Pterygovaginal artery as a target of embolization before endoscopic skull base surgery

Keisuke Yoshida, Takenori Akiyama, Eytan Raz, Dai Kamamoto, Hiroyuki Ozawa, Masahiro Toda

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: The pterygovaginal artery (PtVA), a recurrent branch of the internal maxillary artery (IMA), can be a feeder of skull base tumors. Preoperative embolization can help endoscopic resection of hypervascular lesions, which is performed under a narrow surgical space with restricted instrumental maneuverability. Methods: We performed preoperative embolization in five cases with hypervascular skull base lesions supplied by the PtVA, four of which were resected via endoscopic endonasal approach. In two cases, selective PtVA embolization through the distal IMA was successfully conducted. Results: In all the cases, intraoperative bleeding during endoscopic resection was easily controlled. The medial and lateral origins of the PtVA from the IMA were demonstrated by cone-beam CT images reconstructed from three-dimensional rotational angiography, and anastomoses around the eustachian tube and soft palate were visualized by superselective angiography. Conclusions: The PtVA embolization can be an effective strategy before endoscopic skull base tumor resection. When embolizing through the PtVA, clinicians should be aware of its anatomical variations and dangerous anastomoses. Understanding the surrounding angioarchitecture by angiographic techniques helps ensure safe embolization.

Original languageEnglish
JournalNeuroradiology Journal
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • palatovaginal artery
  • Parasellar tumor
  • pharyngeal artery
  • preoperative embolization
  • pterygopalatine fossa
  • transnasal endoscopic skull base surgery
  • vascular anatomy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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