Anomalous Origins of Ophthalmic Arteries on Three-Dimensional Time-of-Flight Magnetic Resonance Angiography and Their Clinical Importance.

AIM: The purpose of this paper was to evaluate rare cases of anomalous origins of the ophthalmic artery (OA) according to magnetic resonance angiography (MRA) findings. METHODS: This retrospective study included 80 patients diagnosed with anomalous OA origins between March 2015 and July 2018 from a sample of 16,024 patients. The patients included 47 females and 33 males with a mean age of 38.16 years (range 18-62 years). Three-dimensional time-of-flight (3D-TOF) MRA was performed for all patients. RESULTS: Eighty (0.5%) patients had anomalous OA origins. The most common type of OA origin anomaly was the right OA originating from the middle meningeal artery (0.17%). Twelve (0.07%) patients had OAs with an extradural origin. CONCLUSIONS: Anomalous origins of the OA are rare. 3D-TOF MRA is a noninvasive imaging method that can be applied for the diagnosis of OA anomalies. Some OA variations can have a protective effect against ocular complications in vaso-occlusive events. Therefore, it is critical to know the variant anatomy of OAs.

The ophthalmic artery: a new variant involving two branches from the supracavernous internal carotid artery.

PURPOSE: We report an extremely rare, double ophthalmic artery configuration. METHODS: We present 2D- and 3D-angiographic features of an anomalous origin of the ophthalmic artery. RESULTS: The double ophthalmic artery was the result of the persistence of the primitive dorsal ophthalmic artery combined with the presence of a second orbital artery originating from the supracavernous internal carotid artery, passing through the superior orbital fissure and into the orbit to furnish the muscular, lacrimal and ethmoidal arteries and the medial long posterior ciliary artery. CONCLUSIONS: A heretofore undocumented instance of ophthalmic artery duplication is presented. Knowledge of such variations is important for the planning of endovascular treatments and the comprehension of unusual angiographic images. Such fine arterial variants may very well be frequent, but difficult to demonstrate on simple 2D angiographies. Multiplanar reconstructions of 3D angiography data make it possible to diagnose rare, but embryologically predictable arterial variants.

Carotid-anterior cerebral artery (ACA) anastomosis associated with azygos ACA and ophthalmic artery arising from the middle meningeal artery: a case report.

Among variations of the anterior cerebral artery (ACA), anastomosis of its A1-A2 junction with the ophthalmic segment of the internal carotid artery is rare and described as carotid-ACA anastomosis or infraoptic course of the ACA. One common variant, an azygos ACA, demonstrates no pairing of the A2 segment. To our knowledge, association of a carotid-ACA anastomosis with an azygos ACA is not reported in the English-language literature. We report a case diagnosed by magnetic resonance angiography in which right carotid-ACA anastomosis was associated with an azygos ACA and the right ophthalmic artery originated from the middle meningeal artery.

Incidental ethmoidal dural arteriovenous fistula coexisting with a pituitary adenoma exacerbating post-transsphenoidal epistaxis.

A 64 year-old man with pituitary adenoma developed massive epistaxis after an uneventful endoscopic transsphenoidal surgery. Angiography showed extravasation from the sphenopalatine artery, to which embolisation was performed. An incidentally coexisting ethmoidal dural arteriovenous fistula supplied by the ophthalmic artery aberrantly originated from the middle meningeal artery caused increased haemorrhage.

The clinical presentation and collateral pathway development of congenital absence of the internal carotid artery.

