Retraction: Solid hemangioblastoma in the cerebellopontine angle: Importance of external carotid blood supply with regard to the probable site of origin and preoperative embolization

Objectives: To describe a case of the rare complication of facial palsy following preoperative embolization of a juvenile nasopharyngeal angiofibroma (JNA). To illustrate the vascular supply to the facial nerve and as a result, highlight the etiology of the facial nerve palsy. Methods: The angiography and magnetic resonance (MR) imaging of a case of facial palsy following preoperative embolization of a JNA is reviewed. Results: A 13-year-old male developed left-sided facial palsy following preoperative embolization of a left-sided JNA. Evaluation of MR imaging studies and retrospective review of the angiographic data suggested errant embolization of particles into the petrosquamosal branch of the middle meningeal artery (MMA), a branch of the internal maxillary artery (IMA), through collateral vasculature. The petrosquamosal branch of the MMA is the predominant blood supply to the facial nerve in the facial canal. The facial palsy resolved since complete infarction of the nerve was likely prevented by collateral blood supply from the stylomastoid artery. Conclusions: Facial palsy is a potential complication of embolization of the IMA, a branch of the external carotid artery (ECA). This is secondary to ischemia of the facial nerve due to embolization of its vascular supply. Clinicians should be aware of this potential complication and counsel patients accordingly prior to embolization for JNA.

Download Full-text

Preoperative embolization of intracranial hemangiopericytomas: case series and introduction of the transtumoral embolization technique

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011980 ◽

2015 ◽

Vol 8 (10) ◽

pp. 1084-1094 ◽

Cited By ~ 6

Author(s):

Brian W Hanak ◽

Diogo C Haussen ◽

Sudheer Ambekar ◽

Manuel Ferreira ◽

Basavaraj V Ghodke ◽

...

Keyword(s):

Carotid Artery ◽

Blood Loss ◽

Blood Supply ◽

Case Series ◽

External Carotid Artery ◽

External Carotid ◽

Preoperative Embolization ◽

Intraoperative Blood Loss ◽

Hypervascular Tumors ◽

Polyvinyl Alcohol Particles

Background and purposeHemangiopericytomas (HPCs) are rare dural-based neoplasms. Preoperative embolization of these notoriously hypervascular tumors can be challenging as they often receive their dominant blood supply from pial feeders arising from the internal carotid artery (ICA) or vertebrobasilar (VB) circulation. This study reviews our historical experience with HPC embolization and introduces the transtumoral technique for backfilling pial tumor vasculature by delivering Onyx-18 through diminutive external carotid artery (ECA) feeders.MethodsA retrospective review of all preoperative HPC embolizations performed at Anonymous University #1 (September 2002–November 2014) and Anonymous University #2 (January 2014–November 2014) is presented.ResultsFifteen patients with pathologically confirmed HPC underwent 17 embolizations. More extensive devascularization percentages were achieved for HPCs with primarily ECA blood supply (76.4±10.7%; n=6) than with HPCs supplied via the ICA/VB circulation (57.9±26.9%; n=8; p=0.046). There was a trend towards greater devascularization of ICA/VB-dominant HPCs embolized with Onyx (70.0±34.6%; n=4) versus polyvinyl alcohol particles (33.3±15.3%; n=3). The extent of angiographic devascularization negatively correlated with intraoperative blood loss (rho=−0.71; p=0.005). There were no embolization-related complications.ConclusionsThe extent of preoperative embolization of HPCs correlates with decreased intraoperative blood loss. However, HPCs with an ICA/VB-dominant blood supply remain challenging embolization targets, demonstrating reduced devascularization percentages compared with ECA-dominant counterparts. The authors favor the use of Onyx for ICA/VB-dominant HPCs, noting a trend towards an improved devascularization rate.

Download Full-text

Multimodal management of pediatric carotid body tumors: a systematic review and case illustrations

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.8.peds18393 ◽

2019 ◽

Vol 23 (3) ◽

pp. 325-332

Author(s):

Manish Kuchakulla ◽

Ashish H. Shah ◽

Valerie Armstrong ◽

Sarah Jernigan ◽

Sanjiv Bhatia ◽

...

