{
  "abstract": "Background Craniofacial polyostotic fibrous dysplasia can result in highly vascular lesions supplied by complex and distorted external carotid artery (ECA) networks. Accurate identification of dominant tumor feeders is critical for safe embolization but is often limited by overlapping vascular territories on conventional digital subtraction angiography. Advanced 3D imaging with cone beam CT (CBCT) may improve delineation of arterial supply and guide more precise, targeted embolization strategies.Methods We present a 39-year-old male with McCune-Albright syndrome and massive craniofacial fibrous dysplasia involving the left maxilla, orbit, mandible, and neck. Preoperative angiography with CBCT and 3D postprocessing was performed to identify dominant arterial feeders prior to embolization and staged surgical resection.Results Conventional angiography showed diffuse hypertrophy of left external carotid artery branches, but did not clearly define the dominant supply. Cone beam CT (CBCT) with 3D reconstruction identified the infraorbital artery as the primary feeder, with a dominant anterior superior alveolar branch supplying the maxillary component. This clarified compartmentalized supply, with infraorbital branches to the maxillary/orbital component and the facial artery to the mandibular component. CBCT-guided embolization of two infraorbital branches using 300-500 µm particles and coils achieved complete devascularization without complications. Surgical resection was performed with controlled blood loss. A second-stage embolization targeting mandibular feeders is planned.Conclusions Cone beam CT with 3D reconstruction enables precise identification of dominant tumor feeders in complex craniofacial fibrous dysplasia, particularly along the infraorbital-superior alveolar axis, facilitating targeted, compartment-based embolization and staged treatment planning. To our knowledge, this is the first report highlighting the role of CBCT-guided embolization in fibrous osseous dysplasia.Disclosures J. Alzate Ramirez: None. J. Bradley: None. Y. Serulle: None.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, Lenox Hill Hospital, New York, NY"
      ],
      "name": "J Alzate Ramirez"
    },
    {
      "affiliations": [
        "Neurosurgery, Lenox Hill Hospital, New York, NY"
      ],
      "name": "J Bradley"
    },
    {
      "affiliations": [
        "Neurosurgery, Lenox Hill Hospital, New York, NY"
      ],
      "name": "Y Serulle"
    }
  ],
  "title": "E-053 Cone beam CT-guided identification of infraorbital-superior alveolar arterial supply enables targeted embolization in craniofacial polyostotic fibrous dysplasia",
  "uid": "06084909-73d4-578e-8a02-fe263493230b"
}