Balloon-assisted embolization of skull base meningioma with liquid embolic agent

2010 ◽  
Vol 112 (1) ◽  
pp. 70-72 ◽  
Author(s):  
Amr Abdel Kerim ◽  
Fabrice Bonneville ◽  
Betty Jean ◽  
Philippe Cornu ◽  
Lise LeJean ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Embolic Agent ◽  
Inflated Balloon ◽  
Novel Technique ◽  
Skull Base Meningioma ◽  
Small Branch ◽  
Liquid Embolic ◽  
Liquid Embolic Agent

The authors report a novel technique of balloon-assisted embolization of a skull base meningioma supplied by a branch of the cavernous segment of the internal carotid artery using liquid embolic agent. A temporarily inflated balloon distal to the meningioma's feeding vessel may improve the access to this small branch and may reduce the chances of unintended reflux during delivery of the liquid embolic agent.

Embolization of a giant pediatric, posttraumatic, skull base internal carotid artery aneurysm with a liquid embolic agent

2009 ◽  
Vol 4 (5) ◽  
pp. 449-452 ◽  
Author(s):  
Adam S. Reig ◽  
Scott Simon ◽  
Robert A. Mericle
Keyword(s):  
Skull Base ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Embolic Agent ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
The Cost

Many treatments for posttraumatic, skull base aneurysms have been described. Eight months after an all-terrain-vehicle accident, this 12-year-old girl presented with right-side Horner syndrome caused by a 33 × 19–mm internal carotid artery aneurysm at the C-1 level. We chose to treat the aneurysm with a new liquid embolic agent for wide-necked, side-wall aneurysms (Onyx HD 500). We felt this treatment would result in less morbidity than surgery and was less likely to occlude the parent artery than placement of a covered stent, especially in a smaller artery in a pediatric patient. Liquid embolic agents also appear to be associated with a lower chance of recanalization and lower cost compared with stent-assisted coil embolization. After the patient was treated with loading doses of aspirin, clopidogrel bisulfate, and heparin, 99% of the aneurysm was embolized with 9 cc of the liquid embolic agent. There were no complications, and the patient remained neurologically stable. Follow-up angiography revealed durable aneurysm occlusion after 1 year. The cost of Onyx was less than the cost of coils required for coil embolization of similarly sized intracranial aneurysms at our institution. Liquid embolic agents can provide a safe, efficacious, and cost-effective approach to treatment of select giant, posttraumatic, skull base aneurysms in pediatric patients.

Combined transarterial N-butyl cyanoacrylate and coil embolization of direct carotid–cavernous fistulas

2007 ◽  
Vol 106 (5) ◽  
pp. 903-906 ◽  
Author(s):  
Neil A. Troffkin ◽  
Curtis A. Given
Keyword(s):  
Carotid Artery ◽  
Coil Embolization ◽  
Nerve Palsy ◽  
Embolic Agent ◽  
Cyanoacrylate Glue ◽  
Complete Occlusion ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Carotid Cavernous Fistulas ◽  
Complex Cases

✓ The authors report two cases of traumatic carotid–cavernous fistulas treated successfully with combined N-butyl cyanoacrylate glue and coil embolization via a transarterial approach. In both cases complete occlusion of the fistula was achieved, with preservation of the parent carotid artery. Casting of the cavernous sinus with a liquid embolic agent was well tolerated and produced no complications of cranial nerve palsy. This technique provides interventionalists with yet another treatment option in these often complex cases.

scholarly journals Gross Total Resection of a Recurrent in-and-around Cavernous Sinus Meningioma through a Combined Transcavernous Anterior and Middle Infratemporal Fossa Approach with Extracranial-Intracranial Bypass

2021 ◽  
Author(s):  
Yoichi Nonaka ◽  
Naokazu Hayashi ◽  
Takanori Fukushima
Keyword(s):  
Carotid Artery ◽  
Skull Base ◽  
Cavernous Sinus ◽  
Bypass Surgery ◽  
Internal Carotid ◽  
Infratemporal Fossa ◽  
Cavernous Sinus Meningioma ◽  
Skull Base Meningioma ◽  
Cerebral Bypass ◽  
Vessel Reconstruction

Abstract Objectives The study aims to describe surgical management of an invasive cavernous sinus meningioma with a combination of several skull base approaches and bypass surgery. Design This study is an operative video. Results Resection of the recurrent skull base meningioma is still challenging, especially if the tumor involves or encases the carotid artery. Cerebral bypass surgery is an essential adjunct in the armamentarium of skull base surgery when vessel reconstruction is required. In this paper, we describe our experience of successful treatment of an invasive recurrent skull base meningioma, which involved the entire cavernous sinus and the internal carotid artery. A 46-year-old woman presented with a 2-year history of gradually worsening left-sided exophthalmos and visual impairment. The patient had previously undergone two craniotomies for resection of the left-sided spheno-orbital meningioma. Pathological diagnosis was chordoid meningioma, which is classified as an intermediate-grade meningioma. The second surgery had been performed for a rapid tumor regrowth 6 months after the first surgery. The patient lost her left-side vision after the second surgery. Aggressive tumor regrowth was confirmed with extension into the left orbit, infratemporal fossa, and cavernous sinus with engulfment of the carotid artery. A balloon occlusion test revealed intolerance of the left internal carotid artery occlusion. Considering the patient's age, tumor behavior, and intolerance of the carotid artery of the lesion side, we scheduled gross total resection of the tumor with vessel reconstruction. Conclusion Although cerebral bypass surgery is a technically challenging procedure, it plays an important role in the surgical management of the complex vessel-engulfing tumor.The link to the video can be found at https://youtu.be/GCmpxK3hW18.

