Technique to “Trap” a Segment of the Middle Meningeal Artery for Embolization of a Carotid Cavernous Fistula: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
MirHojjat Khorasanizadeh ◽  
Mira Salih ◽  
Dominic Harris ◽  
Christopher S Ogilvy
Keyword(s):  
Internal Carotid ◽  
Transarterial Embolization ◽  
Cranial Nerves ◽  
Middle Meningeal Artery ◽  
Type D ◽  
History Of ◽  
Nerve Paresis ◽  
Carotid Cavernous Fistulas ◽  
Transvenous Approach ◽  
Meningeal Artery

Abstract Transvenous embolization is the favored treatment for indirect carotid-cavernous fistulas (CCFs). However, transarterial embolization can be used as an alternative method when the venous route is inaccessible. We present the case of a 47-yr-old woman with a history of diplopia, headaches, and sixth cranial nerve (CN-VI) palsy who presented with acute worsening of headache and ophthalmoplegia and rise of intraocular pressures. Angiography demonstrated a left indirect CCF (dural arteriovenous malformation) with multiple arterial feeders from the internal carotid artery as well as the middle meningeal artery (MMA) (Barrow type D). Transvenous approach was attempted first but was unsuccessful due to difficult access to the cavernous sinus. Thus, transarterial embolization through the MMA feeding branches was planned. To avoid occluding distal branches of the MMA by Onyx, we coiled it distally. In addition, we used a scepter balloon proximally to prevent the reflux of Onyx into potential collaterals to cranial nerves from proximal MMA. After trapping a segment of the MMA, Onyx was injected into the CCF fistula through the small MMA feeders. A postembolization arteriogram showed obliteration of the CCF. The patient developed mild left facial nerve paresis on the first postoperative day (thought to be related to partial embolization of tiny arteries in the facial canal), which was resolving in the course of hospitalization. She remained neurologically stable, and was discharged on the third postoperative day. To the best of our knowledge, this is the first report of transarterial embolization of CCF by distal coiling and proximal ballooning to trap a segment of an artery. The authors hereby confirm that informed consent was obtained from the patient after thorough discussion of the procedure's rationale, risks, benefits, and alternatives.

Surgical removal of embolic material after its unexpected migration through extracranial-intracranial anastomosis in the treatment of Barrow Type D carotid-cavernous fistula: case report

2018 ◽  
Vol 128 (3) ◽  
pp. 731-734 ◽  
Author(s):  
Jae-Sang Oh ◽  
Dong-Sung Kim ◽  
Jai-Joon Shim ◽  
Seok-Mann Yoon
Keyword(s):  
Cerebral Artery ◽  
Transarterial Embolization ◽  
Cerebral Arteries ◽  
Surgical Removal ◽  
Embolic Material ◽  
Type D ◽  
History Of ◽  
The Right ◽  
Carotid Cavernous Fistulas ◽  
Transvenous Approach

Endovascular occlusion via the transvenous route is the favored treatment for indirect carotid-cavernous fistulas (CCFs). However, transarterial embolization can be used as an alternative method in patients with an inaccessible venous route. The authors present the case of a 49-year-old woman with a 2-month history of chemosis and proptosis in her right eye. Angiography demonstrated a Barrow Type D CCF. Transarterial Onyx embolization through the accessory meningeal artery was performed after an unsuccessful transvenous approach. Unexpected Onyx migrations to the cerebral arteries were detected while injecting the embolic material. Three hours after failed attempts to retrieve the Onyx cast endovascularly, it was microsurgically removed from the right middle cerebral artery. To the authors' knowledge, this is the first report of the surgical removal of Onyx from a normal cerebral artery.

scholarly journals Transarterial onyx embolization of arteriovenous malformation in the infratemporal fossa and parotid region

2013 ◽  
Vol 02 (02) ◽  
pp. 196-198
Author(s):  
Qinghai Huang ◽  
Jianmin Liu ◽  
Xinpu Chen
Keyword(s):  
Arteriovenous Malformation ◽  
Internal Carotid ◽  
Transarterial Embolization ◽  
Infratemporal Fossa ◽  
Surgical Excision ◽  
Middle Meningeal Artery ◽  
High Rate ◽  
Parotid Region ◽  
Life Threatening ◽  
Meningeal Artery

