BackgroundSingle-phase CT angiography (CTA) forms the basis of hyperacute stroke imaging but many patients with terminal internal carotid artery (ICA) occlusion exhibit a pseudo-occlusion of the cervical ICA whereby a column of unopacified blood mimics a tandem cervical ICA lesion. We aimed to investigate the utility of a delayed phase acquisition to aid identification of a pseudo-occlusion and investigated the mechanism for this imaging artefact.MethodsThirteen patients with a pseudo-occlusion were compared with 13 patients without. CT, CTA, and digital subtraction angiographic images were reviewed by two interventional neuroradiologists for extension of thrombus into the ophthalmic segment, filling of the posterior communicating artery and ophthalmic artery, and for extension of contrast beyond the cervical segment and outline of the proximal clot surface by contrast on delayed imaging performed at 40 or 80 s.ResultsThose with a pseudo-occlusion demonstrated more frequent thrombus extension into the ophthalmic segment (100% vs 23%, P=0.0001), less frequent filling of the posterior communicating artery (15% vs 85%, P=0.0012), and less frequent filling of the ophthalmic artery (15% vs 92%, P=0.0002) compared with those without a pseudo-occlusion. Delayed CTA imaging showed contrast beyond the cervical segment and meeting the proximal clot face in 2/11 patients. Each of these two patients showed patency of the posterior communicating artery origin.ConclusionThrombus extension into the ophthalmic segment and patency of the posterior communicating artery and ophthalmic artery seem to govern whether a patient with a terminal ICA occlusion exhibits a pseudo-occlusion. Delayed imaging was of limited value in identification of a pseudo-occlusion.

Anatomic Nuances of the Ophthalmic Artery Origin from a Ventral Viewpoint: Considerations and Implications for Endoscopic Endonasal Surgery

2018 ◽  
Vol 16 (4) ◽  
pp. 478-485
Author(s):  
Cristian A Naudy ◽  
Juan C Yanez-Siller ◽  
Paulo M Mesquita Filho ◽  
Matias Gomez G. ◽  
Bradley A Otto ◽  
...  
Keyword(s):  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Point Of View ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Nerve Segment ◽  
Surgical Field ◽  
The Right ◽  
Ophthalmic Arteries

Abstract BACKGROUND The origin of the ophthalmic artery is within the surgical field of endoscopic endonasal approaches (EEAs) to the suprasellar and parasellar regions. However, its anatomy from the endoscopic point-of-view has not been adequately elucidated. OBJECTIVE To highlight the anatomy of the ophthalmic artery origin from an endoscopic endonasal perspective. METHODS The origin of the ophthalmic artery was studied bilaterally under endoscopic visualization, after performing transplanum/transtubercular EEAs in 17 cadaveric specimens (34 arteries). Anatomic relationships relevant to surgery were evaluated. To complement the cadaveric findings, the ophthalmic artery origin was reviewed in 200 “normal” angiographic studies. RESULTS On the right side, 70.6% of ophthalmic arteries emerged from the superior aspect, while 17.6% and 11.8% emerged from the superomedial and superolateral aspects of the intradural internal carotid artery, respectively. On the left, 76.5%, 17.6%, and 5.9% of ophthalmic arteries emerged from the superior, superomedial, and superolateral aspects of the internal carotid, respectively. Similar findings were observed on angiography. All ophthalmic arteries emerged at the level of the medial opticocarotid recess. Overall, 47%, 26.5%, and 26.5% of ophthalmic arteries (right and left) were inferolateral, inferior, and inferomedial to the intracranial optic nerve segment, respectively. On both sides, the intracranial length of the ophthalmic artery ranged from 1.5 to 4.5 mm (mean: 2.90 ± standard deviation of 0.74 mm). CONCLUSION Awareness of the endoscopic nuances of the ophthalmic artery origin is paramount to minimize the risk of sight-threatening neurovascular injury during EEAs to the suprasellar and parasellar regions.

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