Sanomura Takayuki, Norikane Takashi, Fujimoto Kengo, Kawanishi Masahiko, Hoshikawa Hiroshi, Nishiyama Yoshihiro
Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
Department of Neurological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
CVIR Endovasc. 2020 Oct 2;3(1):74. doi: 10.1186/s42155-020-00167-6.
The majority of maxillary sinus cancers are advanced at initial detection due to anatomical limitations and lack of early symptoms. In patients with orbital invasion, the feeding arteries of the tumor are often associated with the ophthalmic artery in addition to the maxillary artery. We describe a case of tumor bleeding in a patient with recurrent maxillary carcinoma that was treated with embolization from the maxillary and ophthalmic arteries.
A 70-year-old man was treated for left maxillary carcinoma from the maxillary artery with 6 cycles of selective intra-arterial cisplatin infusion with concomitant radiation therapy. He subsequently had epistaxis and underwent arterial embolization for hemostasis. He had almost no sight by this time. Angiography of the left external carotid artery and internal carotid artery revealed blood supply from the maxillary and ophthalmic arteries. Regarding the maxillary artery, coil embolization was performed after embolization with 300-500 μm Embosphere. On the other hand, for the ophthalmic artery, the 3rd portion, supratrochlear artery and dorsal nasal artery, were selected and embolized with coils. Final angiography revealed disappearance of tumor staining and a residual choroidoretinal blush. There was no bleeding that needed treatment up to 2 months after embolization.
In embolization of the ophthalmic artery, it is necessary to embolize the second and subsequent parts because the arteries associated with visual function branch off from the first part. Even in patients whose visual acuity has been almost lost, like in this case, there is a risk of eye pain from embolization at the proximal end, and distal embolization is necessary.
由于解剖学限制和缺乏早期症状，大多数上颌窦癌在初次检测时就已处于晚期。在眼眶受侵的患者中，除上颌动脉外，肿瘤的供血动脉常与眼动脉相关。我们描述了一例复发性上颌癌患者的肿瘤出血病例，该患者接受了来自上颌动脉和眼动脉的栓塞治疗。
一名70岁男性因左上颌癌接受了6个周期的经上颌动脉选择性动脉内顺铂灌注联合放射治疗。随后他出现鼻出血并接受了动脉栓塞止血。此时他几乎失明。左颈外动脉和颈内动脉血管造影显示肿瘤由上颌动脉和眼动脉供血。对于上颌动脉，在用300 - 500μm的Embosphere栓塞后进行了弹簧圈栓塞。另一方面，对于眼动脉，选择了第三段、滑车上动脉和鼻背动脉并用弹簧圈进行栓塞。最终血管造影显示肿瘤染色消失，残留脉络膜视网膜 blush。栓塞后2个月内无需要治疗的出血情况。
在眼动脉栓塞中，由于与视觉功能相关的动脉从第一段分支出来，因此有必要栓塞第二段及后续部分。即使像本例这样视力几乎丧失的患者，近端栓塞也有引起眼痛的风险，因此需要进行远端栓塞。
