EMBOLIZATION OF NEUROSURGICAL LESIONS INVOLVING THE OPHTHALMIC ARTERY

OBJECTIVE: A number of anteriorly located cranial base and extracrania l lesions receive their vascular supply wholly or in part from the oph thalmic artery, and embolization of the ophthalmic artery can be helpf ul in the management of these lesions, either as the primary treatment or as an adjunct to surgery. We present situations in which the embol ization of lesions involving the ophthalmic artery was performed to ef fect a partial or total cure of the lesion. METHODS: Twelve patients u nderwent a total of 15 embolization attempts on lesions involving the ophthalmic artery. Four patients had arteriovenous malformations of th e orbit, four had dural arteriovenous fistulae, two had orbital mening iomas, one had a planum sphenoidale meningioma, and one had a juvenile nasal angiofibroma. In each case, a Tracker No. 18 microcatheter (Tar get 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 m u m in diameter, 2-mm platinum microcoils, and n-butylcyanoacrylate. I n 12 of 15 cases, lidocaine and amytal provocation tests were conducte d before any attempt at embolization to assess the role of the ophthal mic artery in vision. RESULTS: Embolization was successfully performed in the 14 situations in which it was attempted. Positive results of t wo lidocaine/amytal tests were noted. In one case, embolization was no t attempted. in the other case, a larger caliber embolic agent (2-mm p latinum coils) was used. A single transient decrease in visual acuity lasting 4 days was the only embolization-related complication.CONCLUSI ON: Proper case selection, judicious use of embolic agents, and use of provocative testing can result in safe embolization of lesions suppli ed by the ophthalmic artery.