HNO

, 59:340

Neuroradiologische Diagnostik und Interventionen bei Prozessen an der Schädelbasis

Leitthema

Zusammenfassung

In der Zusammenarbeit mit der Kopf-Hals-Chirurgie liegt neben der bildgesteuerten Gewebeentnahme ein besonderer neuroradiologischer Schwerpunkt in gefäßerhaltenden und gefäßverschließenden Maßnahmen. Hierbei ist die Kenntnis „gefährlicher“ Anastomosen zwischen extra- und intrakraniellen Gefäßen entscheidend. Es werden grundlegende Prinzipien der gefäßverschließenden Maßnahmen einschließlich der verwendeten Materialien vorgestellt und anhand von Fallbeispielen erläutert. Neben Embolisationen von Glomustumoren werden Behandlungsverfahren bei Epistaxis und zur präoperativen Okklusion der A. carotis interna vorgestellt. Ebenso werden gefäßerhaltende Behandlungen wie die Einbringung „gecoverter“ Stents zur Verbesserung der Resektabilität bei gefäßinfiltrierenden Tumoren oder nach iatrogener Verletzung der A. carotis interna im Rahmen von Schädelbasisoperationen erläutert.

Schlüsselwörter

Gefährliche Anastomosen Epistaxis Ballonokklusion Hirngefäßokklusion Biopsie 

Neuroradiologic diagnostic and interventional procedures for diseases of the skull base

Abstract

Besides image-guided biopsy techniques, the emphasis in the interdisciplinary cooperation between head and neck surgery and neuroradiology is on vessel-occluding and preserving measures. Knowledge of dangerous anastomoses between extracranial and intracranial vessels is crucial. The principles of vessel-occluding procedures including materials are presented and illustrated with case examples. Embolization of glomus tumors or epistaxis and preoperative permanent vessel occlusion techniques are demonstrated as well as vessel-preserving therapies, such as placement of covered stents for improving tumor resectability or after iatrogenic laceration of the internal carotid artery.

Keywords

Dangerous anastomoses Epistaxis Balloon occlusion Cerebrovascular occlusion Biopsy 

