Department of Neurosurgery, Keio University School of Medicine, Japan.
Department of Neurosurgery, Mihara Memorial Hospital, Japan.
Neuroradiol J. 2021 Dec;34(6):676-682. doi: 10.1177/19714009211013490. Epub 2021 Apr 30.
The pterygovaginal artery (PtVA), a recurrent branch of the internal maxillary artery (IMA), can be a feeder of skull base tumors. Preoperative embolization can help endoscopic resection of hypervascular lesions, which is performed under a narrow surgical space with restricted instrumental maneuverability.
We performed preoperative embolization in five cases with hypervascular skull base lesions supplied by the PtVA, four of which were resected via endoscopic endonasal approach. In two cases, selective PtVA embolization through the distal IMA was successfully conducted.
In all the cases, intraoperative bleeding during endoscopic resection was easily controlled. The medial and lateral origins of the PtVA from the IMA were demonstrated by cone-beam CT images reconstructed from three-dimensional rotational angiography, and anastomoses around the eustachian tube and soft palate were visualized by superselective angiography.
The PtVA embolization can be an effective strategy before endoscopic skull base tumor resection. When embolizing through the PtVA, clinicians should be aware of its anatomical variations and dangerous anastomoses. Understanding the surrounding angioarchitecture by angiographic techniques helps ensure safe embolization.
翼内阴道动脉（PtVA）是上颌内动脉（IMA）的一个分支，可作为颅底肿瘤的供血动脉。术前栓塞可有助于内镜下切除富血管病变，由于手术空间狭窄，器械操作受限，因此需要进行这种治疗。
我们对 5 例由 PtVA 供应的颅底高血运病变进行了术前栓塞，其中 4 例通过经鼻内镜入路进行了切除。在 2 例中，通过 IMA 的远端成功进行了选择性 PtVA 栓塞。
在所有病例中，内镜切除术中的出血均易于控制。通过三维旋转血管造影重建的锥形束 CT 图像显示了 PtVA 从 IMA 的内侧和外侧起源，并通过超选择性血管造影显示了咽鼓管和软腭周围的吻合。
PtVA 栓塞术可作为内镜颅底肿瘤切除前的有效策略。当通过 PtVA 进行栓塞时，临床医生应注意其解剖变异和危险吻合。通过血管造影技术了解周围的血管结构有助于确保安全栓塞。
