Pictorial essay: Vascular interventions in extra cranial head and neck

Suyash S Kulkarni; Nitin S Shetty; Tejas P Dharia; Ashwin M Polnaya

doi:10.4103/0971-3026.111490

Indian Journal of Radiology and Imaging, Table of Contents

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2012; 22(04): 350-357
DOI: 10.4103/0971-3026.111490

ORIGINAL ARTICLE

Pictorial essay: Vascular interventions in extra cranial head and neck

Suyash S Kulkarni

Department of Radiodiagnosis, Tata Memorial Centre, Parel, Mumbai

,

Nitin S Shetty

Department of Radiodiagnosis, Tata Memorial Centre, Parel, Mumbai

,

Tejas P Dharia

Department of Radiodiagnosis, Tata Memorial Centre, Parel, Mumbai

,

Ashwin M Polnaya

Department of Radiodiagnosis, Tata Memorial Centre, Parel, Mumbai

› Author Affiliations

Abstract

PDF Download

Abstract

Medicine is an ever changing field and interventional radiology (IR) procedures are becoming increasingly popular because of high efficacy and its minimally invasive nature of the procedure. Management of disease processes in the extra cranial head and neck (ECHN) has always been a challenge due to the complex anatomy of the region. Cross sectional imaging of the ECHN has grown and evolved tremendously and occupies a pivotal and integral position in the clinical management of variety of head and neck pathologies. Advances in angiographic technologies including flat panel detector systems, biplane, and 3-dimensional rotational angiography have consolidated and expanded the role of IR in the management of various ECHN pathologies. The ECHN is at cross roads between the origins of great vessels and the cerebral vasculature. Thorough knowledge of functional and technical aspects of neuroangiography is essential before embarking on head and neck vascular interventions. The vessels of the head and neck can be involved by infectious and inflammatory conditions, get irradiated during radiotherapy and injured due to trauma or iatrogenic cause. The ECHN is also a common site for various hypervascular neoplasms and vascular malformations, which can be treated with endovascular and percutaneous embolization. This pictorial essay provides a review of variety of ECHN pathologies which were managed by various IR procedures using different approaches.

Keywords

Carotid blowout - Embolization - stent graft - sclerotherapy - vascular interventions

PDF (3554 kb)

References

References
1 Gandhi D, Gemmete JJ, Ansari SA, Gujar SK, Mukherji SK. Interventional Neuroradiology of the Head and Neck. AJNR Am J Neuroradiol 2008;29:1806-15.
2 Lowe LH, Marchant TC, Rivard DC, Scherbel AJ. Vascular malformation: Classifications and terminology the radiologist needs to know. Semin Rotengenol 2012;47:106-17.
3 Armstrong DC, ter Brugge K. Selected interventional procedures for pediatric head and neck vascular lesions. Neuroimaging Clin N Am 2000;10:271-92.
4 Erdmann MW, Jackson JE, Davies DM, Allison DJ. Multidisciplinary approach to the management of head and neck arteriovenous malformations. Ann R Coll Surg Engl 1995;77:53-9.
5 Arat A, Cil BE, Vargel I, Turkbey B, Canyigit M, Peynircioglu B, et al. Embolization of high-flow craniofacial vascular malformations with onyx. AJNR Am J Neuroradiol 2007;28:1409-14.
6 Berenguer B, Burrows PE, Zurakowski D, Mulliken JB. Sclerotherapy of craniofacial venous malformations: Complications and results. Plast Reconstr Surg 1999;104:1-11.
7 Cabrera J, Cabrera J Jr, Garcia-Olmedo MA, Redondo P. Treatment of venous malformations with sclerosant in microfoam form. Arch Dermatol 2003;139:1409-16.
8 Ryu CW, Whang SM, Suh DC, Kim SM, Jang YJ, Kim HJ, et al. Percutaneous Direct Puncture Glue Embolization of High-Flow Craniofacial Arteriovenous Lesions: A New Circular Ring Compression device with a beveled edge. AJNR Am J Neuroradiol 2007;28:528-30.
9 Wakhloo AK, Juengling FD, Van Velthoven V, Schumacher M, Hennig J, Schwechheimer K. Extended preoperative polyvinyl alcohol microembolization of intracranial meningiomas: Assessment of two embolization techniques. AJNR Am J Neuroradiol 1993;14:571-82.
10 Valavanis A. Preoperative embolization of the head and neck: Indications, patient selection, goals, and precautions. AJNR Am J Neuroradiol 1986;7:943-52.
11 Pérez Higueras A, Saura Lorente P, García Alonso J, de las Heras García JA. Diagnosis and treatment of head and neck paragangliomas. Uses of angiography and interventional radiology. Acta Otorrinolaringol Esp 2009;60:53-67.
12 Gruber A, Bavinzski G, Killer M, Richling B. Preoperative embolization of hypervascular skull base tumors. Minim Invasive Neurosurg 2000;43:62-71.
13 Tseng EY, Narducci CA, Willing SJ, Sillers MJ. Angiographic embolization for epistaxis: A review of 114 cases. Laryngoscope 1998;108:615-9.
14 Ungkanont K, Byers RM, Weber RS, Callender DL, Wolf PF, Goepfert H. Juvenile nasopharyngeal angiofibroma: An update of therapeutic management. Head Neck 1996;18:60e6.
15 Chaloupka JC, Putman CM, Citardi MJ, Ross DA, Sasaki CT. Endovascular therapy for the carotid blowout syndrome in head and neck surgical patients: Diagnostic and managerial considerations. AJNR Am J Neuroradiol 1996;17:843-52.
16 Goodman DN, Hoh BL, Rabinov JD, Pryor JC. CT angiography before embolization for hemorrhage in head and neck cancer. AJNR Am J Neuroradiol 2003;24:140-2.
17 Andersen PJ, Kjeldsen AD, Nepper-Rasmussen J. Selective embolization in the treatment of intractable epistaxis. Acta Otolaryngol 2005;125:293-7.
18 Morrissey DD, Andersen PE, Nesbit GM, Barnwell SL, Everts EC, Cohen JI. Endovascular management of hemorrhage in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 1997;123:15-9.
19 Sittel C, Gossmann A, Jungehülsing M, Zähringer M. Superselective embolization as palliative treatment of recurrent hemorrhage in advanced carcinoma of the head and neck. Ann Otol Rhinol Laryngol 2001;110:1126-8.
20 Miller PR, Fabian TC, Croce MA, Cagiannos C, Williams JS, Vang M, et al. Prospective screening for blunt cerebrovascular injuries: Analysis of diagnostic modalities and outcomes. Ann Surg 2002;236:386-93.
21 Chang FC, Lirng JF, Luo CB, Guo WY, Teng MM, Tai SK, et al. Carotid blowout syndrome in patients with head-and-neck cancers: Reconstructive management by self-expandable stent-grafts. AJNR Am J Neuroradiol 2007;28:181-8.
22 Dubose J, Recinos G, Teixeira PG, Inaba K, Demetriades D. Endovascular stenting for the treatment of traumatic internal carotid injuries: Expanding experience. J Trauma 2008;65:1561-6.
23 Santhosh J, Rao VR, Ravimandalam K, Gupta AK, Unni NM, Rao AS. Endovascular management of carotid cavernous fistulae: Observation on angiographic and clinical results. Acta Neurol Scand 1993;88:320-6.
24 Gobin YP, Garcia de la Fuente JA, Herbreteau D, Houdart E, Merland JJ. Endovascular treatment of external carotid-jugular fistulae in the parotid region. Neurosurgery 1993;33:812-6.