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Embolization of branches arising from the cavernous portion of the internal carotid artery
V V Halbach1, R T Higashida, G B Hieshima
1Department of Radiology, University of California, San Francisco 94143-0628.
Insights
Subselective catheterization and embolization effectively treat vascular lesions supplied by the cavernous internal carotid artery. This minimally invasive approach successfully occluded dural fistulas and arteriovenous malformations, offering a viable treatment option.
Area of Science:
- Interventional Neuroradiology
- Vascular Neurology
- Cerebrovascular Surgery
Background:
- Vascular lesions originating from the cavernous internal carotid artery present complex treatment challenges.
- Dural arteriovenous fistulas and arteriovenous malformations require precise therapeutic strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of subselective catheterization and embolization for treating vascular lesions supplied by the cavernous internal carotid artery.
- To assess the outcomes of embolizing specific branches like the meningohypophyseal and inferolateral trunks.
Main Methods:
- Seven patients with vascular disease underwent subselective catheterization and embolization.
- Embolic agents included polyvinyl alcohol particles, hypertonic glucose, and liquid adhesive.
- Targeted embolization of meningohypophyseal and inferolateral trunks was performed.
Main Results:
- Complete occlusion of four cavernous sinus dural fistulas was achieved.
- Successful obliteration of tentorial supply for transverse sinus fistulas prior to surgery in two cases.
- Effective embolization of the cavernous supply to the nasal cavity in a facial arteriovenous malformation patient, resulting in hemorrhage control.
Conclusions:
- Subselective catheterization and embolization are effective in obliterating vascular lesions arising from the cavernous internal carotid artery.
- This technique provides a valuable treatment option for complex cerebrovascular diseases.
- While generally safe, potential complications like embolic stroke should be considered.
Abstract:
Seven patients with vascular disease (four with cavernous and two with transverse sinus dural fistulas and one with a facial arteriovenous malformation, all supplied primarily from cavernous branches of the internal carotid artery) underwent subselective catheterization and embolization. Ten branches were catheterized (seven meningohypophyseal trunks and three inferolateral trunks) and eight branches were embolized. The embolic agents were as follows: polyvinyl alcohol particles in five, hypertonic glucose in two, and liquid adhesive in one. All four cavernous sinus dural fistulas were occluded after embolization. In the two transverse sinus fistulas, the goal of embolization was to obliterate the tentorial supply prior to surgery. This goal was achieved in both cases. In the remaining patient, who had a large facial arteriovenous malformation and recurrent epistaxis, the embolization obliterated the cavernous supply to the nasal cavity and the patient remains hemorrhage-free. Despite one complication, which occurred in the first case when a thrombus formed and dislodged, resulting in an embolic stroke, this study shows that subselective catheterization and embolization can obliterate lesions of the branches arising from the cavernous internal carotid artery.