OBJECTIVE: The objective of this study was to investigate the clinical presentation, risks, and collateral pathway development of the congenital absence of the internal carotid artery (ICA). METHODS: Sixty-four patients (10 new patients and 54 patients from the relevant literature) were studied. Data on demographic, clinical, and radiologic features were collected, followed by an analysis of the risks associated with ICA agenesis. RESULTS: There were 31 male and 33 female patients whose ages ranged from 5 months to 75 years, with a mean age of 31.1 years. The range of clinical symptoms recorded included transient ischemic attack (17 patients), subarachnoid hemorrhage (12 patients), developmental delay (13 patients), asymptomatic (8 patients), and other symptoms (15 patients). All 64 patients presented with absence of unilateral or bilateral ICAs, as measured by cervical computed tomography angiography or magnetic resonance angiography. The carotid canal was absent in all patients on computed tomography of the base of the skull, and abnormal development of collateral circulation pathways was observed. Five patients presented with basilar artery dilation on angiography. Aneurysms were observed in the angiography results from 16 patients. Ten patients presented with variations in the ophthalmic artery origin (the ophthalmic artery originated from the ipsilateral middle meningeal artery in six patients and from the ipsilateral middle cerebral artery in four patients). CONCLUSIONS: From analysis of our 10 cases of ICA agenesis and our review of the relevant literature, we conclude that young patients with ICA agenesis may present with developmental delay, subarachnoid hemorrhage, or other developmental abnormalities, whereas older patients most commonly present with transient neurologic events. Complications of carotid agenesis are related to specific anatomic subtypes and the resulting collateral circulation development.

Bilateral carotid-anterior cerebral artery anastomoses associated with bilateral ophthalmic arteries arising from the anastomotic arteries diagnosed by magnetic resonance angiography: a case report.

Rarely, the anterior cerebral artery (ACA) arises from the ophthalmic segment of the internal carotid artery, a condition described as carotid-ACA anastomosis or infraoptic course of the ACA that generally demonstrates right-sided predominance. We diagnosed a case of bilateral anastomoses of the carotid and ACA vessels in which bilateral ophthalmic arteries arose from the origins of the anastomotic vessels using magnetic resonance (MR) angiography. Identification of rare arterial variations on MR angiography requires careful scrutiny of source images, and creation of partial volume-rendering images can aid visualization of detailed anatomic structures.

Low-Flow Arterialized Venous Malformations of the Orbit.

PURPOSE: Orbital vascular malformations are classified by their hemodynamic properties, either high or low flow. Low-flow lesions may be simple venous, lymphatic, or combined lymphaticovenous malformations. The authors report a series of cases in which predominantly low flow, venous lesions were unexpectedly noted to have arterial feeders. METHODS: A retrospective chart review of patients identified by the authors as having orbital varices with arterial components was conducted. The authors identified 7 such cases. After careful review, 2 cases were excluded due to inconclusive neuroradiographic findings. The authors review the clinical, radiologic, histopathologic, and surgical information from the remaining 5 cases and discuss their clinical significance. RESULTS: All 5 cases were most consistent with variceal lesions: 3 as clinically distensible lesions and 2 as thrombosed lesions. Additional arterial feeder vessels were noted by angiography (3) or intraoperative visualization (2). The arterial contribution varied from faint vessels to distinct branches of the ophthalmic artery. Ages ranged from 13 to 61 years without predilection for gender. Treatments consisted of excision, embolization, and observation. Two poignant cases are highlighted: the first illustrating that an angiogram in isolation of its clinical picture can be misleading and result in treatment intervention with undue risk, and the second illustrating that inadequate treatment of unrecognized arterial components may contribute to recurrences. CONCLUSIONS: Low-flow orbital variceal lesions may have less prominent, arterial components. This type of combined arterialized venous malformation is largely unrecognized in the ophthalmic literature. Correct identification of these lesions is critical in providing safe, effective, and durable treatment.

Arteriovenous Malformation of the Eyelid: Surgical Management and Histologic Study.

A raised erythematous eyelid lesion that appeared in a 31-year-old man was diagnosed as an arteriovenous malformation (AVM), with confirmatory Doppler ultrasound demonstrating high arterial flow. Surgical excision, aided by electrocautery for extensive hemorrhage, resulted in an acceptable cosmetic result. Histopathology of the excised lesion showed collapsed capillary channels lined by endothelium. AVM is rarely encountered in the eyelid.

Immediate Reconstruction After Combined Embolization and Resection of Orbital Arteriovenous Malformation.

Orbital arteriovenous malformations are rare congenital vascular anomalies that can cause eyelid distortion, proptosis, diplopia, and vision loss. The current treatment paradigm involves endovascular embolization followed by resection, with delayed reconstruction. The authors report 2 young adult patients with orbital arteriovenous malformations, who underwent embolization followed days to months later by resection with immediate soft tissue reconstruction. For both patients, the immediate outcome provided good functionality and cosmesis. The authors conclude that immediate reconstruction after embolization-resection of orbital arteriovenous malformations may facilitate early return of form and function for patients, improve quality of life, and potentially reduce the need for further reconstructive procedures.

