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
The clinician must be aware of the potential for vascular injury that can result from gunshot wounds to the skull base and oropharynx. These lesions can be life-threatening or can result in irreversible neurologic defects. The goal is early diagnosis and efficient appropriate treatment. Endovascular therapy has been proven to be of great benefit for the treatment of traumatic aneurysms and carotid-cavernous fistulae. Utilizing either a reconstructive or a deconstructive approach, the traumatic lesions can be treated without the morbidity inherent to surgery of the skull base or cavernous sinus. This article discusses the authors' experience with endovascular treatment, explaining in detail the reconstructive and deconstructive approaches and providing clinical examples of the treatment of pseudoaneurysms and carotid-cavernous fistulae.
