Embolization of Neurosurgical Lesions Involving the Ophthalmic Artery

Embolization of Neurosurgical Lesions Involving the Ophthalmic Artery AbstractOBJECTIVE:A number of anteriorly located cranial base and extracranial lesions receive their vascular supply wholly or in part from the ophthalmic artery, and embolization of the ophthalmic artery can be helpful in the management of these lesions, either as the primary treatment or as an adjunct to surgery. We present situations in which the embolization of lesions involving the ophthalmic artery was performed to effect a partial or total cure of the lesion.METHODS:Twelve patients underwent a total of 15 embolization attempts on lesions involving the ophthalmic artery. Four patients had arteriovenous malformations of the orbit, four had dural arteriovenous fistulae, two had orbital meningiomas, one had a planum sphenoidale meningioma, and one had a juvenile nasal angiofibroma. In each case, a Tracker No. 18 microcatheter (Target Therapeutics, Inc., Fremont, CA) was navigated into the ophthalmic artery using a steerable guidewire and digital road mapping. Embolic agents included polyvinyl alcohol particles ranging from 350 to 1500 fxm in diameter, 2-mm platinum microcoils, and n-butylcyanoacrylate. In 12 of 15 cases, lidocaine and aniytal provocation tests were conducted before any attempt at embolization to assess the role of the ophthalmic artery in vision.RESULTS:Embolization was successfully performed in the 14 situations in which it was attempted. Positive results of two lidocaine/amytal tests were noted. In one case, embolization was not attempted. In the other case, a larger caliber embolic agent (2-mm platinum coils) was used. A single transient decrease in visual acuity lasting 4 days was the only embolization-related complication.CONCLUSION:Proper case selection, judicious use of embolic agents, and use of provocative testing can result in safe embolization of lesions supplied by the ophthalmic artery. (Neurosurgery 43:1298-1303, 1998) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Embolization of Neurosurgical Lesions Involving the Ophthalmic Artery

C L IN IC A L ST U D IE S Embolization of Neurosurgical Lesions Involving the Ophthalm ic Artery Michael Lefkowitz, M.D., Steven L. Giannotta, M.D., Grant Hieshima, M.D., Randall Higashida, M.D., Van Halbach, M.D., Christopher Dowd, M.D., George P. Teitelbaum, M.D. Departm ent of N e u ro lo g ic a l Surgery ( S C , G P T ), U n iv e rsity of Southern C a lifo rn ia Sch o o l of M e d icin e , Los A n g e le s; Departm ent of R a d io lo g y ( G H , R H , V H , C D ) , U n iversity of C a lifo rn ia at San F ra n cisco , San F ra n cisco ; and D epartm ent of R a d io lo g ic a l S cie n ce s (ML), E n d o v a scu la r T h e ra p y Se rvice , U n ive rsity of C a lifo rn ia , Los A n gele s, Los A n gele s, C a lifo rn ia OBJECTIVE: A n um be r o f a n te rio rly located cranial base and extracranial lesions receive th e ir vascular supply wholly or in part fro m the o p h th a lm ic artery, and e m b o liz a tio n o f the o p h th a lm ic a rte ry can be h elpful in the management of these lesions, e ither as the p rim a ry tre a tm e n t o r as an a d ju n ct to surgery. W e present situations in which the e m b o liza tio n o f lesions in v o lv in g the o p h th a lm ic a rte ry was p e rfo rm e d to effect a p a rtia l o r to ta l cure o f the lesion. M E T H O D S : T w e lv e p a tie n ts u n d e rw e n t a to ta l o f 15 e m b o liz a tio n a tte m p ts on lesions in v o lv in g th e ophthalmic a rte ry . Four p a tie n ts had a rte rio v e n o u s m a lfo rm a tio n s o f the o r b it, fo u r had d u ra l a rte rio v e n o u s fistulae, tw o had o r b ita l m e n in g io m a s, one had a p la n u m sp h e n o id a le m e n in g io m a , and one had a ju v e n ile nasal angiofibrom a. In each case, a T ra c k e r N o. 18 m ic ro c a th e te r (Target T h e ra p e u tics, Inc., F re m o n t, C A) was navigated into the o p h th a lm ic a rte ry using a steerable g u id e w ire and d ig ita l road m a p p in g . E m b o lic agents in c lu d e d polyvinyl a...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199812000-00016
Publisher site
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Abstract

AbstractOBJECTIVE:A number of anteriorly located cranial base and extracranial lesions receive their vascular supply wholly or in part from the ophthalmic artery, and embolization of the ophthalmic artery can be helpful in the management of these lesions, either as the primary treatment or as an adjunct to surgery. We present situations in which the embolization of lesions involving the ophthalmic artery was performed to effect a partial or total cure of the lesion.METHODS:Twelve patients underwent a total of 15 embolization attempts on lesions involving the ophthalmic artery. Four patients had arteriovenous malformations of the orbit, four had dural arteriovenous fistulae, two had orbital meningiomas, one had a planum sphenoidale meningioma, and one had a juvenile nasal angiofibroma. In each case, a Tracker No. 18 microcatheter (Target Therapeutics, Inc., Fremont, CA) was navigated into the ophthalmic artery using a steerable guidewire and digital road mapping. Embolic agents included polyvinyl alcohol particles ranging from 350 to 1500 fxm in diameter, 2-mm platinum microcoils, and n-butylcyanoacrylate. In 12 of 15 cases, lidocaine and aniytal provocation tests were conducted before any attempt at embolization to assess the role of the ophthalmic artery in vision.RESULTS:Embolization was successfully performed in the 14 situations in which it was attempted. Positive results of two lidocaine/amytal tests were noted. In one case, embolization was not attempted. In the other case, a larger caliber embolic agent (2-mm platinum coils) was used. A single transient decrease in visual acuity lasting 4 days was the only embolization-related complication.CONCLUSION:Proper case selection, judicious use of embolic agents, and use of provocative testing can result in safe embolization of lesions supplied by the ophthalmic artery. (Neurosurgery 43:1298-1303, 1998)

Journal

NeurosurgeryOxford University Press

Published: Dec 1, 1998

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