Abstract Maxillofacial arteriovenous malformation (AVM) is a rare, but potentially life-threatening entity. Surgical excision usually associates with a high rate of significant blood loss and cosmetic defects. We report a patient who had an AVM involving infratemporal fossa and parotid region, supplied by an enlarged branch of the left ophthalmic artery, cavernous internal carotid artery, middle meningeal artery, and internal maxillary. Successful treatment of this lesion was achieved by transarterial embolization with Onyx. Less invasive transarterial embolization with Onyx is rewarding when curing certain types of maxillofacial AVMs.

scholarly journals Retrograde Approach for Intra-arterial Chemotherapy Delivery in Retinoblastoma

2021 ◽  
Author(s):  
Giancarlo Saal-Zapata ◽  
Walter Durand ◽  
Alfredo Ramos ◽  
Raúl Cordero ◽  
Rodolfo Rodríguez
Keyword(s):  
Internal Carotid ◽  
Middle Meningeal Artery ◽  
Posterior Circulation ◽  
Alternative Form ◽  
Chemotherapeutic Drugs ◽  
Retrograde Approach ◽  
First Line ◽  
The Third ◽  
Cure Rates ◽  
Meningeal Artery

AbstractIntra-arterial chemotherapy (IAC) is currently, the first-line treatment for retinoblastomas with successful cure rates. In difficult access or unsuccessful catheterization of the ophthalmic artery (OA), the middle meningeal artery is a second alternative followed by the Japanese technique using balloon. Nevertheless, when a well-developed posterior communicating artery is present, a retrograde approach to the OA through this vessel can be performed to deliver the chemotherapeutic drugs.We present a case of an unsuccessful catheterization of the OA through the internal carotid artery due to a challenging configuration of the OA/carotid siphon angle and describe an alternative form of navigation and catheterization through the posterior circulation.To our knowledge, this is the third report of a successful retrograde catheterization of the OA for IAC and constitutes an alternative route to deliver chemotherapy.

scholarly journals Possibility of Middle Meningeal Artery-to-Petrous Internal Carotid Artery Bypass: An Anatomic Study

Skull Base ◽  
2004 ◽  
Vol 14 (3) ◽  
pp. 153-156 ◽  
Author(s):  
Mehmet Erkan Üstün ◽  
Mustafa Büyükmumcu ◽  
Muzaffer Şeker ◽  
Ahmet Kağan Karabulut ◽  
İsmihan İlknur Uysal ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Bypass ◽  
Middle Meningeal Artery ◽  
Anatomic Study ◽  
Meningeal Artery

scholarly journals Left temporal craniotomy and direct microcatheterization of the middle meningeal artery for treatment of a complex temporal dural arteriovenous fistula

2019 ◽  
Vol 46 (Suppl_2) ◽  
pp. V8
Author(s):  
Daniel M. S. Raper ◽  
Nasser Mohammed ◽  
M. Yashar S. Kalani ◽  
Min S. Park
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Treatment Approach ◽  
Transarterial Embolization ◽  
Middle Meningeal Artery ◽  
Intraoperative Angiography ◽  
Arteriovenous Fistulae ◽  
Posterior Division ◽  
Technical Considerations ◽  
Meningeal Artery

The preferred method for treating complex dural arteriovenous fistulae of the transverse and sigmoid sinuses is via endovascular, transarterial embolization using liquid embolysate. However, this treatment approach mandates access to distal dural feeding arteries that can be technically challenging by standard endovascular approaches. This video describes a left temporal craniotomy for direct stick microcatheterization of an endovascularly inaccessible distal posterior division of the middle meningeal artery for embolization of a complex left temporal dural arteriovenous fistula. The case was performed in the hybrid operative suite with biplane intraoperative angiography. Technical considerations, operative nuances, and outcomes are reviewed.The video can be found here: https://youtu.be/Dnd4yHgaKcQ.

