PMC6159188_01
MRI and CT images obtained at the age of 3 months. (a) T2-weighted MRI showing a large mass with mixed intensity in the right occipital region (arrow). (b) CT scan showing a large mass with bony structure involvement in the right occipital region (arrow).
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CT and MRI scans showed a large mass in the right occipital region with bony structure involvement (Figure 1).
Digital subtraction angiograms (DSAs) performed during embolization. Small arrowheads indicate previously placed embolization coils. (a) Superselective DSA from the right superficial temporal artery shows tumour blush in the occipital region. (b) DSA from the external carotid artery showing a marked post-embolization decrease in tumour blush. (c) Superselective DSA from the right middle meningeal artery shows the lacrimal artery (arrow) and a tumour blush. After advancing the microcatheter tip distally to the orifice of the lacrimal artery to prevent the migration of embolic materials into the orbital structures, the feeding artery was embolized. (d) Superselective DSA from the right occipital artery reveals a tumour blush and the vertebrobasilar artery (large arrows) via the C1 collateral (small arrow). (e) The anastomosis was embolized before coil embolization. (f) DSA from the external carotid artery after final embolization shows a marked decrease in the tumour blush. The arrow points to the coil used to embolize the C1 collateral.
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Using a 4-French diagnostic catheter as a guiding catheter, a 2.5-French Renegade microcatheter (Boston Scientific Corp.) was selectively positioned at the distal portion of the right superficial temporal artery (Figure 2a) and CPBs (230 mum) suspended in contrast medium were slowly injected until the tumour blush disappeared on DSA (Figure 2b). Then the right middle meningeal artery was similarly embolized after the tip of the microcatheter was advanced distally to the orifice of the lacrimal artery to prevent the migration of CPBs into the orbital structures (Figure 2c). As DSA of the right occipital artery revealed not only tumour blush but also the vertebrobasilar artery (Figure 2d), we used interlocking detachable coils to embolize the dangerous anastomosis of the C1 collateral from the occipital artery (Figure 2e). Embolization of the three feeders was successful and there was a marked decrease in the tumour blush (Figure 2f).
The T2 weighted MRI obtained 6 months after embolization shows a significant decrease in the tumour size (arrow).
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The tumour size decreased gradually and the tumour was remarkably smaller 6 months after embolization (Figure 3).