ABSTRACT
SUMMARY: We describe a novel technique to selectively catheterize the meningohypophyseal trunk (MHT) and its branches. We emphasize the difficulty in accessing the MHT via an ipsilateral approach because of the geometric orientation of this vessel to the parent internal carotid artery.
Subject(s)
Adenoma/surgery , Carotid-Cavernous Sinus Fistula/therapy , Catheterization, Peripheral/instrumentation , Embolization, Therapeutic/instrumentation , Meningeal Arteries , Neoplasm Recurrence, Local/surgery , Pituitary Neoplasms/surgery , Postoperative Complications/therapy , Postoperative Hemorrhage/therapy , Adult , Carotid-Cavernous Sinus Fistula/diagnostic imaging , Cerebral Angiography , Female , Humans , Meningeal Arteries/diagnostic imaging , Pituitary Gland/blood supply , Postoperative Hemorrhage/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Facial and skull base trauma can cause clinically significant epistaxis. Optimal evaluation and treatment require knowledge of the pertinent vascular and skull base anatomy. We describe a patient with extensive skull base injury and epistaxis in whom CT revealed a fracture through the roof of the nasopharynx and arteriography showed injury to the pterygovaginal (pharyngeal) artery. The fracture was successfully treated with transarterial particulate embolization.
Subject(s)
Epistaxis/etiology , Facial Injuries/diagnostic imaging , Maxillary Artery/injuries , Pharynx/blood supply , Adolescent , Angiography , Embolization, Therapeutic , Epistaxis/diagnostic imaging , Epistaxis/therapy , Extravasation of Diagnostic and Therapeutic Materials/diagnostic imaging , Extravasation of Diagnostic and Therapeutic Materials/therapy , Facial Injuries/therapy , Female , Humans , Maxillary Artery/diagnostic imaging , Skull Base/blood supply , Skull Base/injuries , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: This article focuses on an unusual cross-sectional imaging pattern of a deep developmental venous anomaly (DVA). Since these anomalies are nonpathologic, they must not be interpreted as a disease that requires further costly workup and potentially injurious procedures (cerebral angiography). MATERIALS AND METHODS: Two women aged 19 (Case 1) and 30 (Case 2) years sought medical evaluation for severe headaches. Both patients underwent CT, MRI, and conventional cerebral angiography. Case 1 also underwent MR venography. RESULTS: The diagnosis of an unusual DVA in Case 1 was confirmed only after conventional catheter angiography and a follow-up MR venogram. In Case 2 the diagnosis was inferred based upon the CT, MRI, and conventional angiography results and the marked similarity to Case 1. The presumptive diagnosis in Case 2 would not have been made with confidence without the prior experience of managing Case 1. CONCLUSION: DVAs (venous angiomas) are extreme variations in the pattern of intracranial venous drainage. These two case reports highlight an unusual pattern of this benign entity. Individuals interpreting cross-sectional imaging studies should be cognizant of this pattern.
Subject(s)
Cerebral Veins/abnormalities , Adult , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/pathology , Cerebral Angiography , Female , Hemangioma/diagnostic imaging , Hemangioma/pathology , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Tomography, X-Ray ComputedABSTRACT
This case report illustrates a patient who was found to have multiple sites of angioblastic meningiomas in the spinal and intracranial subarachnoid space 15 to 18 years after resection of an angioblastic meningioma from the upper cervical canal. The presence of the multiple sites of tumor could represent either multicentric origin or subarachnoid seeding.