scholarly journals Middle meningeal artery embolization for chronic subdural hematoma: Endovascular technique and radiographic findings

2018 ◽  
Vol 24 (4) ◽  
pp. 455-462 ◽  
Author(s):  
Thomas W Link ◽  
Benjamin I Rapoport ◽  
Stephanie M Paine ◽  
Hooman Kamel ◽  
Jared Knopman
Keyword(s):  
Subdural Hematoma ◽  
Case Reports ◽  
Cranial Nerves ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Safe Alternative ◽  
Selective Embolization ◽  
Radiographic Findings ◽  
Pathologic Process ◽  
Meningeal Artery

Background and purpose Embolization of the middle meningeal artery (MMA) has recently been proposed as an alternative to surgery for treatment of chronic subdural hematoma (SDH), and several case reports have been published supporting its efficacy. It has been suggested that the primary pathologic process in chronic SDH is repeated microhemorrhaging into the subdural collection from fragile neovasculature within the SDH membrane that arises from distal branches of the MMA. Embolization could thus provide a means of eliminating this chronic rebleeding. Materials and methods Images were selected from MMA embolization procedures performed at our institution in order to illustrate the technique and theory behind its efficacy for treatment of chronic SDH. Results Images from MMA angiograms demonstrate the variability of MMA anatomy and help illustrate the importance of avoiding potential ophthalmic collaterals and branches supplying cranial nerves. The findings of irregular wispiness of the distal MMA vasculature, contrast outlining of the SDH membrane on angiography, and homogenous increased density within the SDH on postembolization head computed tomography are described. Conclusion MMA embolization may provide a safe alternative for treatment of chronic SDH, but careful angiographic assessment of MMA anatomy should be performed to avoid potential complications. The findings illustrated here lend support to the theory that the pathologic process of chronic SDH is repeated leakage of blood products from an inflamed, abnormal arterial neovasculature within the SDH membrane that arises from the MMA, and thus selective embolization could provide an effective treatment.

scholarly journals Type D Traumatic Carotido-Cavernous Fistula Due to Selective Transection of the Inferolateral Trunk(ILT)

2003 ◽  
Vol 9 (4) ◽  
pp. 373-377 ◽  
Author(s):  
I.C. Duncan ◽  
P.A. Fourie
Keyword(s):  
Carotid Arteries ◽  
Internal Carotid ◽  
Traumatic Injury ◽  
External Carotid Artery ◽  
External Carotid ◽  
Type D ◽  
Type C ◽  
Transvenous Approach ◽  
Internal Carotid Arteries ◽  
Inferolateral Trunk

A minority of traumatic carotido-cavernous fistulas (CCF) are of the indirect variety, and then usually supplied only by meningeal branches of the ipsilateral external carotid artery (Type C). We describe a case of a Type D CCF due to traumatic injury of the inferolateral trunk (ILT), and describe its angiographic features and endovascular management through both the external and internal carotid arteries following a failed transvenous approach.

Intraspinosum Middle Meningeal Artery Ligation: A Simple Technique to Control Bleeding in the Middle Fossa During the Anterior Transpetrosal Approach

2017 ◽  
Vol 13 (2) ◽  
pp. 163-172
Author(s):  
Shunsuke Shibao ◽  
Hamid Borghei-Razavi ◽  
Kazunari Yoshida
Keyword(s):  
Facial Nerve ◽  
Histological Study ◽  
Middle Meningeal Artery ◽  
Mandibular Nerve ◽  
Petrous Apex ◽  
Middle Fossa ◽  
Foramen Ovale ◽  
Anterior Transpetrosal Approach ◽  
Nerve Paresis ◽  
Meningeal Artery