Keyword(s):

Systematic Review ◽

Carotid Artery ◽

Cranial Nerve ◽

External Carotid Artery ◽

External Carotid ◽

Preoperative Embolization ◽

Surgical Morbidity ◽

Balloon Test Occlusion ◽

Cranial Nerve Palsies ◽

Carotid Body Tumors

OBJECTIVECarotid body tumors (CBTs), extraadrenal paragangliomas, are extremely rare neoplasms in children that often require multimodal surgical treatment, including preoperative anesthesia workup, embolization, and resection. With only a few cases reported in the pediatric literature, treatment paradigms and surgical morbidity are loosely defined, especially when carotid artery infiltration is noted. Here, the authors report two cases of pediatric CBT and provide the results of a systematic review of the literature.METHODSThe study was divided into two sections. First, the authors conducted a retrospective review of our series of pediatric CBT patients and screened for patients with evidence of a CBT over the last 10 years (2007–2017) at a single tertiary referral pediatric hospital. Second, they conducted a systematic review, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, of all reported cases of pediatric CBTs to determine the characteristics (tumor size, vascularity, symptomatology), treatment paradigms, and complications.RESULTSIn the systematic review (n = 21 patients [includes 19 cases found in the literature and 2 from the authors’ series]), the mean age at diagnosis was 11.8 years. The most common presenting symptoms were palpable neck mass (62%), cranial nerve palsies (33%), cough or dysphagia (14%), and neck pain (19%). Metastasis occurred only in 5% of patients, and 19% of cases were recurrent lesions. Only 10% of patients presented with elevated catecholamines and associated sympathetic involvement. Preoperative embolization was utilized in 24% of patients (external carotid artery in 4 and external carotid artery and vertebral artery in 1). Cranial nerve palsies (cranial nerve VII [n = 1], IX [n = 1], X [n = 4], XI [n = 1], and XII [n = 3]) were the most common cause of surgical morbidity (33% of cases). The patients in the authors’ illustrative cases underwent preoperative embolization and balloon test occlusion followed by resection, and both patients suffered from transient Horner’s syndrome after embolization.CONCLUSIONSSurgical management of CBTs requires an extensive preoperative workup, anesthesia, and multimodal surgical management. Due to a potentially high rate of surgical morbidity and vascularity, balloon test occlusion with embolization may be necessary in select patients prior to resection. Careful thorough preoperative counseling is vital to preparing families for the intensive management of these children.

Download Full-text

Preoperative Embolization for Meningioma Using Lipiodol

Interventional Neuroradiology ◽

10.1177/15910199980040s111 ◽

1998 ◽

Vol 4 (1_suppl) ◽

pp. 63-66 ◽

Cited By ~ 4

Author(s):

K. Yasui ◽

Y. Shoda ◽

T. Suyama ◽

Y. Numa ◽

Y.Y. Amanouchi ◽

...

Keyword(s):

Carotid Artery ◽

External Carotid Artery ◽

The Other ◽

External Carotid ◽

Preoperative Embolization ◽

Embolic Material ◽

Operative Complications ◽

Perifocal Oedema ◽

Slow Infusion ◽

Proximal Occlusion

Four patient (3 males, 1 female) with meningioma treated by preoperative embolization using lipiodol since January 1997 were included in this study. Almost the same procedure was performed on them; superselective catheterization into feeders from the external carotid artery, slow infusion of lipiodol, and proximal occlusion with liquid coils. Duration between embolization and direct surgery varied (5–13 days). Three meningiomas resected 5 days after the embolization were successful but one resected after 13 days needed transfusion. Post operative complications were seen in two patients, one is lockjaw due to ischaemia of the temporal muscles, and the other is transient dilatation of perifocal oedema. The ischaemic effect and safety of lipiodol as embolic material are discussed.

Download Full-text

Posterior Petrosal Transotic Approach for Cerebellopontine Angle Hemangioblastoma: Technical Case Report

Operative Neurosurgery ◽

10.1093/ons/opz058 ◽

2019 ◽

Vol 17 (6) ◽

pp. E269-E273

Author(s):

Michael A Mooney ◽

Claudio Cavallo ◽

Evgenii Belykh ◽

Sirin Gandhi ◽

Justin Mascitelli ◽

...

Keyword(s):

Blood Supply ◽

Cerebellopontine Angle ◽

Radiation Treatment ◽

Vascular Supply ◽

Vascular Tumors ◽

Subtotal Resection ◽

Anterior Inferior Cerebellar Artery ◽

Adjuvant Radiation ◽

Arterial Blood ◽

Transotic Approach

Abstract BACKGROUND AND IMPORTANCE Although posterior petrosal approaches are utilized less frequently in many practices today, they continue to provide distinct surgical advantages in carefully selected cases. Here, we report a case of a recurrent cerebellopontine angle (CPA) hemangioblastoma that had failed a prior, more conservative, surgical approach. We provide cadaveric dissections of variations of posterior petrosal approaches to illustrate the advantages of the selected approach. CLINICAL PRESENTATION A 70-yr-old female presented with a growing left CPA hemangioblastoma. The lesion had undergone a prior subtotal resection from a retrosigmoid approach and subsequent adjuvant radiation treatment. The patient had worsening left facial strength, progressive balance difficulty, and absent left auditory function. Preoperative angiogram demonstrated arterial blood supply from the left anterior inferior cerebellar artery (AICA) that was deemed unsafe for embolization due to significant arteriovenous shunting. A posterior petrosal transotic approach was performed in order to optimize the working angle to the anterior brainstem and afford the ability to occlude the vascular supply from AICA prior to surgical resection of the lesion. CONCLUSION The posterior petrosal transotic approach offers an improved surgical working angle to the anterior brainstem compared to the translabyrinthine approach. This advantage can be particularly important with vascular tumors that receive blood supply anteriorly, as in this case from AICA, and can improve the safety of the resection.

