In this article, we review current practices in therapeutic embolization of the head and neck. Major applications including vascular malformations, highly vascular tumors, trauma, and other sources of hemorrhage are discussed. We emphasize the importance of a thorough knowledge of head and neck vascular anatomy, especially of potential connections to critical territories not intended for embolization. The choice of embolic agent and its effect on safety and efficacy of treatment are presented.
KEYWORDS:Intervention, head and neck, vascular malformation, tumor, bleedingObjectives: On completion of this article, the reader should (1) appreciate the importance of preprocedural evaluation of vascular anatomy of the head and neck, (2) be familiar with important potential collateral pathways posing risk in intervention, and (3) understand basic principles of intervention in the head and neck. Accreditation: Tufts University School of Medicine (TUSM) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Credit: TUSM designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit TM . Physicians should only claim credit commensurate with the extent of their participation in the activity.Intricate anatomy greatly complicates the diagnostic and therapeutic management of head and neck pathology. Intimate anatomic relationships provide risks of visual loss, cranial nerve injury, and airway compromise related to treatment. Advances in endovascular techniques have expanded the role for catheter-based therapies beyond acute hemorrhage and into secondary and primary treatment of vascular anomalies and tumors of the face, neck, and skull base. This article is a concise review of the current practices in endovascular management of head and neck pathologies.
ANATOMYThe embryonic development of the great vessels is a complex process involving the formation and regression of six paired arterial arches, creating the internal and external carotid arteries. The vascular commonalities during this process create redundancy in external and internal distributions, as well as varying degrees of interconnection between the external and internal and the anterior and posterior cerebral circulation. [1][2][3] As an operator, a firm understanding of these collateral pathways and potential anastomoses is paramount to the safety and efficacy of head and neck intervention. For the purposes of this article, we will limit discussion to extracranial and skull base vasculature.
INTERNAL CAROTID ARTERYThe internal carotid artery (ICA) is a terminal branch of the common carotid artery that originates at the level of