INHOUSE 26 ACHIEVEMENTS IN THE FIELD OF INTERVENTIONAL RADIOLOGY By: Rama Alawneh
You may have heard the latest commotion regarding the most recent “Worldly Medical Accomplishment” performed at the King Abdullah University Hospital (KAUH) by a team of Jordanian doctors. Well, this uproar is not out of place. It reflects the current skill and capacity of the Jordanian Doctor, and also the potential that Jordan has to offer to the medical field through its gifted medical professionals. The paper published recently in The Journal of Craniofacial Surgery is authored by Khaled Alawneh, MD, Bashar Abuzayed, MD, Majdi Al Qawasmeh, MD, and Liqaa Raffee, MD. It proposes the use of a “novel technique of endovascular and surgical devascularization” in the removal of a scalp arteriovenous malformation. A 26-year-old female patient presented to the emergency department at KAUH with chief complaints of an increasing headache and swelling of the left upper eyelid. The swelling was noticed to be soft and pulsatile upon examination. Consequently, a brain computed tomography (CT) scan was performed along with a brain magnetic resonance imaging (MRI) scan. Following that, brain CT angiography was performed and revealed that there was a vascular lesion. A six-vessel cerebral angiography showed that there was a left frontal scalp arteriovenous malformation (AVM). An arteriovenous malformation of the scalp is an “abnormal fistulous connection between the feeding arteries and draining veins without an intervening capillary bed within the subcutaneous layer.” The symptoms of an AVM depends on its location. This particular AVM was supplied by the left and right superficial temporal arteries along with the left supraorbital artery. The superficial temporal arteries and the supraorbital arteries are arteries of the scalp. “The nidus of the AVM and the direct high flow venous drainage to the superior sagittal sinus through a wide pore (See Figure 1C – black arrow) in the bone carries a high risk of passing the embolizing materials, especially since that the bony pore of the venous drainage does not collapse like the venous vessel wall when there is decreased intranidal pressure.” In the process of her treatment, the patient was sedated and through her right femoral artery, both superficial temporal arteries were occluded using Onyx 18 – liquid embolic agent used for the occlusion of blood vessels. Post-procedure, cerebral angiography displayed regression of the nidus. There was complete cutoff of the flow from the bilateral superficial temporal arteries. Two days following this procedure, the patient was operated on through a left eyebrow incision. This operation was done in order to expose, ligate, and cut the supraorbital artery.
