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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleNeurointervention

Tumor Embolization through Meningohypophyseal and Inferolateral Trunks is Safe and Effective

E. Raz, D.D. Cavalcanti, C. Sen, E. Nossek, M. Potts, S. Peschillo, E. Lotan, V. Narayan, A. Ali, V. Sharashidze, P.K. Nelson and M. Shapiro
American Journal of Neuroradiology August 2022, 43 (8) 1142-1147; DOI: https://doi.org/10.3174/ajnr.A7579
E. Raz
aFrom the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
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D.D. Cavalcanti
aFrom the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
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C. Sen
bNeurointerventional Section, and Neurosurgery (C.S., E.N. P.K.N.), NYU Langone Health, New York, New York
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E. Nossek
bNeurointerventional Section, and Neurosurgery (C.S., E.N. P.K.N.), NYU Langone Health, New York, New York
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M. Potts
cDepartment of Neurological Surgery (M.P.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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S. Peschillo
dDepartment of Neurosurgery (S.P.), University of Catania, Catania, Italy
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E. Lotan
aFrom the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
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V. Narayan
aFrom the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
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A. Ali
aFrom the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
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V. Sharashidze
aFrom the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
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P.K. Nelson
aFrom the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
bNeurointerventional Section, and Neurosurgery (C.S., E.N. P.K.N.), NYU Langone Health, New York, New York
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M. Shapiro
aFrom the Departments of Radiology (E.R., D.D.C., E.L., V.N., A.A., V.S., P.K.N., M.S.)
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  • FIG 1.
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    FIG 1.

    A patient with a large right sphenoid wing meningioma with encasement of the ICA visible on a T1-weighted, axial, postcontrast image (A). Right ICA DSA injection in a lateral view (B) demonstrates the supply to the tumor from an enlarged meningohypophyseal trunk. After selective embolization through both the meningohypophyseal trunk and indirectly from the middle meningeal artery, a final right common carotid artery injection in a lateral view (C) demonstrates interval 90% tumor embolization. Complete gross resection of the meningioma is visible on the T1-weighted, axial, postcontrast image (D). RT indicates right; CCA, common carotid artery; EMB, embolization.

  • FIG 2.
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    FIG 2.

    A patient with a Meckel cave meningioma also with involvement of the cavernous sinus visible on a T1-weighted, axial, postcontrast image (A). Right ICA DSA injection in lateral view (B) demonstrates the supply to the tumor from an enlarged inferolateral trunk from the left ICA. Inferolateral trunk catheterization is performed with a Headway Duo over a Synchro-14 microguidewire (C and D). MICRO DSA performed through a microcatheter on a lateral view (unsubtracted, E, and subtracted, F) better demonstrates the selective supply to the meningioma. Final lateral view ICA injection (G) demonstrates marked interval reduction of blush in the region of the tumor. Complete gross resection of the meningioma is visible on a T1-weighted, axial, postcontrast image (H). LT indicates left.

  • FIG 3.
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    FIG 3.

    A patient with a right petroclival meningioma as shown on MR imaging T2 (A) and postcontrast T1 (B). A right ICA injection lateral view DSA (C) demonstrates a large blush supplied by the meningohypophyseal trunk. Selective catheterization and DSA (D) with a Marathon microcatheter (Medtronic), followed by embolization with 45- to 150- and 150- to 250-μm particles. Final right ICA injection, lateral view DSA (E) demonstrates resolution of the previously seen blush. Final CT (F) postsurgical resection demonstrates complete excision with a small amount of retraction injury in the right temporal lobe.

  • FIG 4.
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    FIG 4.

    A patient with a left anterior clinoid meningioma as shown on postcontrast T1 MR imaging (A). A left ICA injection, lateral view DSA (B), demonstrates a large blush supplied by the meningohypophyseal trunk. Selective catheterization with unsubtracted (C) and subtracted (D) views with a Marathon microcatheter, followed by embolization with 45- to 150-μm particles. A final left ICA injection, lateral view DSA (E) demonstrates 60% embolization of the tumor. A final MR imaging T1 postcontrast (F) postsurgical resection demonstrates partial excision of the mass.

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American Journal of Neuroradiology: 43 (8)
American Journal of Neuroradiology
Vol. 43, Issue 8
1 Aug 2022
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Cite this article
E. Raz, D.D. Cavalcanti, C. Sen, E. Nossek, M. Potts, S. Peschillo, E. Lotan, V. Narayan, A. Ali, V. Sharashidze, P.K. Nelson, M. Shapiro
Tumor Embolization through Meningohypophyseal and Inferolateral Trunks is Safe and Effective
American Journal of Neuroradiology Aug 2022, 43 (8) 1142-1147; DOI: 10.3174/ajnr.A7579

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Tumor Embolization through Specific Arteries
E. Raz, D.D. Cavalcanti, C. Sen, E. Nossek, M. Potts, S. Peschillo, E. Lotan, V. Narayan, A. Ali, V. Sharashidze, P.K. Nelson, M. Shapiro
American Journal of Neuroradiology Aug 2022, 43 (8) 1142-1147; DOI: 10.3174/ajnr.A7579
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  • Tumor Embolization via the Meningohypophyseal and Inferolateral Trunk in Patients with Skull Base Tumors Using the Distal Balloon Protection Technique
  • Outcomes of Preoperative Transophthalmic Artery Embolization of Meningiomas: A Systematic Review with a Focus on Embolization Agent
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