ARRS 2022 Abstracts

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E1718. I See the Light...and Variant Ophthalmic Arteries: What the Neurosurgeon Wants to Know
Authors
  1. Fatima Khan; University of North Texas Health Science Center Texas College of Osteopathic Medicine
  2. Rebekah Padilla; University of Florida College of Medicine - Jacksonville
  3. Sai Swarupa Vulasala; University of Florida College of Medicine - Jacksonville
  4. Padma Adimula; University of Florida College of Medicine - Jacksonville
  5. David Szames; University of Florida College of Medicine - Jacksonville
  6. Peter Fiester; University of Florida College of Medicine - Jacksonville
Background
This exhibit will review and illustrate ophthalmic artery embryology, anatomy and radiologic findings on various imaging modalities to aid radiologists, radiology residents, and radiology medical students in effective communication of clinically important findings to the neurosurgeon and neurointerventionalist.

Educational Goals / Teaching Points
We discuss ophthalmic artery embryology and anatomy, as it relates to the internal carotid artery. Types of variations that have been reported and their associated findings are reviewed. We also examine how these variations are relevant clinically and discuss what neurosurgeons and neurointerventionalists should consider when planning treatments. Real-world cases in which bilateral ophthalmic arteries originate from the cavernous segment of the internal carotid artery (ICA) are utilized to illustrate imaging findings. Dangerous anastomoses are reviewed. Origin from the cavernous segment of the ICA have also been reported and have been coined as persistent dorsal OA. According to the widely accepted Padget’s theory of OA development, an intra-cavernous origin of the OA is explained by the persistence of anastomoses of the lateral branch of the primitive maxillary artery with the first segment of OA. The prevalence of a persistent dorsal OA and OA arising from the middle meningeal artery are reviewed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Findings on CTA images of variant persistent dorsal ophthalmic arteries originating from the cavernous segment of the ICA are reviewed. Sagittal CTA images of the variant left ophthalmic artery coursing through the superior orbital fissure rather than its original course through the optic canal. We also present MRA images with 3D maximal intensity projection demonstrating variant persistent left dorsal ophthalmic artery originating from the cavernous internal carotid artery.

Conclusion
Variations in origin of the ophthalmic artery have been reported from the middle meningeal, anterior communicating, posterior communicating as well as the basilar arteries. Knowledge of variant origins of the ophthalmic artery is imperative for interventionalists when planning procedures or neurosurgeons when planning supraclinoid surgery.