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An Anatomical Feasibility Study for Revascularization of the Ophthalmic Artery. Part II: Intraorbital Segment.

Abstract

INTRODUCTION

Distal ophthalmic artery (OpA) aneurysms are a rare subset of vascular lesions with lack of optimal treatment. The management of these aneurysms may require complete occlusion of the parent vessel, carrying a risk of permanent visual impairment due to individual variations of extracranial collateral flow to the intraorbital ophthalmic artery (iOpA).

OBJECTIVE

To test the feasibility of a superficial temporal artery (STA) to iOpA bypass to prevent acute ischemic retinal injury. Two different transorbital corridors (superomedial and posterolateral approaches) for this bypass were evaluated.

METHODS

Each approach was carried out in 10 specimens each (n = 20). The corridors were compared to achieve the optimal exposure of the iOpA until the central retinal artery origin was visualized. An end-to-end anastomosis was performed from STA-to-iOpA. The arterial caliber and length at the anastomotic sites, required donor artery length, and intraorbital surgical area were measured.

RESULTS

STA-iOpA bypasses were performed in all specimens. For the posterolateral transorbital approach, the mean caliber of STA was 1.8 ± 0.2 mm, and that of iOpA was 1.7 ± 0.5 mm. The required STA graft length was 78.3 ± 1 mm with lateral iOpA transposition of 8.2 ± 1.1 mm. For the superomedial approach, the average STA length required for an intraorbital bypass was 130.8 ± 14.0 mm. The mean calibers of iOpA and STA were 1.5 ± 0.1 mm and 1.5 ± 0.1 mm, respectively.

CONCLUSIONS

This study demonstrates the feasibility of a novel revascularization technique of the iOpA using 2 different transorbital approaches. These techniques can be used in the management of intraorbital lesions such as OpA aneurysms, tumoral infiltrations, or intraoperative injuries.

Authors+Show Affiliations

Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA. Electronic address: neurodriguez@gmail.com.Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31520756

Citation

Rubio, Roberto Rodriguez, et al. "An Anatomical Feasibility Study for Revascularization of the Ophthalmic Artery. Part II: Intraorbital Segment." World Neurosurgery, 2019.
Rubio RR, Vigo V, Gandhi S, et al. An Anatomical Feasibility Study for Revascularization of the Ophthalmic Artery. Part II: Intraorbital Segment. World Neurosurg. 2019.
Rubio, R. R., Vigo, V., Gandhi, S., Tabani, H., Meybodi, A. T., Winkler, E. A., ... Benet, A. (2019). An Anatomical Feasibility Study for Revascularization of the Ophthalmic Artery. Part II: Intraorbital Segment. World Neurosurgery, doi:10.1016/j.wneu.2019.08.261.
Rubio RR, et al. An Anatomical Feasibility Study for Revascularization of the Ophthalmic Artery. Part II: Intraorbital Segment. World Neurosurg. 2019 Sep 11; PubMed PMID: 31520756.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An Anatomical Feasibility Study for Revascularization of the Ophthalmic Artery. Part II: Intraorbital Segment. AU - Rubio,Roberto Rodriguez, AU - Vigo,Vera, AU - Gandhi,Sirin, AU - Tabani,Halima, AU - Meybodi,Ali Tayebi, AU - Winkler,Ethan A, AU - Abla,Adib A, AU - Lawton,Michael T, AU - Benet,Arnau, Y1 - 2019/09/11/ PY - 2019/05/15/received PY - 2019/08/20/revised PY - 2019/08/22/accepted PY - 2019/9/15/pubmed PY - 2019/9/15/medline PY - 2019/9/15/entrez KW - Extracranial–intracranial bypass KW - Intracanalicular KW - Intraorbital KW - Ophthalmic artery KW - Posterolateral orbitotomy KW - Superficial temporal artery KW - Superomedial orbitotomy JF - World neurosurgery JO - World Neurosurg N2 - INTRODUCTION: Distal ophthalmic artery (OpA) aneurysms are a rare subset of vascular lesions with lack of optimal treatment. The management of these aneurysms may require complete occlusion of the parent vessel, carrying a risk of permanent visual impairment due to individual variations of extracranial collateral flow to the intraorbital ophthalmic artery (iOpA). OBJECTIVE: To test the feasibility of a superficial temporal artery (STA) to iOpA bypass to prevent acute ischemic retinal injury. Two different transorbital corridors (superomedial and posterolateral approaches) for this bypass were evaluated. METHODS: Each approach was carried out in 10 specimens each (n = 20). The corridors were compared to achieve the optimal exposure of the iOpA until the central retinal artery origin was visualized. An end-to-end anastomosis was performed from STA-to-iOpA. The arterial caliber and length at the anastomotic sites, required donor artery length, and intraorbital surgical area were measured. RESULTS: STA-iOpA bypasses were performed in all specimens. For the posterolateral transorbital approach, the mean caliber of STA was 1.8 ± 0.2 mm, and that of iOpA was 1.7 ± 0.5 mm. The required STA graft length was 78.3 ± 1 mm with lateral iOpA transposition of 8.2 ± 1.1 mm. For the superomedial approach, the average STA length required for an intraorbital bypass was 130.8 ± 14.0 mm. The mean calibers of iOpA and STA were 1.5 ± 0.1 mm and 1.5 ± 0.1 mm, respectively. CONCLUSIONS: This study demonstrates the feasibility of a novel revascularization technique of the iOpA using 2 different transorbital approaches. These techniques can be used in the management of intraorbital lesions such as OpA aneurysms, tumoral infiltrations, or intraoperative injuries. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/31520756/An_Anatomical_Feasibility_Study_for_Revascularization_of_the_Ophthalmic_Artery__Part_II:_Intraorbital_Segment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(19)32429-5 DB - PRIME DP - Unbound Medicine ER -