Embolisation of the ophthalmic artery branches distal to its visual supply

Álvarez, H.; Rodesch, Georges; García-Mónaco, Ricardo; Lasjaunias, P.

doi:10.1007/bf01623709

Cited by 40 publications

(24 citation statements)

References 3 publications

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“…Understanding the anatomy of the OPH, being able to advance the microcatheter tip to a safe position, and performing very slow, intermittent Onyx injections while avoiding excessive reflux are necessary to achieve good postembolization results. Alvarez et al 24 described a "safety point" easily recognized on angiogram, which should be considered as a secure limit for embolization in OPH. Their study, based on embryologic analysis, showed that visual deficit can be avoided if embolization is restricted to the vessels anterior to this safety point, because the central retinal artery arises proximally to this point.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Onyx Embolization of Meningiomas Fed by the Ophthalmic Artery: A Case Series

Trivelatto¹,

Nakiri²,

Manisor³

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY:Embolization of head and neck hypervascular tumors is a well-established therapeutic technique. Preoperative embolization reduces intraoperative blood loss, shortens the length of surgery, and decreases surgical morbility and mortality. This study assesses the safety and efficacy of preoperative embolization of meningiomas fed by the OPH by using Onyx liquid embolic agent.ABBREVIATIONS: ACA ϭ anterior cerebral artery; DSA ϭ digital subtraction angiography; MMA ϭ middle meningeal artery; OPH ϭ ophthalmic artery, PVA ϭ polyvinyl alcohol. Preoperative embolization of meningiomas can reduce surgical blood loss, shorten operation length, reduce the risk of damage to surrounding structures, and increase the likelihood of complete tumor resection.1-11 Embolization becomes especially important when meningiomas are located at the skull base, because of the difficulties of bleeding management in this region. 2,11,12 The blood supply of meningiomas usually arises from branches of the external carotid artery, except in cases of anterior and middle skull base tumors. In these cases, hypervascularized tumors are often fed by internal carotid artery branches, such as the OPH. [2][3][4][5][12][13][14][15] In this situation, the benefits of preoperative embolization must be weighed against the risk of complications, as an inadvertent interruption of blood flow to the central retinal artery may lead to retinal ischemia and visual compromise. 1,8,[13][14][15][16] The preoperative embolization of meningiomas supplied by the OPH requires superselective catheterization and the most distal placement of the microcatheter as possible, aiming to protect the central retinal artery of any reflux. There are several embolic materials, such as PVA particles, spheres, and glue, that were widely used in the literature. 3,4,6,[14][15][16][17][18] However, these embolic agents are usually injected by using guide-dependent microcatheters that are known to have limited distal reach.Liquid embolic agent reflux into the OPH could lead to inadvertent occlusion of the central retinal artery. 3,[14][15][16][17][18] This article reports our experiences with the preoperative embolization of meningiomas fed by OPH branches by using Onyx (ev3, Irvine, California). This endovascular approach with Onyx was proposed as an alternative strategy for a more controlled embolization, aiming to reduce the risks of visual impairment caused by central retinal artery occlusion. Materials and MethodsFrom February 2008 to January 2010, 5 patients with untreated intracranial meningiomas fed mainly by OPH branches underwent preoperative embolization with Onyx-18 at our institution. There were 2 men and 3 women, with a mean age of 56 with an SD of 11.11 years (median, 53.3 years; range, 46 -74 years).Clinical presentation included headache in 3 patients, confusion in 3, anosmia in 1 patient, decreased visual acuity in 1 patient, and epilepsy in 1 patient. No patient had appendicular deficits. All patients underwent a CT scan, MR imaging, and DSA. Hypervascular blush ...

