Transarterial onyx embolization of arteriovenous malformation in the infratemporal fossa and parotid region

Abstract Maxillofacial arteriovenous malformation (AVM) is a rare, but potentially life-threatening entity. Surgical excision usually associates with a high rate of significant blood loss and cosmetic defects. We report a patient who had an AVM involving infratemporal fossa and parotid region, supplied by an enlarged branch of the left ophthalmic artery, cavernous internal carotid artery, middle meningeal artery, and internal maxillary. Successful treatment of this lesion was achieved by transarterial embolization with Onyx. Less invasive transarterial embolization with Onyx is rewarding when curing certain types of maxillofacial AVMs.

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Technique to “Trap” a Segment of the Middle Meningeal Artery for Embolization of a Carotid Cavernous Fistula: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab273 ◽

2021 ◽

Author(s):

MirHojjat Khorasanizadeh ◽

Mira Salih ◽

Dominic Harris ◽

Christopher S Ogilvy

Keyword(s):

Internal Carotid ◽

Transarterial Embolization ◽

Cranial Nerves ◽

Middle Meningeal Artery ◽

Type D ◽

History Of ◽

Nerve Paresis ◽

Carotid Cavernous Fistulas ◽

Transvenous Approach ◽

Meningeal Artery

Abstract Transvenous embolization is the favored treatment for indirect carotid-cavernous fistulas (CCFs). However, transarterial embolization can be used as an alternative method when the venous route is inaccessible. We present the case of a 47-yr-old woman with a history of diplopia, headaches, and sixth cranial nerve (CN-VI) palsy who presented with acute worsening of headache and ophthalmoplegia and rise of intraocular pressures. Angiography demonstrated a left indirect CCF (dural arteriovenous malformation) with multiple arterial feeders from the internal carotid artery as well as the middle meningeal artery (MMA) (Barrow type D). Transvenous approach was attempted first but was unsuccessful due to difficult access to the cavernous sinus. Thus, transarterial embolization through the MMA feeding branches was planned. To avoid occluding distal branches of the MMA by Onyx, we coiled it distally. In addition, we used a scepter balloon proximally to prevent the reflux of Onyx into potential collaterals to cranial nerves from proximal MMA. After trapping a segment of the MMA, Onyx was injected into the CCF fistula through the small MMA feeders. A postembolization arteriogram showed obliteration of the CCF. The patient developed mild left facial nerve paresis on the first postoperative day (thought to be related to partial embolization of tiny arteries in the facial canal), which was resolving in the course of hospitalization. She remained neurologically stable, and was discharged on the third postoperative day. To the best of our knowledge, this is the first report of transarterial embolization of CCF by distal coiling and proximal ballooning to trap a segment of an artery. The authors hereby confirm that informed consent was obtained from the patient after thorough discussion of the procedure's rationale, risks, benefits, and alternatives.

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Endoscopic Approach to the Infratemporal Fossa

Neurosurgery ◽

10.1227/01.neu.0000359224.75185.43 ◽

2010 ◽

Vol 66 (1) ◽

pp. 196-203 ◽

Cited By ~ 59

Author(s):

Philip V. Theodosopoulos ◽

Bharat Guthikonda ◽

Aaron Brescia ◽

Jeffrey T. Keller ◽

Lee A. Zimmer

Keyword(s):