Literatur

  1. 1.
    Geibprasert S, Pongpech S, Armstrong D, Krings T (2009) Dangerous extracranial-intracranial anastomoses and supply to the cranial nerves: vessels the neurointerventionalist needs to know. AJNR Am J Neuroradiol 30:1459–1468PubMedCrossRefGoogle Scholar
  2. 2.
    Landwehr P, Arnold S, Voshage G, Reimer P (2008) Grundlagen der Embolisation und anderer verschließender Verfahren. Radiologe 48:73–95PubMedCrossRefGoogle Scholar
  3. 3.
    Ulrich S, Lehmann M, Ebmeyer J et al (2009) Direct percutaneous embolization of a carotid body tumor with Onyx. HNO 57:1305–1310PubMedCrossRefGoogle Scholar
  4. 4.
    Wanke I, Jackel MC, Goericke S et al (2009) Percutaneous embolization of carotid paragangliomas using solely Onyx. AJNR Am J Neuroradiol 30:1594–1597PubMedCrossRefGoogle Scholar
  5. 5.
    Lehmann M, Ulrich S, Reineke U et al (2010) Intratumoral Onyx embolisation in the management of juvenile nasopharyngeal angiofibroma. HNO 58:853–857PubMedCrossRefGoogle Scholar
  6. 6.
    Turowski B, Zanella FE (2003) Interventional neuroradiology of the head and neck. Neuroimaging Clin N Am 13:619–645PubMedCrossRefGoogle Scholar
  7. 7.
    Christensen NP, Smith DS, Barnwell SL, Wax MK (2005) Arterial embolization in the management of posterior epistaxis. Otolaryngol Head Neck Surg 133:748–753PubMedCrossRefGoogle Scholar
  8. 8.
    Wanke I, Lautermann J, Moller-Hartmann C, Forsting M (2009) Endovascular treatment of epistaxis of the internal carotid artery. Vessel occlusion and vessel preservation. HNO 57:953–957PubMedCrossRefGoogle Scholar
  9. 9.
    Koh E, Frazzini VI, Kagetsu NJ (2000) Epistaxis: vascular anatomy, origins, and endovascular treatment. AJR Am J Roentgenol 174:845–851PubMedGoogle Scholar
  10. 10.
    Willems PW, Farb RI, Agid R (2009) Endovascular treatment of epistaxis. AJNR Am J Neuroradiol 30:1637–1645PubMedCrossRefGoogle Scholar
  11. 11.
    Layton KF, Kallmes DF, Gray LA, Cloft HJ (2007) Endovascular treatment of epistaxis in patients with hereditary hemorrhagic telangiectasia. AJNR Am J Neuroradiol 28:885–888PubMedGoogle Scholar
  12. 12.
    Maves MD, Bruns MD, Keenan MJ (1992) Carotid artery resection for head and neck cancer. Ann Otol Rhinol Laryngol 101:778–781PubMedGoogle Scholar
  13. 13.
    Matas R (1911) Testing the efficiency of the collateral circulation as a preliminary to the occlusion of the great surgical arteries. Ann Surg 53:1–43PubMedCrossRefGoogle Scholar
  14. 14.
    Keller E, Ries F, Urbach H et al (1996) Endovascular balloon occlusion test of the internal carotid artery with increased hemodynamic monitoring for determination of circulatory reserve before planned carotid occlusion. Rofo 164:324–330PubMedGoogle Scholar
  15. 15.
    Sorteberg A, Bakke SJ, Boysen M, Sorteberg W (2008) Angiographic balloon test occlusion and therapeutic sacrifice of major arteries to the brain. Neurosurgery 63:651–660PubMedCrossRefGoogle Scholar
  16. 16.
    Gruber A, Dorfer C, Bavinszki G, Standhardt HKE (2010) Neurochirurgische Möglichkeiten der Versorgung endovaskulär vorbehandelter zerebraler Aneurysmen. Management von Aneurysmarezidiven, Nachblutungen und endovaskulären Komplikationen. J Neurol Neurochir Psychiatr 11:46–57Google Scholar
  17. 17.
    Mathis JM, Barr JD, Jungreis CA et al (1995) Temporary balloon test occlusion of the internal carotid artery: experience in 500 cases. AJNR Am J Neuroradiol 16:749–754PubMedGoogle Scholar
  18. 18.
    Serbienko FA (1974) Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 41:125–145CrossRefGoogle Scholar
  19. 19.
    Barr JD, Lemley TJ (1999) Endovascular arterial occlusion accomplished using microcoils deployed with and without proximal flow arrest: results in 19 patients. AJNR Am J Neuroradiol 20:1452–1456PubMedGoogle Scholar
  20. 20.
    Murphy KJ, Houdart E, Szopinski KT et al (2001) A report of the Clinical Use of the Detach-18 mechanical Detachable Platinum Coil in 41 patients. AJNR Am J Neuroradiol 22:341–344Google Scholar
  21. 21.
    Sanna M, Piazza P, Ditrapani G, Agarwal M (2004) Management of the internal carotid artery in tumors of the lateral skull base: preoperative permanent balloon occlusion without reconstruction. Otol Neurotol 25:998–1005PubMedCrossRefGoogle Scholar
  22. 22.
    Field M, Jungreis CA, Chengelis N et al (2003) Symptomatic cavernous sinus aneurysms: management and outcome after carotid occlusion and selective cerebral revascularization. AJNR Am J Neuroradiol 24:1200–1207PubMedGoogle Scholar
  23. 23.
    Mehdorn HM (2008) Cerebral revascularization by EC-IC bypass–present status. Acta Neurochir Suppl 103:73–77PubMedCrossRefGoogle Scholar
  24. 24.
    Vajkoczy P (2009) Revival of extra-intracranial bypass surgery. Curr Opin Neurol 22:90–95PubMedCrossRefGoogle Scholar
  25. 25.
    Brott TG, Hobson RW, Howard G et al (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23PubMedCrossRefGoogle Scholar
  26. 26.
    Ederle J, Dobson J, Featherstone RL et al (2010) Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 375:985–997PubMedCrossRefGoogle Scholar
  27. 27.
    Hopkins LN, Roubin GS, Chakhtoura EY et al (2010) The Carotid Revascularization Endarterectomy versus Stenting Trial: credentialing of interventionalists and final results of lead-in phase. J Stroke Cerebrovasc Dis 19:153–162PubMedCrossRefGoogle Scholar
  28. 28.
    Sanna M, De DG, Piazza P, Falcioni M (2006) Revision glomus tumor surgery. Otolaryngol Clin North Am 39:763–82, viiPubMedCrossRefGoogle Scholar
  29. 29.
    Sanna M, Piazza P, De DG et al (2009) Combined endovascular-surgical management of the internal carotid artery in complex tympanojugular paragangliomas. Skull Base 19:26–42PubMedCrossRefGoogle Scholar
  30. 30.
    Vanninen RL, Manninen HI, Rinne J (2003) Intrasellar latrogenic carotid pseudoaneurysm: endovascular treatment with a polytetrafluoroethylene-covered stent. Cardiovasc Intervent Radiol 26:298–301PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Institut für Diagnostische und Interventionelle Radiologie, Medizinische FakultätHeinrich-Heine-UniversitätDüsseldorfDeutschland

Personalised recommendations