Transarterial Embolization of a Spontaneous Intraorbital Arteriovenous Fistula With n-BCA Glue.

Arteriovenous fistulae of the orbit are exceedingly rare. They are high-flow vascular malformations involving a fistula from the ophthalmic artery to one of the draining ophthalmic veins. Presenting symptoms can mimic those of carotid cavernous fistulae or of ophthalmic venous varices, and include diplopia, proptosis, chemosis, decreased visual acuity, and retro-orbital pain. Very few case reports are published on the treatment of this aggressive vascular malformation, and they uniformly describe techniques involving a transvenous access for the embolization of the fistula. To the best of authors' knowledge, they report the first case of transarterial embolization of an intraorbital AVF.

Comprehensive Treatment of Primary Orbital Arteriovenous Malformation.

Primary orbital arteriovenous malformations are a rare kind of vascular malformation lesions. The authors present a 17-year-old man presented with swelling and pulsation in the left upper eyelid. The angiogram of the left internal carotid artery showed that arteriovenous malformations at the left upper eyelid area were supplied with one of the branches of ophthalmic artery. In this report, the authors elaborated the comprehensive treatments of primary arteriovenous malformation.

A New Anatomic Variation: Coexistence of Both Dandy-Walker Variant and Ophthalmic Artery Originating From Contralateral Internal Carotid Artery.

The authors report on 1 patient of variant origin of right ophthalmic artery (OA) from ophthalmic segment of the left internal carotid artery. A 41-year-old man was performed magnetic resonance (MR) imaging and MR angiography. Cerebral MR imaging revealed a Dandy-Walker variant. In MR angiography the authors observed this unusual variant of origin of OA and a complete occlusion of right internal carotid artery. To the authors' knowledge, this is the first patient who has coincidence of both Dandy-Walker variant and origin of OA from contralateral internal carotid artery. Careful observation of MR angiography images with maximum intensity projection is very important for detecting rare vascular variations.

True fenestration of the anterior communicating artery diagnosed by magnetic resonance angiography.

Variations of the anterior cerebral artery-anterior communicating artery (ACoA) complex are common. Most are duplicated or partially duplicated ACoAs that are confused with fenestration of the ACoA. We report here an extremely rare case of true fenestration of the ACoA diagnosed by magnetic resonance angiography. Tiny true fenestrations of the ACoA may be overlooked easily by MR angiography. Partial maximum-intensity-projection image and volume-rendering image are useful in identifying true fenestration of the ACoA.

Double ophthalmic arteries arising from the internal carotid artery: a case report of a hidden second ophthalmic artery.

A case of double ophthalmic arteries arising from the internal carotid artery with unique features is reported. This case was discovered following in the course of time the progress of a thrombosis of the anterior cavernous sinus associated with a low-flow direct arteriovenous fistula of the superior ophthalmic vein. At different time points, the same patient underwent four angiographic studies and one computerized tomography with contrast medium. Angiographies showed that the double internal carotid artery origin of the ophthalmic artery was detectable only within a short range of time. To the best of our knowledge, this case is unique as it demonstrates that a second ophthalmic artery may lie hidden, showing itself only under particular hemodynamic requirements.

Unusual origin of the left ophthalmic artery from the basilar trunk.

The formation of the ophthalmic artery (OA) is a complex process with two different proposed embryological steps for its development. Several anatomical variants have been described. We present a very unusual origin of the ophthalmic artery from the basilar trunk, in a 45-year-old male with a history of pontine hemorrhagic stroke. MRI and CTA showed evidence of previous hemorrhage in the pons and several intracranial arterial dysplastic dilatations. DSA confirmed several fusiform dilatations of the basilar trunk. In the left ICA, no ophthalmic artery was seen arising from the carotid siphon. The left ophthalmic artery arises from the basilar trunk and runs lateral to the cavernous sinus through the middle cranial fossa, entering the left orbit at the superior orbital fissure. The patient was treated conservatively. Two main theories for this anomaly are known, one from Lasjaunias and the other from Paget. To our knowledge, this basilar origin of the OA has only been described three times in the literature. For its origin, we propose a partial persistence of the trigeminal artery together with a dominance of the dorsal ophthalmic artery.