Internal Carotid ◽

Infratemporal Fossa ◽

Middle Meningeal Artery ◽

Anatomic Study ◽

Entire Region ◽

Trigeminal Schwannoma ◽

Cervical Portion ◽

Extended Exposure ◽

Formalin Fixed ◽

Meningeal Artery

Abstract OBJECTIVE Classic surgical exposures of the infratemporal fossa region, including the adjacent intracranial space, temporal bone, and sinonasal region, require the extensive exposure associated with the transcranial, transfacial, and transmandibular approaches with their inherent neurological and cosmetic morbidities. In this study, we evaluated the feasibility and exposure afforded by combining 2 endoscopic transmaxillary approaches, endonasal and Caldwell-Luc supplement, to the infratemporal fossa. METHODS Endoscopic transmaxillary dissection was performed in 4 formalin-fixed cadaver heads (8 sides). We quantified the extent of exposure achieved within the pterygopalatine and infratemporal fossae after our initial dissection, which was endonasal with a medial antrostomy, and after addition of a Caldwell-Luc incision with an anterior antrostomy. Complementing this anatomic study, we report on a patient in whom this endoscopic transmaxillary approach combining the endonasal and Caldwell-Luc approaches was used for resection of a trigeminal schwannoma in the infratemporal fossa. RESULTS The combination of these 2 endoscopic transmaxillary approaches enabled visualization of the entire region of the pterygopalatine fossa and anteromedial aspect of the infratemporal fossa. Additional posterolateral exposure of the infratemporal fossa requires significant traumatic traction on the nose. Addition of the Caldwell-Luc transmaxillary approach exposed the remainder of the infratemporal fossa, including the mandibular nerve and branches, middle meningeal artery, and even the distal cervical portion of the internal carotid artery. CONCLUSION Endoscopic exposure of the infratemporal fossa is feasible. Using the combination of the endonasal and Caldwell-Luc approaches for direct transmaxillary access significantly extended exposure, allowing safe and effective resection of infratemporal fossa lesions.

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Retrograde Approach for Intra-arterial Chemotherapy Delivery in Retinoblastoma

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0041-1727584 ◽

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.

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Possibility of Middle Meningeal Artery-to-Petrous Internal Carotid Artery Bypass: An Anatomic Study

Skull Base ◽

10.1055/s-2004-832258 ◽

2004 ◽

Vol 14 (3) ◽

pp. 153-156 ◽

Cited By ~ 6

Author(s):

Mehmet Erkan Üstün ◽

Mustafa Büyükmumcu ◽

Muzaffer Şeker ◽

Ahmet Kağan Karabulut ◽

İsmihan İlknur Uysal ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Artery Bypass ◽

Middle Meningeal Artery ◽

Anatomic Study ◽

Meningeal Artery

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Left temporal craniotomy and direct microcatheterization of the middle meningeal artery for treatment of a complex temporal dural arteriovenous fistula

Neurosurgical FOCUS ◽

10.3171/2019.2.focusvid.18650 ◽

2019 ◽

Vol 46 (Suppl_2) ◽

pp. V8

Author(s):

Daniel M. S. Raper ◽

Nasser Mohammed ◽

M. Yashar S. Kalani ◽

Min S. Park

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Treatment Approach ◽

Transarterial Embolization ◽

Middle Meningeal Artery ◽

Intraoperative Angiography ◽

Arteriovenous Fistulae ◽

Posterior Division ◽

Technical Considerations ◽

Meningeal Artery

The preferred method for treating complex dural arteriovenous fistulae of the transverse and sigmoid sinuses is via endovascular, transarterial embolization using liquid embolysate. However, this treatment approach mandates access to distal dural feeding arteries that can be technically challenging by standard endovascular approaches. This video describes a left temporal craniotomy for direct stick microcatheterization of an endovascularly inaccessible distal posterior division of the middle meningeal artery for embolization of a complex left temporal dural arteriovenous fistula. The case was performed in the hybrid operative suite with biplane intraoperative angiography. Technical considerations, operative nuances, and outcomes are reviewed.The video can be found here: https://youtu.be/Dnd4yHgaKcQ.

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Middle Meningeal Artery Aneurysm: Non-traumatic Incidental Aneurysm of a Middle Meningeal Artery Supplying a Pial Arteriovenous Malformation; Endovascular Occlusion of the Aneurysm Using nBCA During the Preoperative Embolization of the AVM

The Aneurysm Casebook ◽

10.1007/978-3-319-77827-3_20 ◽

2020 ◽

pp. 1571-1583

Author(s):

Pervinder Bhogal ◽

Marta Aguilar Pérez ◽

Marcel Alfter ◽

Oliver Ganslandt ◽

Hans Henkes

Keyword(s):

Arteriovenous Malformation ◽

Artery Aneurysm ◽

Middle Meningeal Artery ◽

Preoperative Embolization ◽

Endovascular Occlusion ◽

Meningeal Artery

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Dural-cortical anastomosis in pial arteriovenous malformation

Journal of Neurosurgery ◽

10.3171/jns.1979.50.4.0522 ◽

1979 ◽

Vol 50 (4) ◽

pp. 522-524 ◽

Cited By ~ 1

Author(s):

Shiro Waga ◽

Atsunori Morikawa ◽

Tadashi Kojima

Keyword(s):

Arteriovenous Malformation ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Middle Meningeal Artery ◽

Review Of The Literature ◽

Total Removal ◽

Content Type ◽

Posterior Parietal ◽

Meningeal Artery ◽

Fine Print

✓ A patient is reported with a purely pial arteriovenous malformation (AVM) supplied from the posterior parietal artery. The prominent middle meningeal artery contributed to opacification of the angular branches distal to the AVM, but did not contribute to the AVM. After total removal of the AVM, the angular branches became opacified from the middle cerebral artery. Review of the literature suggests that hypertrophied dural arteries which do not contribute to the AVM's but which do opacify the cortical branches distal to the AVM's are rare.