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Section: Discussionmentioning

confidence: 99%

Preoperative Onyx Embolization of Meningiomas Fed by the Ophthalmic Artery: A Case Series

Trivelatto¹,

Nakiri²,

Manisor³

et al. 2011

AJNR Am J Neuroradiol

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“…After diagnosis and MRI, 48 cases were followed up; 1 case not included in the follow-up is not shown in the table.Baron et al,41 eye problems resulted in many complications, including blindness despite the application of different treatments. In AV orbital shunts fed by ophthalmic artery branches, embolization can sometimes be safely performed; however, this is only possible if the microcatheter can be passed beyond the branches that supply the optic nerve and globe 42. …”

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confidence: 99%

Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity

R¹

2003

Orbit

178

103

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The author investigated 101 cases with direct dural carotid-cavernous and orbital arteriovenous fistulas (CCF). The characteristic clinical findings, such as specific epibulbar arterialized loops, are described and the differential diagnosis of the striking diagnostic triad (exophthalmos, the above-mentioned loops and glaucoma) is discussed, together with the exclusion criteria for other causes of red eyes, episcleral measurements and blood flow. The results of various diagnostic procedures, such as ultrasonography, Doppler hematotachography and color Doppler of the orbit and carotid systems, magnetic resonance imaging and angiography, and of conservative treatment and embolization processes are dealt with successively. The classification of different types of carotid-cavernous fistulas is presented,(1-3) together with the clinical signs in relation to morbidity and mortality during or after conservative or intervention therapies. The importance of patient follow-up, in the clinic as well as with Doppler methods, is emphasized in order to differentiate a progressive or diminished clinical condition caused by spontaneous thrombosis in the healing process or more arteriovenous flow. A 'decision tree' for use in daily practice is provided. In this study, of the 101 cases in which the localization was diagnosed by angiography, 42 were direct (30 traumatic, 12 spontaneous), 31 were dural (3 traumatic, 28 spontaneous) and 10 were orbital CCFs. In 18 other cases, usually dural or orbital shunts, angiography was not performed. For the management of 42 direct fistulas, conservative treatment was used in 12 cases (7 with success; 58%) and balloon embolization was performed in 18 cases (17 with success; 94.5%); the other cases were treated by direct or indirect surgery. Of the 48 (spontaneous and traumatic) dural fistulas, 39 were treated conservatively (32 recovered or were much improved: 82%, of the total cases, 67%). All seven cases in which embolization was performed were cured and/or much improved. In two cases, one fistula was conservatively treated while one was embolized at another location, both with success. Of the 10 orbital arteriovenous shunts showing signs of dural fistulas, the features disappeared in 8 cases, although after a much longer follow-up period than for the typical dural carotid-cavernous sinus fistulas; in one patient, direct surgery was performed successfully and in one patient the original, non-progressive, orbital features could still be observed.

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“…Even the OphA can be embolized safely, provided that embolization is performed only distally to the origin of the central retinal artery. 1 Nevertheless, in cases in which the artery feeding the shunt originates proximal to the origin of the central retinal artery, transarterial embolization of the OphA proximal to that point could result in a loss of vision. A second way to treat these lesions, involving direct surgical removal or obliteration by means of a frontoorbital approach, could fully restore vision and correct proptosis.…”

Section: Discussionmentioning

confidence: 99%

Transvenous embolization for a purely intraorbital arteriovenous fistula

Deguchi

Yamada²,

Ogawa³

et al. 2005

Journal of Neurosurgery

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Purely intraorbital arteriovenous fistulas (AVFs) are rare, and their clinical management is controversial. The authors successfully treated a patient with an intraorbital AVF by transvenous embolization alone. An accurate distinction between an arteriovenous malformation (AVM), which is characterized by the existence of a nidus, and an AVF, which has no nidus, is important and requires superselective ophthalmic artery angiography. Treatment of an intraorbital AVF by transvenous embolization can improve visual function.

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Embolisation of the ophthalmic artery branches distal to its visual supply

Cited by 40 publications

References 3 publications

Preoperative Onyx Embolization of Meningiomas Fed by the Ophthalmic Artery: A Case Series

Preoperative Onyx Embolization of Meningiomas Fed by the Ophthalmic Artery: A Case Series

Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity

Transvenous embolization for a purely intraorbital arteriovenous fistula

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