Embolization of neurosurgical lesions involving the ophthalmic artery.

OBJECTIVE: A number of anteriorly located cranial base and extracranial lesions receive their vascular supply wholly or in part from the ophthalmic artery, and embolization of the ophthalmic artery can be helpful in the management of these lesions, either as the primary treatment or as an adjunct to surgery. We present situations in which the embolization of lesions involving the ophthalmic artery was performed to effect a partial or total cure of the lesion. METHODS: Twelve patients underwent a total of 15 embolization attempts on lesions involving the ophthalmic artery. Four patients had arteriovenous malformations of the orbit, four had dural arteriovenous fistulae, two had orbital meningiomas, one had a planum sphenoidale meningioma, and one had a juvenile nasal angiofibroma. In each case, a Tracker No. 18 microcatheter (Target Therapeutics, Inc., Fremont, CA) was navigated into the ophthalmic artery using a steerable guidewire and digital road mapping. Embolic agents included polyvinyl alcohol particles ranging from 350 to 1500 microm in diameter, 2-mm platinum microcoils, and n-butyl-cyanoacrylate. In 12 of 15 cases, lidocaine and amytal provocation tests were conducted before any attempt at embolization to assess the role of the ophthalmic artery in vision. RESULTS: Embolization was successfully performed in the 14 situations in which it was attempted. Positive results of two lidocaine/amytal tests were noted. In one case, embolization was not attempted. In the other case, a larger caliber embolic agent (2-mm platinum coils) was used. A single transient decrease in visual acuity lasting 4 days was the only embolization-related complication. CONCLUSION: Proper case selection, judicious use of embolic agents, and use of provocative testing can result in safe embolization of lesions supplied by the ophthalmic artery.

Direct intratumoral embolization of juvenile angiofibroma.

INTRODUCTION: Embolization is a well-established technique that facilitates the subsequent surgical removal of vascularized tumors such as juvenile angiofibroma. However, there is risk of a neurological accident during angiography and tumor embolization from the internal carotid artery. Direct intratumoral embolization may help prevent these potential side effects. METHOD: A group of 7 patients with juvenile angiofibroma vascularized through the branches of the internal carotid artery underwent direct tumoral embolization under general anesthesia. An injection made slowly with an intranasal or lateral percutaneous route with either a mixture of cyanoacrylate, lipiodal, and tungsten powder. Continuous radiographic control was used. RESULTS: This technique induced a marked devascularization and necrosis of the tumor. The technique provided useful perioperative visualization of the tumor. No neurologic sequelae were encountered. CONCLUSION: Direct intratumoral embolization deserves further consideration. This might be especially important in tumors with extracranial extension, cavernous sinus involvement, or those with small or multiple recurrences.

Intraosseous hemangioma of the vomer: a case report.

We describe an unusual case of intraosseous hemangioma of the vomer. The lesion had a characteristic radiographic appearance, especially on the computed tomographic scan. The two most interesting points in this case were the rarity as a site for the occurrence of hemangioma and the successful extirpation of the tumor via the Le Fort 1 osteotomy approach without embolization of the feeding vessels. The benefits of this approach included the wide surgical field afforded deep in the midface region, which was important for controlling bleeding, as well as the complete extirpation of the tumor.