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Contralateral De Novo Intraosseous Arteriovenous Malformation in a Child with Arteriovenous Malformation of Mandible Treated by Endovascular Embolotherapy

Interventional Neuroradiology ◽

10.1177/159101991201800415 ◽

2012 ◽

Vol 18 (4) ◽

pp. 484-489 ◽

Cited By ~ 4

Author(s):

C-H Yeh ◽

Y-M Wu ◽

Y-L Chen ◽

H-F Wong

Keyword(s):

Arteriovenous Malformation ◽

De Novo ◽

Transarterial Embolization ◽

Subsequent Development ◽

Cyanoacrylate Glue ◽

Direct Puncture ◽

Life Threatening ◽

Detachable Coils ◽

The Right

We describe our experience of the development of contralateral de novo intraosseous AVMs in a ten-year-old girl with AVMs of the mandible who underwent endovascular embolotherapy. She initially presented with intermittent oral bleeding. Computed tomography and digital subtraction angiography demonstrated intraosseous AVMs within the right mandible. The AVMs were treated by transosseous direct-puncture and transarterial embolization with Guglielmi detachable coils and n-butyl cyanoacrylate glue. However, de novo intraosseous AVMs developed within the previously healthy contralateral mandible and resulted in dangerous oral bleeding. Therefore, we suggest regular follow-up and prompt retreatment of any residual mandibular AVMs in patients undergoing endovascular or surgical treatment to prevent subsequent development of “secondary” AVMs and life-threatening oral bleeding.

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Abstract 1122‐000098: A New Technique to Prevent Ophthalmic Complications Prior to Middle Meningeal Artery Embolization

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000098 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Kiana Moussavi ◽

Mohammad Moussavi

Keyword(s):

Internal Carotid ◽

Chronic Subdural Hematoma ◽

Invasive Procedure ◽

Middle Meningeal Artery ◽

Adjunctive Treatment ◽

Artery Embolization ◽

Main Trunk ◽

A New Technique ◽

Meningeal Artery

Introduction : Embolization of the Middle Meningeal Artery (MMA) is a minimally invasive procedure used as an alternative or adjunctive treatment of chronic subdural hematoma (cSDH). The benefits of MMA embolization have been attributed to targeting of the pathophysiology of cSDH which currently favors a process of increasing inflammatory response causing immature and leaky neovascularization. The major dural arteries and hazards associated with their embolization have been thoroughly described in past literature. The unintended embolization of orbital arteries leading to blindness is the most significant hazard associated with MMA embolization. The purpose of this study is to present 5 cases demonstrating the success of our technique in the treatment of cSDH while preventing the possibility of blindness by coiling the anastomotic vessel between MMA and Ophthalmic Artery (OA) branches prior to particle embolization. Methods : After doing an Internal Carotid Artery (ICA) run and ensuring the origination of the OA from the ICA and observing retinal blush, we routinely infused 10–20mcg of Nitroglycerine into the main trunk of MMA through a microcatheter to dilate and better visualize the MMA branches including anastomosis. If the meningeo‐ophthalmic collaterals were visualized during the follow‐up microcatheter run, we coil embolized the proximal segment of those collaterals through the same microcatheter. We then infused 100–300µm particles through the main branches of the MMA supplying the dura. Results : Of the 39 patients who underwent MMA embolization for cSDH, 5 received MMA/OA collateral variants coil embolization followed by successful particle embolization of all MMA branches supplying the dura without complication. Conclusions : In our cSDH patients, the collaterals from MMA to Ophthalmic or Lacrimal branches were safely coil embolized before complete particle embolization of the MMA dural branches. In a few patients these collaterals became obvious after inducing vasodilatation. None of these patients had major complications. This technique may be safer, more effective and cheaper than wedging, gluing or low pressure infusion. Our literature search did not find a similar technique used in this application.

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