Zygomatico-orbital intra-arterial melphalan infusion for intraocular retinoblastoma

Abstract

Retinoblastoma is a rare and curable malignancy affecting the pediatric population. For advanced stage intraocular retinoblastoma, enucleation remains the primary treatment modality, although the use of laser photocoagulation, cryotherapy, radiotherapy and chemotherapy are frequently used, particularly in the setting of bilateral disease. Intravenous chemotherapy is the long-standing method of delivery, but local administration (subtenon, intravitreal or intra-arterial) is gaining in popularity because of the reduced side effects related to systemic administration. Of these newer methods, intra-arterial infusion has demonstrated technical feasibility, few procedural complications and robust tumor response. A case is described where a collateral supply to the affected ophthalmic artery was via the zygomatico-orbital branch of the ipsilateral superficial temporal artery. Melphalan infusion was performed via this pathway without incident.

Transorbital anastomotic pathways between the external and internal carotid systems in children affected by intraocular retinoblastoma

“…In the second case, the regular local hemodynamic of the OA can be altered by the flow coming from the ECA [3,7,17]. Consequently, to reach their target, antitumoral drugs may require administration routes alternatives to the OA [3,7,17,27]. Potentially, the many anastomoses that we have shown give an ample variety of chances that goes far beyond the previously reported infusion into the middle meningeal artery [17].…”

“…When contrast medium infusion into the OA fails, the possibility to use a distal branch of the external carotid system to inject antitumoral drugs should be carefully explored for the treatment of intraocular retinoblastoma. Actually, sporadic accounts of interventional radiologists exploiting these pathways have been already reported [3,7]. Similar considerations can be put forward when the target of intraarterial chemotherapy is the lacrimal gland affected by adenoid cystic carcinoma [19,26].…”

“…In the first case, a careful angiographic study aimed to seek for such anastomoses should be mandatory to avoid unwelcome passage of embolic material into the OA and/or, from there, into the internal carotid territory [2]. In the second case, the regular local hemodynamic of the OA can be altered by the flow coming from the ECA [3,7,17]. Consequently, to reach their target, antitumoral drugs may require administration routes alternatives to the OA [3,7,17,27].…”

Hemodynamic and Anatomic Variations Require an Adaptable Approach during Intra-Arterial Chemotherapy for Intraocular Retinoblastoma: Alternative Routes, Strategies, and Follow-Up

“…10 Far from it, we believe that the ECA and some of its branches represent potential alternative routes for IAC. In our and in others' experience, 9,16,17 some of these routes have already been used to deliver antitumoral drugs. Our study shows that 16.29% of procedures occurred via 1 of the many alternative pathways previously described and involving branches of the ECA.…”

Intra-Arterial Chemotherapy as a Treatment for Intraocular Retinoblastoma: Alternatives to Direct Ophthalmic Artery Catheterization

“…Two case reports have also examined other routes aside from direct OA catheterization for the delivery of intra-arterial chemotherapy for the treatment of retinoblastoma. 14,15 In 1968, Kiribuchi and Hasegawa 16 compared the tissue concentration of mitomycin in dogs when treated intra-arterially via the common carotid artery and the external OA by way of the infraorbital artery. Despite an equal dose of 2 mg of mitomycin, they reported universally higher doses in the aqueous, vitreous, and retina/uvea when injected via the infraorbital artery compared with the common carotid artery.…”