48
3
a
External Carotid Artery
b
Fig. 3.23 Large tympano-jugular paraganglioma supplied mainly by tympanic branches of the ascending pharyngeal artery. (a) Angiogram (oblique view) of the selective catheterization of an enormous dilated ascend-
ing pharyngeal artery. Tympanic branches (arrow) supplying the tumor. (b) Drainage in the jugular vein (arrow) infiltrated by the paraganglioma
be considered when endovascular treatment is planned. These anastomoses can be minimal or large (Morris 1997; Lasjaunias et al. 2001; Geibprasert et al. 2009). They can already be recognizable at the beginning of endovascular treatment or may enlarge and appear during it, following super-selective injection or opening of collateral paths as a consequence of occlusion
of other arteries. Frequent angiographic control is mandatory. • Another important aspect is the supply of a few cranial nerves from branches of the ECA (Table 3.2). This should be considered whenever a vascular treatment involves these branches. It is essential to take particular caution in the choice of embolic material in these cases.