The road less traveled: transarterial embolization of dural arteriovenous fistulas via the ascending pharyngeal artery

Gross, Bradley A.; Albuquerque, Felipe C; Moon, Karam; McDougall, Cameron G.

doi:10.1136/neurintsurg-2016-012488

Cited by 21 publications

(12 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although the ascending pharyngeal artery approach has been successfully utilized for dAVF embolization,2 the procedure does carry a significant risk due to the potential for non-target embolization of arteries supplying the vasa nervosum of the 9th to 12th cranial nerves 1 3. Trans-venous embolization using coils has therefore become a favored treatment technique achieving high curative rates with relatively low morbidity 1 4 5.…”

Section: Background and Purposementioning

confidence: 99%

Transvenous coil embolization with intra-operative cone beam CT assistance in the treatment of hypoglossal canal dural arteriovenous fistulae

Crockett

Chiu

Singh

et al. 2018

J NeuroIntervent Surg

View full text Add to dashboard Cite

show abstract

Section: Background and Purposementioning

confidence: 99%

Transvenous coil embolization with intra-operative cone beam CT assistance in the treatment of hypoglossal canal dural arteriovenous fistulae

Crockett

Chiu

Singh

et al. 2018

J NeuroIntervent Surg

View full text Add to dashboard Cite

show abstract

“…The APA is well reported in the literature as a suitable option for embolization of skull base meningiomas, paragangliomas, hemangiopericytomas, and dural arteriovenous fistulas. This has been described with nBCA, PVA particles, and Onyx 25 26. Despite its smaller caliber (mean 1.54 mm) compared with other external carotid artery (ECA) branches, superselective catheterization of the vessel is possible and safe.…”

Section: Discussionmentioning

confidence: 99%

Predictors of preoperative endovascular embolization of meningiomas: subanalysis of anatomic location and arterial supply

Barros

Feroze

Sen

et al. 2019

J NeuroIntervent Surg

View full text Add to dashboard Cite

IntroductionEndovascular embolization of intracranial meningiomas is commonly used as an adjunct to surgical resection. We sought to describe the anatomic locations and vascular supplies of meningiomas to identify characteristics predictive of successful preoperative endovascular embolization.MethodsWe conducted a retrospective review of 139 meningioma cases receiving cerebral angiograms for possible preoperative endovascular embolization at our institution between December 2000 and March 2017. The extent of embolization, arterial supply, anatomic location, and procedural complications were recorded for each case. Univariate and multivariate analyses were performed to identify tumor characteristics that predicted successful embolization.ResultsOf the total meningioma patients undergoing preoperative angiography, 78% (108/139) were successfully embolized, with a 2.8% periprocedural complication rate (3/108). Within the subset of patients with successful embolization, 31% (33/108) achieved complete angiographic embolization. Significant multivariate predictors of embolization (either partial or complete) were convexity/parasagittal locations (OR 5.15, 95% CI 0.93 to 28.54, p=0.060), meningohypophyseal trunk (MHT, OR 4.65, 95% CI 1.63 to 13.23, p=0.004), middle meningeal artery (MMA, OR 10.89, 95% CI 3.43 to 34.64, p<0.001), and ascending pharyngeal artery supply (APA, OR 9.96, 95% CI 1.88 to 52.73, p=0.007). Significant predictors for complete embolization were convexity/parasagittal locations (OR 4.79, 95% CI 1.66 to 13.84, p=0.004) and embolized APA supply (OR 6.94, 95% CI 1.90 to 25.39, p=0.003). Multiple arterial supply was a negative predictor of complete embolization (OR 0.38, 95% CI 0.15 to 0.98, p=0.05).ConclusionsTumor characteristics can be used to predict the likelihood of preoperative meningioma embolization. Parasagittal and convexity meningiomas, and those with APA supply, are most likely to achieve complete angiographic embolization.

show abstract

“…To date, several TAE techniques using the APA for dAVF have been reported, and TAE with Onyx has also been performed for CS-dAVF. 3,15,16) However, glue leakage and feeder rupture were reported as complications. 15) Then, as a next option to avoid the disadvantages of TAE, TAIV has been reported.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Therapeutic Access Routes for Endovascular Therapy of Cavernous Sinus-dural Arteriovenous Fistula

Ryu

Sato

Mochizuki

et al. 2019

JNET

View full text Add to dashboard Cite

The usefulness of endovascular treatment for cavernous sinus (CS)-dural arteriovenous fistula (dAVF) has been established. As the first choice of endovascular intervention for CS-dAVF, transvenous embolization (TVE) is generally performed, and the inferior petrosal sinus (IPS) is usually selected as the main access route to the affected CS because of its accessibility. However, the angiographical pattern of the CS varies among individuals. In some cases, it is difficult to access the affected CS via the ipsilateral IPS because of thrombosis, hypoplasia, or aplasia. Therefore, in some cases, alternative venous access routes are needed for TVE. Methods: A retrospective study was performed with 27 patients diagnosed with intracranial dAVF who underwent endovascular embolization at our institution. Among these, the data of nine patients with CS-dAVF treated by endovascular intervention were analyzed retrospectively in this study. We reviewed the endovascular access routes for CS-dAVF treatment based on anatomical and embryological considerations. Results: The most common complaint was diplopia, followed by exophthalmos and chemosis. There was no hemorrhagic onset. Cortical venous reflux (CVR) was recognized angiographically in six patients. The IPS on the affected side was angiographically occluded in four patients. TVE was attempted first in all patients. In five patients where the ipsilateral IPS was patent, TVE was successfully performed via the ipsilateral IPS. In four patients where the ipsilateral IPS was occluded, microcatheter access to the affected CS via the ipsilateral IPS was unsuccessful. The following alternative approach routes were selected: the superficial temporal vein, facial vein, direct puncture of the superficial middle cerebral vein (SMCV), and ascending pharyngeal artery (APA) for transarterial intravenous embolization (TAIV). The CS-dAVF had disappeared in all patients at the final follow-up examination. In the case of difficult access, compartment formations of the intracavernous sinus were recognized. Compartment formation due to the anatomical and embryological differences of the intracavernous structure may have influenced the ability of the catheter to reach the affected shunted pouch. Conclusions: In cases where the approach via the ipsilateral IPS was difficult, alternative access routes were effective for the required embolization. It is extremely important to fully understand the angioarchitecture, location of the shunted pouch, and compartments of the CS for successful endovascular treatment. Anatomical and developmental CS considerations may be useful for better access route selection. Keywords▶ ascending pharyngeal artery, cavernous sinus, dural arteriovenous fistula, transarterial embolization, transvenous embolization This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

show abstract

The road less traveled: transarterial embolization of dural arteriovenous fistulas via the ascending pharyngeal artery

Abstract: In rare, select cases, the APA is an excellent route for transarterial embolization of cranial dAVFs.

Cited by 21 publications

References 12 publications

Transvenous coil embolization with intra-operative cone beam CT assistance in the treatment of hypoglossal canal dural arteriovenous fistulae

Transvenous coil embolization with intra-operative cone beam CT assistance in the treatment of hypoglossal canal dural arteriovenous fistulae

Predictors of preoperative endovascular embolization of meningiomas: subanalysis of anatomic location and arterial supply

Assessment of Therapeutic Access Routes for Endovascular Therapy of Cavernous Sinus-dural Arteriovenous Fistula

Contact Info

Product

Resources

About