From the Department of Neurosurgery (K.Y., M. Hayakawa), Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
Department of Neurosurgery (K.Y., M. Hayakawa, K.A., Y.H.), Fujita Health University, Toyoake, Aichi, Japan.
AJNR Am J Neuroradiol. 2024 May 9;45(5):618-625. doi: 10.3174/ajnr.A8169.
Tumor embolization through the meningohypophyseal trunk and inferolateral trunk is known to be effective in skull base tumors; however, microcatheter cannulation into these arteries is difficult, and the number of cases that can be safely embolized is limited. In this study, we present a novel embolization procedure for the meningohypophyseal trunk and inferolateral trunk using the distal balloon protection technique and detail its clinical efficacy and complication risks. We developed this procedure to allow safe embolization in patients who cannot be adequately cannulated with microcatheters into these arteries.
Patients who underwent meningohypophyseal trunk or inferolateral trunk embolization using the distal balloon protection technique for skull base tumors at our institution between 2010 and 2023 were included. In this procedure, the ICA was temporarily occluded with a balloon at the ophthalmic artery bifurcation, the microcatheter was guided to the meningohypophyseal trunk or inferolateral trunk vicinity, and embolic particles were injected into the arteries. The balloon was deflated after the embolic particles that had refluxed into the ICA were aspirated.
A total of 25 meningohypophyseal trunks and inferolateral trunks were embolized during 21 operations. Of these 25 arteries, only 9 (36.0%) were successfully cannulated with microcatheters. Nevertheless, effective embolization was achieved in all cases. Permanent complications occurred in only 1 case (4.8%) in which the central retinal artery was occluded during inferolateral trunk embolization, resulting in a visual field defect. No permanent complications resulting from the embolic cerebral infarction were observed. Of 16 cases that underwent MR imaging within a week after embolization, however, 11 (68.8%) demonstrated embolic cerebral infarctions.
In patients with skull base tumors with meningohypophyseal trunk or inferolateral trunk feeders that cannot be catheterized directly, embolization using the distal balloon protection technique for tumor supply can be considered as a salvage technique.
通过颈内动脉终末支和外侧支对颅底肿瘤进行肿瘤栓塞已被证实是有效的；然而，微导管进入这些动脉的插管非常困难，且能够安全栓塞的病例数量有限。在本研究中，我们提出了一种使用远端球囊保护技术栓塞颈内动脉终末支和外侧支的新方法，并详细介绍了其临床疗效和并发症风险。我们开发了这种方法，以允许在无法用微导管充分插管进入这些动脉的患者中进行安全栓塞。
本研究纳入了 2010 年至 2023 年期间在我院接受颅底肿瘤颈内动脉终末支或外侧支栓塞治疗的患者。在该操作中，暂时用球囊闭塞眼动脉分叉处的颈内动脉，将微导管引导至颈内动脉终末支或外侧支附近，然后将栓塞颗粒注入动脉。当回流到颈内动脉的栓塞颗粒被抽吸后，球囊就会被放气。
共对 21 例手术中的 25 条颈内动脉终末支和外侧支进行了栓塞。在这 25 条动脉中，只有 9 条（36.0%）成功地用微导管插管。然而，所有病例均实现了有效的栓塞。仅 1 例（4.8%）在外侧支栓塞时发生中央视网膜动脉闭塞，导致视野缺损，出现永久性并发症。未观察到因栓塞性脑梗死导致的永久性并发症。在栓塞后一周内进行 MRI 检查的 16 例患者中，有 11 例（68.8%）显示有栓塞性脑梗死。
对于颈内动脉终末支或外侧支供血的颅底肿瘤患者，如果无法直接进行导管插入，可以考虑使用远端球囊保护技术栓塞肿瘤供应动脉作为挽救性治疗。
