Devascularization of craniofacial tumors by percutaneous tumor puncture.
OBJECTIVE
To present and evaluate a devascularization technique for hypervascular tumors of the head and neck by direct tumor puncture.


METHODS
Tumor puncture was performed percutaneously or via natural orifices (nose and mouth). In one case, an intrasellar tumor was embolized via a transseptosphenoidal surgical approach. The embolization material used was NBCA, lipiodol, and tungsten in the majority of tumors (14 out of 17) and alcohol for 3 metastases of the calvarium. We used this technique to embolize 10 nasopharyngeal fibromas, 4 tumors of the calvarium (3 metastases and 1 hemangiopericytoma), 1 intrasellar hemangiopericytoma, and 2 glomus tumors. Reflux of blood was obtained in every case after direct puncture of the tumor. Direct injection of contrast agent into the tumor revealed local parenchymography followed by local and regional venous drainage without extravasation.


RESULTS
Total devascularization was obtained in 14 cases, and devascularization greater than 90% was obtained in 3 cases. Thirteen tumors were totally resected without requiring blood transfusion. During surgery, the limits of the exsanguinated tumor were very well defined in every case by the black staining induced by tungsten. Of the 4 tumors embolized but not operated on (3 metastases and 1 glomus tumor), 2 metastases needed retreatment after 6 and 8 months of remission, respectively. The other metastasis is still in remission after 3 months, and the volume of the glomus tumor decreased by 80% remains unchanged after 8 months.


CONCLUSIONS
This technique was initially used to devascularize tumors with difficult or dangerous intravascular access, but in view of the hemodynamic and surgical results obtained, we believe that the indications for this technique can be extended to hypervascular tumors accessible to conventional embolization.
Department of Interventional Neuroradiology, Hôpital Lariboisière, Paris, France.
A
A
Casasco
D
D
Herbreteau
E
E
Houdart
B
B
George
P
P
Tran Ba Huy
D
D
Deffresne
J J
JJ
Merland
D018322:Angiofibroma / Q000098:blood supply / Q000628:therapy; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D003131:Combined Modality Therapy; D003399:Craniotomy; D004621:Embolization, Therapeutic / Q000379:methods*; D005500:Follow-Up Studies; D005918:Glomus Tumor / Q000098:blood supply / Q000628:therapy; D006258:Head and Neck Neoplasms / Q000098:blood supply / Q000556:secondary / Q000628:therapy*; D006393:Hemangiopericytoma / Q000098:blood supply / Q000628:therapy; D006801:Humans; D009303:Nasopharyngeal Neoplasms / Q000098:blood supply / Q000628:therapy; D011677:Punctures; D012886:Skull / Q000098:blood supply; D012888:Skull Neoplasms / Q000098:blood supply / Q000556:secondary / Q000628:therapy; D013964:Thyroid Neoplasms / Q000098:blood supply / Q000628:therapy