Combined internal maxillary and anterior ethmoidal arterial occlusion: the treatment of choice in intractable epistaxis

Singh, Bhugwan; Med, M.

doi:10.1017/s0022215100120006

Cited by 21 publications

(23 citation statements)

References 20 publications

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“…1 Involvement of the ethmoid arterial systems in refractory epistaxis should also be considered after nasal injury, anterior skull base trauma, or recent endoscopic sinus surgery. 11 Previous studies evaluated the presence of supernumerary ethmoid arteries.…”

Section: Discussionmentioning

confidence: 99%

Transorbital Endoscopic Identification of Supernumerary Ethmoid Arteries

Berens

Davis

Moe

2016

Allergy�Rhinol (Providence)

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Background:Anterior and posterior ethmoid arteries supply the paranasal sinuses, septum, and lateral nasal wall. Precise identification of these arteries is important during anterior skull base procedures, endoscopic sinus surgery, and ligation of ethmoid arteries for epistaxis refractory to standard treatment. There is controversy in the literature regarding the prevalence of supernumerary ethmoid arteries.Objective:This study examined the prevalence of supernumerary ethmoid arteries by using direct visualization after transorbital endoscopic dissection.Methods:Nineteen cadaveric specimens were evaluated by using a superior lid crease (blepharoplasty) incision and an endoscopic approach to the medial orbital wall. Ethmoid arteries were identified as they pierced the lamina papyracea coplanar with the skull base and optic nerve. The distances from the anterior lacrimal crest to the ethmoid arteries and optic nerve were measured with a surgical ruler under endoscopic guidance.Results:Thirty-eight cadaveric orbits were measured. Overall, there were three or more ethmoid arteries (including anterior and posterior arteries) in 58% of orbits, with 8% of the total sample that contained four or more ethmoid arteries. The average number of ethmoid arteries was 2.7. Bilateral supernumerary ethmoid arteries were noted in 42% of the specimens. The distance between the anterior lacrimal crest and the anterior ethmoid, posterior ethmoid, and optic nerve averaged 20, 35, and 41 mm, respectively. The average distance to the supernumerary or middle ethmoid artery was 29 mm.Conclusion:This study found supernumerary ethmoid arteries in 58% of cadaveric specimens, a prevalence much higher than previously reported. Recognition of these additional vessels may improve safety during endoscopic sinus surgery and skull base surgery, and may permit more effective ligation for refractory epistaxis originating from the ethmoid system.

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Section: Discussionmentioning

confidence: 99%

Transorbital Endoscopic Identification of Supernumerary Ethmoid Arteries

Berens

Davis

Moe

2016

Allergy�Rhinol (Providence)

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“…1 A few years before, Singh and Snyderman had found that ligature of the sphenopalatine artery associated with ligature of the anterior ethmoidal artery reduced the number of recurrences, and therefore the need for additional anesthesia and surgery to control bleeding. 5,6 Ligature of the anterior ethmoidal artery is classically described using the external approach. Common complications are scarring, facial edema, and damage to the medial canthal ligament, which may affect drainage in lacrimal ducts and result in epiphore.…”

Section: Discussionmentioning

confidence: 99%

Ligadura endoscópica da artéria etmoidal anterior: estudo de dissecção em cadáveres

Filho¹,

Pinheiro‐Neto²,

Ramos

et al. 2011

Braz. j. otorhinolaryngol. (Impr.)

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Ant erior ethmoidal artery (AEA) ligation may be necessary in cases of severe epistaxis not controllable with traditional therapy. Endoscopic endonasal ligation of the AEA is not used frequently; there are few studies in the literature for standardization of the endoscopic technique for this vessel. Aim:To demonstrate the feasibility of periorbital AEA ligation in a transethmoidal endoscopic approach. Methods:A prospective study where 50 nasal cavities were dissected. After anterior ethmoidectomy and partial removal of lamina papyracea, the periorbital area was carefully dissected along a subperiosteal plane to identify the AEA. The vessel was exposed within the orbit and dissected.Results: Data on technical difficulties, complications, the learning curve and anatomical variations were gathered. Conclusion:An endonasal endoscopic approach to the AEA within the orbit was shown to be feasible. Identifying the artery is not difficult, and this technique avoids external incisions. This approach appears to be an excellent alternative for approaching the AEA. Further clinical studies are needed to demonstarte the benefits of this technique. Braz J Otorhinolaryngol. 2011;77(1):33-8. ORIGINAL ARTICLE

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“…39,42,45,47 However, we have only 3 patients with meningioma who were treated with this technique. It is therefore difficult to quantitate the efficacy of our procedure, as there are no external or internal controls.…”

Section: 44mentioning

confidence: 99%

Extracranial ligation of ethmoidal arteries before resection of giant olfactory groove or planum sphenoidale meningiomas: 3 illustrative cases with a review of the literature on surgical techniques

Manjila¹,

Cox²,

Smith³

et al. 2013

FOC

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Object There are several surgical techniques for reducing blood loss—open surgical and endoscopic—prior to resection of giant anterior skull base meningiomas, especially when preoperative embolization is risky or not technically feasible. The authors present examples of an institutional experience using surgical ligation of the anterior and posterior ethmoidal arteries producing persistent tumor blush in partially embolized tumors. Methods The authors identified 12 patients who underwent extracranial surgical ligation of ethmoidal arteries through either a transcaruncular or a Lynch approach. Of these, 3 patients had giant olfactory groove or planum sphenoidale meningiomas. After approval from the institution privacy officer, the authors studied the medical records and imaging data of these 3 patients, with special attention to surgical technique and outcome. The variations of ethmoidal artery foramina pertaining to this surgical approach were studied using preserved human skulls from the Hamann-Todd Osteological Collection at the Museum of Natural History, Cleveland, Ohio. Results The extracranial ligation was performed successfully for control of the ethmoidal arteries prior to resection of hypervascular giant anterior skull base meningiomas. The surgical anatomy and landmarks for ethmoidal arteries were reviewed in anthropology specimens and available literature with reference to described surgical techniques. Conclusions Extracranial surgical ligation of anterior, and often posterior, ethmoidal arteries prior to resection of large olfactory groove or planum sphenoidale meningiomas provides a safe and feasible option for control of these vessels prior to either open or endoscopic resection of nonembolized or partially embolized tumors.

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Combined internal maxillary and anterior ethmoidal arterial occlusion: the treatment of choice in intractable epistaxis

Cited by 21 publications

References 20 publications

Transorbital Endoscopic Identification of Supernumerary Ethmoid Arteries

Transorbital Endoscopic Identification of Supernumerary Ethmoid Arteries

Ligadura endoscópica da artéria etmoidal anterior: estudo de dissecção em cadáveres

Extracranial ligation of ethmoidal arteries before resection of giant olfactory groove or planum sphenoidale meningiomas: 3 illustrative cases with a review of the literature on surgical techniques

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