Go Back
This abstract was viewed 61 times

Case report


Imaging of Unilateral Meningo-ophthalmic Artery Anomaly in a Patient with Bilateral Nasopharyngeal Angiofibroma.

Louise LouwJohan SteylEugene Loggenberg
Departments of Otorhinolaryngology, Basic Medical Sciences and Clinical Imaging Sciences, University of the Free State, Bloemfontein, South Africa
Date of Submission: 12-Aug-2014, Date of Acceptance: 14-Oct-2014, Date of Web Publication: 29-Nov-2014.
Corresponding Author:
Corresponding Author

Louise Louw

Department Otorhinolaryngology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
E-mail: gnanll@ufs.ac.za

Corresponding Author:
Corresponding Author

Louise Louw

Department Otorhinolaryngology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
E-mail: gnanll@ufs.ac.za

DOI: 10.4103/2156-7514.145889 Facebook Twitter Google Linkedin

ABSTRACT


A 12-year-old boy with epistaxis presented with a rare midline nasopharyngeal angiofibroma that extended lateral into the pterygoid and infratemporal fossae. Pre-operative angiography revealed bilateral prominent feeder arteries and two major anastomotic connections, and a rare left meningo-ophthalmic artery (M-OA) anomaly that was the sole path of supply to the eye. A literature search using Pubmed and Medline was conducted. For imaging, a six-vessel study (i.e. external and internal carotid and vertebral arteries on both sides) was selected. Embolization of prominent tumor feeder arteries was unsafe for tumor extirpation, but super-selective embolization of both sphenopalatine arteries was performed to control epistaxis. The M-OA anomaly that originated from the maxillary artery (MA) was marked by an ophthalmic artery (OA) variant with orbital and ocular divisions that coursed through the superior orbital fissure and optic foramen, respectively, each with distinct branching patterns, a middle meningeal artery (MMA) with normal branches (i.e. anterior and posterior branches), and two branch variations (i.e. lacrimal and meningeal branches) that originated from the anterior branch of the MMA. The lacrimal branch coursed through a cranio-orbital foramen, but the meningeal branch remained outside the orbit. The anatomy of the right OA was normal. The left M-OA anomaly was considered incidental and not tumor-related since the tumor was more prominent on the right side, and no intra-orbital infiltrations occurred. Of clinical significance is that proximal embolization of MA or MMA carries a high risk of visual impairment in cases where M-OA anomalies are the sole mode of supply to the eye.
Keywords: Dangerous Extracranial–intracranial Anastomoses, Dangerous Intracranial–extracranial Connections, Meningo-ophthalmic Artery Anomaly, Nasopharyngeal Angiofibroma, Pre-operative Angiography

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.