Abstract BACKGROUND: Although the greater superficial petrosal nerve (GSPN) is an important landmark of the anterior transpetrosal approach (ATPA), bleeding from the interdural space around the foramen spinosum (FS), the GSPN, and the foramen ovale impedes the identification of the GSPN, during epidural dissection in the ATPA. OBJECTIVE: To describe the technique of intraspinosum middle meningeal artery (MMA) ligation, which enables us to control bleeding from the interdural space. METHODS: During epidural dissection, we identified the FS and partially drilled the lateral side of the FS. Next, we cut the convergence site of the neurovascular structures such as the MMA, middle meningeal vein, and the meningeal branch of the mandibular nerve with the periosteal dura within the FS and continued dural detachment epidurally to expose the petrous apex. Bleeding control around the FS and postoperative facial nerve paresis were assessed for 96 patients treated with the ATPA. Additionally, histological study was performed around the FS using Masson's trichrome stain. RESULTS: In all cases, in which this technique was used, bleeding from the interdural space was well controlled and no persistent facial nerve paresis was identified. In the histological study, we confirmed that the MMA, the middle meningeal vein, and the meningeal branch of the mandibular nerve converged into the FS and many venous channels existed in the interdural space around the FS and the foramen ovale. CONCLUSION: Intra-FS MMA ligation is an effective method for control of bleeding from the interdural space of the middle fossa during the ATPA.

Type D Dural Carotid—Cavernous Fistula

1996 ◽  
Vol 37 (1P1) ◽  
pp. 294-298 ◽  
Author(s):  
K. Hasuo ◽  
A. Mizushima ◽  
S. Matsumoto ◽  
A. Uchino ◽  
S. Uehara ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Complete Resolution ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Symptomatic Improvement ◽  
Carotid Cavernous Fistula ◽  
Type D ◽  
One Year ◽  
Carotid Cavernous Fistulas ◽  
Internal Carotid Arteries

Purpose: To assess the efficacy of irradiation combined with particulate embolization for treating type D dural carotid—cavernous fistulas, supplied by the meningeal branches of both external (ECA) and internal carotid arteries. Material and Methods: Nine patients were treated by particulate embolization via the ECA branches, followed by radiation therapy with doses of 30 Gy. One of these patients with recurrent symptoms received an additional 30 Gy one year after initial treatment, making a total dose of 60 Gy. Results: In all cases, symptoms were improved immediately after the particulate embolizations. In 8 cases, complete resolution of symptoms were obtained in 4–19 months and an average of 8 months after treatment. In one case, chemosis was markedly improved and persisted minimally 41 months later. Conclusion: Particulate embolization is effective for immediate symptomatic improvement, and complete resolution of symptoms can usually be achieved by subsequent radiation therapy.

Transradial embolization of the left middle meningeal artery and accessory middle meningeal artery for treatment of subacute–chronic subdural hematoma

2020 ◽  
Vol 12 (4) ◽  
pp. 436-436 ◽  
Author(s):  
Gary B Rajah ◽  
Michael K Tso ◽  
Rimal Dossani ◽  
Kunal Vakharia ◽  
Adnan H Siddiqui
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Middle Meningeal Artery ◽  
Vascular Lesion ◽  
External Carotid ◽  
Invasive Treatment ◽  
History Of ◽  
The Right ◽  
Meningeal Artery

This 52-year-old man with no remarkable medical history, no anticoagulation use, and no history of trauma was noted to have a subacute–chronic left subdural hematoma during outpatient headache evaluation. No occult vascular lesion or cross-calvarial supply of the right middle meningeal artery (MMA) to the left side was identified on bilateral selective external carotid injections. Because the patient preferred non-surgical management, we performed a left MMA embolization with Onyx 18 (Medtronic), utilizing a Headway Duo microcatheter (MicroVention) via the transradial route. A 6 French Benchmark (Penumbra) was utilized for transradial support into the left external carotid. The patient was discharged home the same day. Repeat scans from 2 to 6 weeks revealed complete resolution of the subdural hematoma. The patient’s headaches resolved. Transradial MMA embolization for subacute–chronic subdural hematoma represents a minimally invasive treatment option for mass effect and hemorrhage-related symptoms. Tailored embolizations are necessary when >1 meningeal vessel supplies the subdural hematoma.

Sign in / Sign up

Export Citation Format

Share Document