Lefkowitz M, Giannotta S L, Hieshima G, Higashida R, Halbach V, Dowd C, Teitelbaum G P
Department of Neurological Surgery, University of Southern California School of Medicine, Los Angeles, USA.
Neurosurgery. 1998 Dec;43(6):1298-303. doi: 10.1097/00006123-199812000-00016.
A number of anteriorly located cranial base and extracranial lesions receive their vascular supply wholly or in part from the ophthalmic artery, and embolization of the ophthalmic artery can be helpful in the management of these lesions, either as the primary treatment or as an adjunct to surgery. We present situations in which the embolization of lesions involving the ophthalmic artery was performed to effect a partial or total cure of the lesion.
Twelve patients underwent a total of 15 embolization attempts on lesions involving the ophthalmic artery. Four patients had arteriovenous malformations of the orbit, four had dural arteriovenous fistulae, two had orbital meningiomas, one had a planum sphenoidale meningioma, and one had a juvenile nasal angiofibroma. In each case, a Tracker No. 18 microcatheter (Target Therapeutics, Inc., Fremont, CA) was navigated into the ophthalmic artery using a steerable guidewire and digital road mapping. Embolic agents included polyvinyl alcohol particles ranging from 350 to 1500 microm in diameter, 2-mm platinum microcoils, and n-butyl-cyanoacrylate. In 12 of 15 cases, lidocaine and amytal provocation tests were conducted before any attempt at embolization to assess the role of the ophthalmic artery in vision.
Embolization was successfully performed in the 14 situations in which it was attempted. Positive results of two lidocaine/amytal tests were noted. In one case, embolization was not attempted. In the other case, a larger caliber embolic agent (2-mm platinum coils) was used. A single transient decrease in visual acuity lasting 4 days was the only embolization-related complication.
Proper case selection, judicious use of embolic agents, and use of provocative testing can result in safe embolization of lesions supplied by the ophthalmic artery.
许多位于颅底前部和颅外的病变全部或部分由眼动脉供血，眼动脉栓塞术有助于这些病变的治疗，可作为主要治疗手段或手术辅助手段。我们介绍了对累及眼动脉的病变进行栓塞以实现病变部分或完全治愈的情况。
12例患者对累及眼动脉的病变共进行了15次栓塞尝试。4例患有眼眶动静脉畸形，4例患有硬脑膜动静脉瘘，2例患有眼眶脑膜瘤，1例患有蝶骨平台脑膜瘤，1例患有青少年鼻血管纤维瘤。在每种情况下，使用可操纵导丝和数字路线图将18号Tracker微导管（Target Therapeutics公司，弗里蒙特，加利福尼亚州）插入眼动脉。栓塞剂包括直径为350至1500微米的聚乙烯醇颗粒、2毫米铂微线圈和正丁基氰基丙烯酸酯。在15例中的12例中，在进行任何栓塞尝试之前进行了利多卡因和异戊巴比妥激发试验，以评估眼动脉在视力中的作用。
在14次尝试栓塞的情况中成功进行了栓塞。记录到2例利多卡因/异戊巴比妥试验结果为阳性。1例未尝试栓塞。在另1例中，使用了更大口径的栓塞剂（2毫米铂线圈）。唯一与栓塞相关的并发症是视力单次短暂下降持续4天。
正确的病例选择、明智地使用栓塞剂以及进行激发试验可实现对由眼动脉供血的病变进行安全栓塞。
