[Therapeutic embolization in the external carotid artery region (author's transl)]

This paper reports our experience of therapeutic embolization in the external carotid artery region. Therapeutic embolization was done for the purpose of decreasing hemorrhage during operation.

Therapeutic embolization was done in 6 cases of meningioma, 1 case of capillary hemangioma of the cheek and one case of olfactory neuroblastoma. Catheterization was done through the common carotid artery in adults and done through the femoral artery in an infant. Small pieces of Gelfoam were used as emboli. Emboli, 1 X 1 X 0.5 mm in size, were instilled with normal saline. One embolus was used in one instillation as a rule. A larger embolus was used for occlusion of a larger artery. Heparin was not used through entire procedure. Four illustrative cases are presented. when a feeder of a tumor is occluded by artificial emboli, two kinds of effect can be resulted. when emboli lodge within the tumor or in a feeding artery distal to arterial anastomoses, blood is no longer supplied to the tumor (embolization effect). On the other hand, when a feeding artery is occluded by emboli at the point proximal to arterial anastomoses, blood supply to the tumor is transiently reduced but it is soon restored through arterial anastomoses (ligation effect). To minimize bleeding during surgery it is very important to gain embolization effect. For this purpose small emboli should be instilled repeatedly until embolization effect is established. Then ligation effect should be obtained, if necessary, by injection lower emboli. Operation was performed on the day following embolization in cases of meningioma. In a case of capillary hemangioma of the cheek operation was performed three days after embolization and in a case of olfactory neuroblastoma surgery was performed two days after embolization. In all cases the primary purpose to minimize bleeding during operation was achieved. No untoward side effects were encountered in this series. The ophthalmic artery may arise from the middle meningeal artery. The vertebral artery might be visualized through the collateral from the occipital artery. We should pay attention to these vascular anomalies before embolization to prevent possible catastrophe.