E-051 Putting the “Eye” in I.V. Access—unconventional approaches in head and neck intervention
Bibliographic record
Abstract
Introduction/purpose Unconventional Access techniques have been documented in the literature and have the potential to provide a complimentary platform for intervention in select cases. This limited case series illustrates two such approaches. Materials/methods Periprocedural clinical data and imaging was gathered around two cases requiring unconventional methods of access. Results A 29-year-old female with known NF-1 was found to have a large dural AVF causing significant compression of the cervical cord. In the first stage of embolization, the right vertebral artery and thyrocervical perforating vessels providing antegrade flow to the lesion were occluded using a traditional femoral approach. Access to the left vertebral artery from the same approach was precluded by an aplastic proximal segment. Access to deploy coils and onyx to the distal right vertebral artery occluding retrograde filling was achieved by direct puncture of the artery near the skull base under fluoroscopic guidance. A 67-year-old female was diagnosed with a dural cavernous-carotid fistula after presenting with proptosis and conjuctival chemosis. Embolization of perforating branches from the external carotid by femoral approach was unsuccessful in occluding flow. Access was obtained by performing a limited cut down of the upper eyelid with ultrasound-guided catheterization the superior ophthalmic vein. Embolization of the cavernous sinus with coils and onyx resulted in immediate symptom resolution. Conclusion In the absence of favorable access to a lesion by conventional femoral approach, unconventional access techniques may be safely employed for definitive treatment. Competing interests B Baxter: Stryker Neurovascular, Penumbra, EV3, Codman, Rapid Medical, Reverse Medical. M Mayich: None. J Hungerford: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.014 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".