Download Full-text

Primary Intracranial Rhabdomyosarcoma in the Cerebellopontine Angle Resected After Preoperative Embolization

World Neurosurgery ◽

10.1016/j.wneu.2018.05.054 ◽

2018 ◽

Vol 116 ◽

pp. 110-115 ◽

Cited By ~ 2

Author(s):

Keisuke Yoshida ◽

Tomoru Miwa ◽

Takenori Akiyama ◽

Masaaki Nishimoto ◽

Dai Kamamoto ◽

...

Keyword(s):

Cerebellopontine Angle ◽

Preoperative Embolization

Download Full-text

Arteriovenous malformation in the posterior fossa supplied by the external carotid circulation

Journal of Neurosurgery ◽

10.3171/jns.1974.41.4.0502 ◽

1974 ◽

Vol 41 (4) ◽

pp. 502-507 ◽

Cited By ~ 6

Author(s):

Carl J. Graf ◽

Arnold H. Menezes

Keyword(s):

Carotid Artery ◽

Arteriovenous Malformation ◽

Posterior Fossa ◽

Blood Supply ◽

External Carotid Artery ◽

External Carotid ◽

Content Type ◽

Carotid Circulation ◽

Fine Print

✓ The authors report a case in which the blood supply of a posterior fossa arteriovenous malformation was derived entirely from the external carotid artery.

Download Full-text

The Innervation and Vascular Supply of the Antrum

Proceedings of the Royal Society of Medicine ◽

10.1177/003591573402700657 ◽

1934 ◽

Vol 27 (6) ◽

pp. 745-751 ◽

Cited By ~ 1

Author(s):

Cecil Strong

Keyword(s):

Carotid Artery ◽

Prussian Blue ◽

Blood Supply ◽

Vascular Supply ◽

External Carotid Artery ◽

External Carotid ◽

Antral Mucosa ◽

Thermal Tests ◽

Made In

An attempt has been made to obtain information about the condition of the pulp of teeth, immediately below the bony incision, made in the lateral antral wall in radical antrotomy, and to investigate the conditions obtaining in the vascular supply of that neighbourhood. The investigation has two parts: (1) Experimental; (2) Clinical. Experimental.—( a) Injections of specimens of the superior maxillæ were made with lipiodol, then X-rayed. These showed vascular anastomoses along the antral floor. ( b) Sections of the lateral antral wall and floor were cut and stained to show nerves and blood spaces. ( c) The external carotid artery was injected with Prussian Blue and the maxilla then removed. ( d) Transverse sections of the teeth denervated were cut and their pulps examined. Clinical.—The patients who had been submitted to operation were taken, and their teeth examined by:— ( a) Transillumination. ( b) Percussion. ( c) Thermal tests. ( d) Faradic currents. ( e) Radiography. From these investigations it appears that the teeth are denervated but not devitalized by the trauma to the lateral antral wall above their apices. Their blood-supply is still present, and probably comes through a collateral anastomosis, along the antral floor and partly through the antral mucosa.

Download Full-text

High Grade Astrocytoma with Spontaneous Meningeal and Cranial Invasion

Neurosurgery ◽

10.1227/00006123-198212000-00020 ◽

1982 ◽

Vol 11 (6) ◽

pp. 813-815 ◽

Cited By ~ 5

Author(s):

Francesco Tognetti ◽

Giancarlo Piazza ◽

Bernardino Morrone

Keyword(s):

Blood Supply ◽

Dura Mater ◽

External Carotid ◽

High Grade ◽

High Grade Astrocytoma ◽

Direct Invasion ◽

Aggressive Tumors

Abstract Unusual features of a Grade IV cerebral astrocytoma (glioblastoma) are presented; infiltration of the dura mater and destruction of the overlying calvarium. The meningeal fibroblastic reaction and the blood supply recruitment of the tumor from the external carotid system are also described. The literature dealing with biologically “aggressive” tumors of the glial series displaying direct invasion of the cranial extraneural structures is summarized.

Download Full-text