Treatment of experimental aneurysms with a new liquid embolic agent and a retrievable stent: proof of concept and feasibility study

2015 ◽  
Vol 8 (9) ◽  
pp. 934-939 ◽  
Author(s):  
Alejandro Berenstein
Keyword(s):  
Carotid Artery ◽  
Cerebral Aneurysms ◽  
Long Term Results ◽  
Embolic Agent ◽  
Embolic Material ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Partially Occluded ◽  
Treatment For Cerebral Aneurysms ◽  
Retrievable Stent

BackgroundOcclusion of canine bifurcation and sidewall aneurysms was undertaken with a new liquid embolic agent (PHIL 35) assisted by a high-density partially retrievable stent (FRED) with preservation of the carotid artery.MethodsThree dogs were used as acute preparations for development of the technique and two were used for chronic studies lasting 90 days. In one animal we intentionally did not completely fill the aneurysm to determine the long-term results of incomplete treatment. The degree of occlusion, carotid artery compromise, and dislodgement and/or migration of embolic material in treated aneurysms were assessed.ResultsAll aneurysms planned for complete obliteration were totally occluded successfully. By design, we partially occluded one aneurysm. In this aneurysm, angiography performed at 30 days revealed less filling, but at 90 days it had persistent small residual filling. We did not detect any distal embolization during the injection and no angiographic occlusions, change in configuration, or delayed migration of the embolic material were found. In the inspected stent, no foreign material was noted. In four animals we successfully removed the stent with preservation of the integrity of the carotid artery. In the fifth we intentionally left both stents deployed.ConclusionsWe have developed a new treatment for cerebral aneurysms using a combination of a retrievable stent and a new liquid embolic agent.

scholarly journals PHIL Migration to Internal Carotid Artery and Middle Cerebral Artery: Late Mechanical Retrieval with Solitaire AB Stent

2020 ◽  
Author(s):  
Giancarlo Saal-Zapata ◽  
Walter Durand ◽  
Ricardo Vallejos ◽  
Dante Valer ◽  
Jesús Flores ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Venous Drainage ◽  
Stent Retriever ◽  
Embolic Agent ◽  
Anterior Circulation ◽  
Liquid Embolic

AbstractPrecipitating hydrophobic injecting liquid (PHIL) is a novel embolic agent used in the endovascular treatment of arteriovenous malformations (AVM) and arteriovenous fistulas. Complications can occur during embolization with migration of the liquid embolic material to normal vasculature. In these cases, use of a stent retriever is an option for removal of the plug. Herein, we present the case of a patient who presented with a right occipital hemorrhage due to a ruptured occipital AVM fed by the calcarine and parieto-occipital arteries with venous drainage to the straight sinus. Embolization via the anterior circulation through the right posterior communicating artery was attempted but PHIL migrated to right internal carotid artery and middle cerebral artery due to kinking and rupture of the microcatheter. The patient developed mild left hemiparesis. When this complication occurred, no stent retriever was available at our institution and 1 day later, the Solitaire AB stent was used to remove the plug of PHIL successfully, with good reperfusion of the proximal and distal vessels. The patient improved after the procedure and was discharged home without deficit. Mechanical stent retrievers can be used in cases of migration of liquid embolic agents to normal vasculature with good clinical and radiological results.

Internal carotid artery hemorrhage after irradiation and osteoradionecrosis of the skull base

2001 ◽  
Vol 125 (5) ◽  
pp. 522-527 ◽  
Author(s):  
H LAM ◽  
V ABDULLAH ◽  
P WORMALD ◽  
C VANHASSELT
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid

Nasopharyngeal muscle patch for the management of internal carotid artery injury in endoscopic endonasal surgery

2020 ◽  
Vol 133 (5) ◽  
pp. 1382-1387 ◽  
Author(s):  
Wei-Hsin Wang ◽  
Stefan Lieber ◽  
Ming-Ying Lan ◽  
Eric W. Wang ◽  
Juan C. Fernandez-Miranda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Management Technique ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Muscle Graft

