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The importance of neurovascular anatomy when managing patients, using endovascular techniques, was emphasized by neuroanatomists such as Pierre Lasjaunias some three dec-ades ago.
Over the years, many neurointerventional thera-pists have remained unaware of the pertinent details of neurovascular anatomy and its relevance for safe therapy. This often resulted in “unexpected” neurological complica-tions after embolization and. eventually, the perceived need to performvarious testing procedures to avoid complications at the time of embolization. Not only were these testing procedures unnecessary if available knowledge of the region-al anatomy had been applied, but these testing procedures were also often false-negative because of the fact that increased flow associated with arteriovenous shunts would simply sump the testing material away from the territory to be assessed. The tools that have become available during the last two decades are more and more sophisticated, making it tech-nically possible to reach very distal positions in the head and neck arterial vasculature.
It is thus not surprising that once such positions were reached. embolization with liquid mate-hal resulted in an anatomical cure of the target lesion but could also result in neurological complications because the distal arterial supply to the region, including collaterals, was completely eliminated.This has significant practical implica-tions: for instance, transarterial embolization of lesions in the cavernous sinus region may result in disruption of the arterial supply to the cranial nerves in this region. This. in turn, may correctly sway the neurointerventional therapist to not use the arterial approach but, rather, use the safer transvenous route’ The recognition of the presence of arterial variations is relevant in many clinical circumsiances:
• Variations in the arterial vascular anatomy may be responsible for “unexpected” neurological symptoms not in the classic distribution of the parent vessel’ therefore, protocols to examine the regional vascular anatomy a re of practical importance for understanding clinical symptoms and guiding therapy.
• Variations in the arterial anatomy indirectly indicate a lack of full maturation of the vessels, and therefore, a vulnerability tovessel wall disorders such as aneurysm formation.
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Medical Book PDF: Neurovascular Anatomy in Interventional Neuroradiology
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