764 - Illustrated Review of Angiographic Anatomy and Hemodynamics of Ophthalmic Artery: Implications for Treatment of Retinoblastoma with Intra-arterial Chemotherapy

Monday, April 13, 2026

5:09 PM - 5:15 PM ET

Abstract Presenter(s)

vA

venkata Subbaih Arunachalam, MD

Clinical Fellow
University of Toronto, Canada

Author/Co-author(s)

HM

Humberto Madrinan-Navia, MD

Neurosurgeon
St. Joseph Hospital and Medical Center, United States
ST

Suma Thareja, MD

Resident, Ophthalmology
Medical College of Wisconsin, United States
VS

Visish Srinivasan, MD

Neurosurgeon
Barrow Neurological Institute, United States
VP

Vivek Pai, MD

Assistant Professor
The Hospital for Sick Children, Canada
PM

Prakash Muthusami, MD

Associate Professor
The Hospital for Sick Children, Canada
CP

Carmen Parra-Farinas, MD

Assistant Professor
The Hospital for Sick Children, Canada
MS

Manohar Shroff, MD

Professor
The Hospital for Sick Children, Canada
AR

Aparna Ramasubramanian, MS

Associate Professor Ophthalmology
Medical College of Wisconsin, United States
FA

Felipe Albuquerque, MD

Professor
Barrow Neurological Institute, United States
TA

Todd Abruzzo, MD

Professor
Phoenix Children's Hospital, United States

Learning Objectives: 1) To understand OphA segmental anatomy with common and uncommon variants relevant to interventional treatment of Retinoblastoma.
2) To recognise the angiographic characteristics that predict successful drug delivery.
3) To identify intra-orbital anastomoses of internal and external carotid branches and implications for treatment
4) To explore the role of adjunctive techniques such as ECA balloon occlusion to optimize ocular hemodynamics

Background: Intra-arterial chemotherapy has revolutionized the treatment of retinoblastoma, offering high ocular salvage rates with minimal systemic toxicity. However, the success of intra-arterial chemotherapy is critically dependent on ophthalmic artery (OphA) anatomy and orbital hemodynamics. Variations in origin, branching patterns, and collateral flow from external carotid artery (ECA) can significantly impact drug delivery and therapeutic outcomes.

Clinical Findings/Procedure Details: This pictorial review illustrates a schematic and angiographic review of OphA origin, segmentation and course, focusing on clinically important variants. It highlights the embryological basis of key variants like ventral ophthalmic artery, dorsal ophthalmic artery, as well as ectopic origination from anterior cerebral artery, basilar artery and middle meningeal artery. The dynamic interplay between internal carotid and external carotid flow and ways to manipulate competitive countercurrent streams using balloon occlusion or alternate middle meningeal or anterior deep temporal approaches are illustrated with animations and case-based discussion.

Conclusion and/or Teaching Points: A clear understanding of ophthalmic artery anatomy and orbital hemodynamics is essential for neurointerventionists administering intra-arterial chemotherapy for retinoblastoma. Tailoring the infusion strategy to individual vascular anatomy enhances drug delivery, minimises complications, and improves clinical outcomes. This pictorial review aims to educate interventional radiologists with practical insights to refine their approach to pediatric ocular interventions.