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A case of central retinal artery occlusion following embolization procedure for juvenile nasopharyngeal angiofibroma.

Ramezani A, Haghighatkhah H, Moghadasi H, Taheri MS, Parsafar H - Indian J Ophthalmol (2010 Sep-Oct)

Bottom Line: Classic CRAO management was initiated by an ophthalmologist after 12 h.During endoscopic excision, the tumor was found to originate extraordinarily from midline structures.Careful preoperative angiographic evaluations to detect communicating arteries and immediate ophthalmologic consultation in case of developing visual symptoms during the procedure are necessary.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Imam Hossein Medical Center, Shaheed Beheshti Medical University, Tehran, Iran.

ABSTRACT
A 23-year-old male patient with right nasal Juvenile Nasopharyngeal Angiofibroma (JNA) developed Central Retinal Artery Occlusion (CRAO) during embolization of the tumor using polyvinyl alcohol particles before endoscopic excision. Classic CRAO management was initiated by an ophthalmologist after 12 h. Retrospective evaluation of the angiograms revealed a tiny communication between the external carotid and ophthalmic arteries which had not been noticed before embolization. During endoscopic excision, the tumor was found to originate extraordinarily from midline structures. It was concluded that CRAO might be a rare complication of JNA embolization. Careful preoperative angiographic evaluations to detect communicating arteries and immediate ophthalmologic consultation in case of developing visual symptoms during the procedure are necessary.

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Pre-embolization angiogram demonstrating tumor bush (arrow head) and a suspicious tiny communicating artery between external carotid and ophthalmic arteries (arrows)
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Figure 0001: Pre-embolization angiogram demonstrating tumor bush (arrow head) and a suspicious tiny communicating artery between external carotid and ophthalmic arteries (arrows)

Mentions: In order to reduce bleeding during the later endoscopic resection, the patient underwent a transarterial particulate embolization procedure as a part of preoperative preparation. After catheterization of both external carotid arteries with 5 F MP catheters (Cordis) via right transfemoral approach, selective angiography was performed. Abnormal tumor blush [Fig. 1, arrowhead] was noted with bilateral supply from both internal maxillary and ascending pharyngeal arteries. Neither extracranial-intracranial communication nor external-internal carotid collateral artery was detected. Therefore, embolization process was carried out bilaterally using Polyvinyl Alcohol (PVA) particles (150-250 micrometer) through both internal maxillary and ascending pharyngeal arteries. The progress of the vascular occlusion during embolization was monitored with repeated hand injection of contrast mediath. Before finishing the embolization the patient complained of sudden loss of vision in his left eye. After a control angiography, the procedure was stopped and 5000 IU heparin was injected intravenously. Immediate post-embolization angiograms demonstrated a successful reduction of the tumor blush with no reperfusion.


A case of central retinal artery occlusion following embolization procedure for juvenile nasopharyngeal angiofibroma.

Ramezani A, Haghighatkhah H, Moghadasi H, Taheri MS, Parsafar H - Indian J Ophthalmol (2010 Sep-Oct)

Pre-embolization angiogram demonstrating tumor bush (arrow head) and a suspicious tiny communicating artery between external carotid and ophthalmic arteries (arrows)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992919&req=5

Figure 0001: Pre-embolization angiogram demonstrating tumor bush (arrow head) and a suspicious tiny communicating artery between external carotid and ophthalmic arteries (arrows)
Mentions: In order to reduce bleeding during the later endoscopic resection, the patient underwent a transarterial particulate embolization procedure as a part of preoperative preparation. After catheterization of both external carotid arteries with 5 F MP catheters (Cordis) via right transfemoral approach, selective angiography was performed. Abnormal tumor blush [Fig. 1, arrowhead] was noted with bilateral supply from both internal maxillary and ascending pharyngeal arteries. Neither extracranial-intracranial communication nor external-internal carotid collateral artery was detected. Therefore, embolization process was carried out bilaterally using Polyvinyl Alcohol (PVA) particles (150-250 micrometer) through both internal maxillary and ascending pharyngeal arteries. The progress of the vascular occlusion during embolization was monitored with repeated hand injection of contrast mediath. Before finishing the embolization the patient complained of sudden loss of vision in his left eye. After a control angiography, the procedure was stopped and 5000 IU heparin was injected intravenously. Immediate post-embolization angiograms demonstrated a successful reduction of the tumor blush with no reperfusion.

Bottom Line: Classic CRAO management was initiated by an ophthalmologist after 12 h.During endoscopic excision, the tumor was found to originate extraordinarily from midline structures.Careful preoperative angiographic evaluations to detect communicating arteries and immediate ophthalmologic consultation in case of developing visual symptoms during the procedure are necessary.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Imam Hossein Medical Center, Shaheed Beheshti Medical University, Tehran, Iran.

ABSTRACT
A 23-year-old male patient with right nasal Juvenile Nasopharyngeal Angiofibroma (JNA) developed Central Retinal Artery Occlusion (CRAO) during embolization of the tumor using polyvinyl alcohol particles before endoscopic excision. Classic CRAO management was initiated by an ophthalmologist after 12 h. Retrospective evaluation of the angiograms revealed a tiny communication between the external carotid and ophthalmic arteries which had not been noticed before embolization. During endoscopic excision, the tumor was found to originate extraordinarily from midline structures. It was concluded that CRAO might be a rare complication of JNA embolization. Careful preoperative angiographic evaluations to detect communicating arteries and immediate ophthalmologic consultation in case of developing visual symptoms during the procedure are necessary.

Show MeSH
Related in: MedlinePlus