OBJECTIVEInjury to the internal carotid artery (ICA) is the most critical complication of endoscopic endonasal skull base surgery. Packing with a crushed muscle graft at the injury site has been an effective management technique to control bleeding without ICA sacrifice. Obtaining the muscle graft has typically required access to another surgical site, however. To address this concern, the authors investigated the application of an endonasally harvested longus capitis muscle patch for the management of ICA injury.METHODSOne colored silicone-injected anatomical specimen was dissected to replicate the surgical access to the nasopharynx and the stepwise dissection of the longus capitis muscle in the nasopharynx. Two representative cases were selected to illustrate the application of the longus capitis muscle patch and the relevance of clinical considerations.RESULTSA suitable muscle graft from the longus capitis muscle could be easily and quickly harvested during endoscopic endonasal skull base surgery. In the illustrative cases, the longus capitis muscle patch was successfully used for secondary prevention of pseudoaneurysm formation following primary bleeding control on the site of ICA injury.CONCLUSIONSNasopharyngeal harvest of a longus capitis muscle graft is a safe and practical method to manage ICA injury during endoscopic endonasal surgery.

scholarly journals Role of Extradural Clinoidectomy and Optic Unroofing in Resection of an Anterior Clinoidal Meningioma with Encasement of the Internal Carotid Artery and Its Branches

2021 ◽  
Author(s):  
Sima Sayyahmelli ◽  
Zhaoliang Sun ◽  
Emel Avci ◽  
Mustafa K. Başkaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Vision Loss ◽  
Internal Carotid ◽  
Extent Of Resection ◽  
World Health ◽  
Who Grade ◽  
The Right ◽  
Supraclinoid Internal Carotid Artery

AbstractAnterior clinoidal meningiomas (ACMs) remain a major neurosurgical challenge. The skull base techniques, including extradural clinoidectomy and optic unroofing performed at the early stage of surgery, provide advantages for improving the extent of resection, and thereby enhancing overall outcome, and particularly visual function. Additionally, when the anterior clinoidal meningiomas encase neurovascular structures, particularly the supraclinoid internal carotid artery and its branches, this further increases morbidity and decreases the extent of resection. Although it might be possible to remove the tumor from the artery wall despite complete encasement or narrowing, the decision of whether the tumor can be safely separated from the arterial wall ultimately must be made intraoperatively.The patient is a 75-year-old woman with right-sided progressive vision loss. In the neurological examination, she only had light perception in the right eye without any visual acuity or peripheral loss in the left eye. MRI showed a homogeneously enhancing right-sided anterior clinoidal mass with encasing and narrowing of the supraclinoid internal carotid artery (ICA). Computed tomography (CT) angiography showed a mild narrowing of the right supraclinoid ICA with associated a 360-degree encasement. The decision was made to proceed using a pterional approach with extradural anterior clinoidectomy and optic unroofing. The surgery and postoperative course were uneventful. MRI confirmed gross total resection (Figs. 1 and 2). The histopathology was a meningothelial meningioma, World Health Organization (WHO) grade I. The patient continues to do well without any recurrence and has shown improved vision at 15-month follow-up.This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors.The link to the video can be found at https://youtu.be/vt3o1c2o8Z0

scholarly journals Transcavernous Resection of a Giant Extensive Chondrosarcoma with Endoscopic Assistance

2021 ◽  
Author(s):  
Walid Elshamy ◽  
Burcak Soylemez ◽  
Sima Sayyahmelli ◽  
Nese Keser ◽  
Mustafa K. Baskaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Gross Total Resection ◽  
Petrous Apex ◽  
Left Internal Carotid Artery ◽  
Total Resection ◽  
Complete Occlusion ◽  
Grade Ii

AbstractChondrosarcomas are one of the major malignant neoplasms which occur at the skull base. These tumors are locally invasive. Gross total resection of chondrosarcomas is associated with longer progression-free survival rates. The patient is a 55-year-old man with a history of dysphagia, left eye dryness, hearing loss, and left-sided facial pain. Magnetic resonance imaging (MRI) showed a giant heterogeneously enhancing left-sided skull base mass within the cavernous sinus and the petrous apex with extension into the sphenoid bone, clivus, and the cerebellopontine angle, with associated displacement of the brainstem (Fig. 1). An endoscopic endonasal biopsy revealed a grade-II chondrosarcoma. The patient was then referred for surgical resection. Computed tomography (CT) scan and CT angiogram of the head and neck showed a left-sided skull base mass, partial destruction of the petrous apex, and complete or near-complete occlusion of the left internal carotid artery. Digital subtraction angiography confirmed complete occlusion of the left internal carotid artery with cortical, vertebrobasilar, and leptomeningeal collateral development. The decision was made to proceed with a left-sided transcavernous approach with possible petrous apex drilling. During surgery, minimal petrous apex drilling was necessary due to autopetrosectomy by the tumor. Endoscopy was used to assist achieving gross total resection (Fig. 2). Surgery and postoperative course were uneventful. MRI confirmed gross total resection of the tumor. The histopathology was a grade-II chondrosarcoma. The patient received proton therapy and continues to do well without recurrence at 4-year follow-up. This video demonstrates steps of the combined microsurgical skull base approaches for resection of these challenging tumors.The link to the video can be found at: https://youtu.be/WlmCP_-i57s.

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