AJDRAJNR - American Journal of Neuroradiology

This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Robinson, D. H.
Right arrow Articles by Eskridge, J. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Robinson, D. H.
Right arrow Articles by Eskridge, J. M.

Embolization of Meningohypophyseal and Inferolateral Branches of the Cavernous Internal Carotid Artery

David H. Robinsona, Joon K. Songa and Joseph M. EskridgeGo,a

a From the Departments of Radiology (D.H.R., J.K.S., J.M.E.) and Neurosurgery (J.M.E.), University of Washington, Seattle.



View larger version (81K):

[in a new window]
  		FIG 1. Case 2: 38-year-old woman with recurrent AVM.

A, Lateral view during right internal carotid injection. An enlarged tentorial marginal branch of the MHT (closed arrow) and enlarged anterior choroidal artery (arrowheads) contribute to supply of the AVM (open arrow).

B, Selective right MHT injection after catheterization with a Tracker-10 catheter (arrow).

C, Repeat right ICA angiogram after embolization of the right MHT with 0.2 mL of cyanoacrylate glue/Ethiodol contrast mixture (1:1) shows complete obliteration of the MHT supply to the AVM (arrow).



View larger version (186K):

[in a new window]
  		FIG 2. Case 3: 48-year-old woman with a left sphenoid wing meningioma.

A, Left ICA injection in mid-arterial phase shows an enlarged ILT branch and the early blush from the sphenoid wing meningioma.

B, Late arterial phase shows a dense tumor stain, which persisted late into the venous phase.

C, Selective injection of left ILT after direct catheterization with an extended tip Tracker-18 catheter. Capillary phase confirms supply to the meningioma via the enlarged ILT (arrow).

D, Left ILT injection after embolization with 2 mL of 150 to 250 µm PVA suspension. Late arterial phase shows abrupt cutoff of the posterior branch of the enlarged MHT (closed arrow).



View larger version (233K):

[in a new window]
  		FIG 3. Case 5: 58-year-old woman with poor control of the left foot and left body hypesthesia.

A, Preembolization angiogram in late arterial phase during left ICA injection shows a dense tumor stain (open arrow) fed in part by left MHT branches (closed arrow).

B, Lateral view during selective injection in left MHT with an extended-tip, Tracker-18 catheter. Capillary phase confirms significant contribution to the tumor stain from left MHT.

C, Selective injection of left MHT after embolization with 2 mL of 150- to 250-µm PVA particle suspension shows near complete obliteration of the MHT supply to the tumor.

D, Left ICA injection after embolization confirms near complete devascularization of the tumor, with faint filling of the left tentorial marginal branch of the residual MHT (arrow).



View larger version (149K):

[in a new window]
  		FIG 4. Diagram of the arteries arising from the cavernous segment of the ICA. AC, anterior clinoid; C3, C4, C5, segments of the intracavernous ICA; DS, dorsum sella; SOF, superior orbital fissure; O, foramen ovale; mma, middle meningeal artery; V1–V3, branches of the fifth cranial nerve coursing through superior orbital fissure (V1), foramen rotundum (V2), and foramen ovale (V3) accompanied by arterial branches of the ILT; 1, ophthalmic artery.

Branches of the ILT (C4 branches, 2 through 4):

2, Superior branch, supplying the roof of cavernous sinus; 3, anterior branch (to superior orbital fissure and foramen rotundum); 4, posterior branch (to foramen ovale and foramen spinosum).

Branches of the MHT (C5 branches, 5 through 8):

5, Recurrent artery of the foramen lacerum; 6, medial and lateral dorsal clival arteries; 7, tentorial marginal artery; 8, inferior hypophyseal artery.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X