Embolization of meningohypophyseal and inferolateral branches of the cavernous internal carotid artery.

Background And Purpose: Despite the continued improvements in endovascular techniques this decade, few dedicated studies addressing the feasibility of such procedures or their efficacy relative to risk have been conducted. The purpose of this study was to use current endovascular techniques to assess the feasibility, effectiveness, and safety of direct selective catheterization and embolization of the small branches of the cavernous segment of the internal carotid artery.

Methods: We retrospectively reviewed the findings in 10 patients with lesions (five meningiomas and five arteriovenous malformations) primarily or partly supplied by branches of the meningohypophyseal trunk or inferolateral trunk who had undergone endovascular embolization of the feeding arteries during the period from 1991 to 1997. In each case, the artery was selectively catheterized with a microcatheter/microguidewire system and embolized with polyvinyl alcohol particles (n = 5), n-butyl cyanoacrylate tissue adhesive (n = 4), or both (n = 1).

Results: In all 10 patients, the feeding artery from the meningohypophyseal trunk (eight patients) or inferolateral trunk (three patients; one patient with both) was successfully catheterized and embolized. In nine patients, embolization resulted in complete obliteration of the vascular territory; in the remaining patient, blood supply was decreased by an estimated 80%. No immediate or delayed complications occurred.

Conclusion: Advances in microcatheter and microguidewire technology allow more efficient and safer selective catheterization and embolization of branches of the cavernous segment of the internal carotid artery than in the recent past. Meticulous technique and detailed knowledge of the vascular anatomy of the cavernous sinus region are necessary to maximize lesion devascularization and to minimize the risk of stroke, cranial nerve palsies, and blindness.