Tears of blood: an unusual case of haemolacria due to conjunctival vascular malformation successfully managed by embolisation.

A boy in his mid-teens presented with progressively increasing bleeding from the right eye and nostril intermittently over a period of 6 weeks. A complete ophthalmic examination revealed nothing significant. His otorhinological examination and haematological investigations were within normal limits. The patient came a month later with frank bleeding from the right eye. Ophthalmic examination revealed hyperaemia and maceration of the right lower palpebral conjunctiva. A histopathological examination of conjunctival scrapings from the site showed abnormal dilated blood vessels suggestive of a vascular malformation. Digital subtraction angiography confirmed the presence of a conjunctival micro arteriovenous malformation supplied by the external carotid and ophthalmic artery branches. He underwent successful transarterial Onyx embolisation resulting in complete resolution of the haemolacria.

The inter-optic course of a unique precommunicating anterior cerebral artery with aberrant origin of an ophthalmic artery: an anatomic case report.

BACKGROUND AND IMPORTANCE: Some variations of the cerebral arterial circle of Willis, such as an inter-optic course of the anterior cerebral artery are exceedingly rare. Imaging of very rare anatomical features may be of interest. CLINICAL PRESENTATION: In a 67-year-old male individual, the unique precommunicating part of the left anterior cerebral artery was found to course between both optic nerves. There was an agenesis of the right precommunicating cerebral artery. This variation was associated with an aberrant origin of the ophthalmic artery, arising from the anterior cerebral artery. The anatomic features, the possible high prevalence of associated aneurysms of the anterior communicating artery complex as well as implications for surgical planning or endovascular treatments are outlined and embryologic considerations are discussed. CONCLUSION: To the best of our knowledge, this is a very rare illustrated case of an inter-optic course of a unique precommunicating anterior cerebral artery with aberrant origin of an ophthalmic artery.

Persistent dorsal ophthalmic artery and ophthalmic artery arising from the middle meningeal artery diagnosed by MR angiography at 3 T.

INTRODUCTION: A persistent dorsal ophthalmic artery (OA) is a rare variation that originates from the cavernous segment of the internal carotid artery (ICA) and enters the orbit via the superior orbital fissure (SOF). Occasionally, the OA also arises from the middle meningeal artery (MMA) and enters the orbit via the SOF. These two major variations of the OA have not been well described by magnetic resonance (MR) angiography. We evaluated their prevalence on MR angiography at 3 T. METHODS: We retrospectively reviewed our database of MR angiographic images obtained using a 3 T imager. Of images of 846 patients, we evaluated those of 826 patients (1,652 OAs) with special attention to OA origin and its course into the orbit. We excluded images of the 20 because quality was insufficient to assess. RESULTS: We found 7 (0.42%) persistent dorsal OAs among 1,652 OAs (right/left, 6/1; male/female, 3/4). Twenty-four (1.45%) OAs arose from the MMA (right/left/bilateral, 11/5/4; male/female, 10/10), three of which also demonstrated a small normally branching OA. In one patient, we observed both right persistent dorsal OA and left OA arising from the MMA. CONCLUSIONS: Per OA, the prevalence of persistent dorsal OA was 0.42% and of OA arising from the MMA, 1.45%, with a tendency toward right-side predominance. OA arising from the MMA can be seen bilaterally; preprocedural knowledge of this variation is important because of the danger associated with endovascular procedures of the external carotid system when the OA arises from the MMA.

Double ophthalmic arteries arising from the internal carotid artery.

Rarely, the ophthalmic artery (OA) arises from the cavernous segment of the internal carotid artery (ICA) inferolaterally and enters into the orbit via the superior orbital fissure. This anomalous OA that originates from the inferolateral trunk is regarded as a persistent dorsal OA. Extremely rarely, both normal OA and persistent dorsal OA arise from the ICA. We report the first case of such double OAs, one of which arose from the cavernous segment of the ICA superolaterally and we believe that it originated from the meningohypophyseal trunk rather than the inferolateral trunk.